Mailing Add.

Office: ICICI Lombard General Insurance Company LTD , ICICI LOMBARD HOUSE , 414, Veer Savarkar Marg, Near Siddhi
Vinayak Temple, Prabhadevi, Mumbai 400 025
Corporate Office: ICICI Lombard General Insurance Company LTD , ICICI LOMBARD HOUSE , 414, Veer Savarkar Marg, Near Siddhi
Vinayak Temple, Prabhadevi, Mumbai 400 025

Endorsement Schedule of Two Wheeler Package Policy

We value your relationship with ICICI Lombard. We thank you for preferring us as your motor insurance partner. We write to this on the
basis of your request vide letter for correction in respect of below subject matter.

Name of the Servicing Gurgaon Tower D, Twelth Global Business

IL Branch : Address of the IL Branch : Park Mehrauli Gurgaon Road
Customer ID : 101129666047 Gurgaon Haryana 122002
Correspondence Office Name GURGAON
Name : NIKHIL NAIR
:
Address : 90­B, POCKET ­6, MIG FLATS MAYUR
Policy Number : 3005/325929447/00/000
VIHAR PHASE­3 DELHI DELHI PIN ­
110096, MOBILE NO. ­ 919773834726 Period of Insurance : From: 21/01/2024
Time: 12:00:00 Hours
Contact No : Mobile Number 919773834726
To Midnight of 20/01/2025
Invoice Number :
Endorsement No : 3005/325929447/00/001
Customer GSTIN No :
Effective time and date: 00:00 Hours ­ 22/01/2024
Date of issue : 22/01/2024
Intermediary Code : 202050956510
Registration Number Engine Number Chassis Number
KA04JT7425 BR1HJ2617615 MD637BR14J2G16334
Not withstanding anything to the contrary contained in the policy, it is hereby declared and agreed that the policy stands amended for
the reasons given below:
Endorsement wording :
Address correction
The following(s) are modified :
Description Old Value New Value
90­B, POCKET ­6, MIG FLATS MAYUR
90 B POCKET 6 MIG FLATS EAST DELHI INDIA
Customer Mailing Address VIHAR PHASE­3 DELHI DELHI PIN ­
KARNATAKA BANGALORE PIN ­ 560054
110096
Location_Code 3403139412 3403854045
The following(s) are modified :
Description Old Value New Value
Address 90 B POCKET 6 MIG FLATS EAST DELHI INDIA 90­B, POCKET ­6, MIG FLATS MAYUR VIHAR PHASE­3
KARNATAKA BANGALORE PIN ­ 560054 DELHI DELHI PIN ­ 110096, MOBILE NO. ­
CHAUHANPRIYANSHU030902@GMAIL.COM 919773834726
CHAUHANPRIYANSHU030902@GMAIL.COM

GSTIN Reg. No:

HSN/SAC code : 997134 ­ GENERAL INSURANCE SERVICES
Subject otherwise to the terms, conditions, exclusions, limitations and warranties attached to the within mentioned policy.
Compulsory Deductibles :Rs.100

In witness whereof this policy has been signed at MUMBAI on 22/01/2024

All amounts are in Rs. Authorised Signatory

ICICI Lombard General Insurance Company Ltd.

At ICICI Lombard we are always at your service. If you have any questions, you are welcome to: 1. Visit us at our nearest branch, or 2.
Email us at customersupport@icicilombard.com or 3. Write to us at Customer Support Team,ICICI Lombard General Insurance Company
LTD , ICICI LOMBARD HOUSE , 414, Veer Savarkar Marg, Near Siddhi Vinayak Temple, Prabhadevi, Mumbai 400 025
Now one number for all your Insurance needs call us on 1800 2 666(toll free) also accessible from your mobile phone.