no

Product Code: 3005/O UIN: IRDAN115RP0002V02201920

Reference No.: W339906922

Date: Aug 10, 2024

ZAID SHEIK N
NO 8/18 KANAKANANTHAL ROAD, SANTHAPETTAI, TIRUKKOVILUR TK,
KALLAKURICHI,
VILLUPURAM
TAMIL NADU 605766
Mobile No: 8508070990

Sub: Risk Assumption Letter

Dear ZAID SHEIK N,

We value your relationship with ICICI Lombard General Insurance Company Limited and thank you for choosing us as your preferred insurance provider.

Please find enclosed Policy No. 3005/O/355571863/00/000, The same has been issued based on below mentioned details, provided by you at the time of policy
purchase.

Insured & Vehicle Details

Name of the Insured ZAID SHEIK N
Period of Insurance - Own Damage Aug 16, 2024 to Aug 15, 2025
Vehicle Make / Model YAMAHA / CYGNUS RAY ZR DISC
RTO City TAMILNADU-KALLAKURICHI
Vehicle Registration No. TN15F0580
Vehicle Registration Date Aug 18, 2023
Engine No. E33SE0416164
Chassis No. ME1SEK758P0022597
Current Year NCB(%) 20%
Previous Policy Details
Previous Policy No. 2806823123P105437907
Previous Policy Period 16-08-2023 to 15-08-2024
Previous Year NCB(%) 0%
Claims Made Under Previous Policy 0
Previous Insurer Name UIIC
Previous Policy Type Bundled Package Policy
Third Party Insurance Details
Third Party Policy No. 2806823123P105437907
Third Party Period of Insurance Aug 16, 2023 to Aug 15, 2028
Third Party Insurer Name UNITED INDIA INSURANCE COMPANY LTD.
1
The commencement of coverage of risk under the policy is subject to realisation of payment of premium in full. In case the premium is not realised due to
cheque dishonour or any other reason, the insurance cover shall be void ab-initio.
1
We have issued the policy basis your confirmation that you hold a valid PUC and/or Fitness certificate, as applicable.

Government of India has mandated electronic toll payments using FASTag to reduce vehicular traffic at toll plazas. Customers are advised to comply with the
direction of the government and get their FASTag from Point of Sale locations at Toll Plazas or from Issuer Agency. Please visit http://www.fastag.org/ for
details.

“Updating your bank details with us would help facilitating future transactions. Bank details can be easily updated using “IL – Take care” App.Download the app 1
now for all your insurance and wellness needs and for faster resolution”

Please check the policy details for accuracy. Should you find any discrepancy / require any changes in the Certificate of Insurance cum Policy Schedule, please
contact us immediately at our toll free number 1800 2666 or email us at [email protected], so that we can rectify the same. Absence of any
communication within a period of 15 days of the date mentioned on this letter, would mean that the issued policy is in order and as per your proposal.

Important Points:
a. Any accidental loss, damage and/or liability caused, sustained or incurred, while vehicle not being registered permanently will not be covered.
b. Any minor scratches to the vehcile, paint fading, wear and tear arising out of normal use and requiring touch-up or minor repair under routine maintenance
will not be covered.
c. Any liability of whatsoever nature caused by, contributed by or arising due to the vehicle being driven by a person without having valid driving license will not
be covered.
CORP/SUP/OPI/2014/1777

Aug 10, 2024

CERTIFICATE OF INSURANCE CUM POLICY SCHEDULE
no
Stand-Alone Own Damage Two wheeler Insurance Policy
Product Code: 3005/O UIN: IRDAN115RP0002V02201920

( Please visist www.icicilombard.com for the policy wordings, for complete details on terms and conditions governing the coverage and NCB)

The information provided is merely illustrative and shall not be construed to be an evidence of existence of a contract of insurance. The Risk Assumption Letter
is to be read in conjunction with the policy and shall be considered null and void without the same.

CORP/SUP/OPI/2014/1777

Aug 10, 2024

CERTIFICATE OF INSURANCE CUM POLICY SCHEDULE
no
Stand-Alone Own Damage Two wheeler Insurance Policy
Product Code: 3005/O UIN: IRDAN115RP0002V02201920

Name of the Insured : ZAID SHEIK N Policy No. : 3005/O/355571863/00/000

Address : NO 8/18 KANAKANANTHAL ROAD, SANTHAPETTAI, Period of Insurance - : Aug 16, 2024 12:00:00 to
TIRUKKOVILUR TK, KALLAKURICHI,, VILLUPURAM, TAMIL Own Damage Midnight of Aug 15, 2025
NADU 605766
Telephone No : Mobile No: 8508070990 Tenure : 1 year
Email Address : [email protected] E-Policy No. : 3005/O/355571863/00/000
Nominee Name : - Named Passenger's Nominee: Policy Issued On : Aug 10, 2024
Relationship : - - Covernote No. : 355571863
Age : - RTO Location : TAMILNADU-KALLAKURICHI
GSTIN No. (Customer) : Hypothecated To : -
Servicing Branch Name : Chennai Invoice No. : 100824785300
:
This Policy covers only Own Damage Risk with no other liability in connection with Two Wheeler Vehicle including Third Party Cover and is issued basis the following:
Third Party Policy No. - 2806823123P105437907, valid from Aug 16, 2023 to Aug 15, 2028, Insured by UNITED INDIA INSURANCE COMPANY LTD.

Servicing Branch Address : Unit No.684-690, Third Floor, Seethakathi Business Centre, 4 Moores Road Thousand Lights Anna Salai, Chennai, Tamil Nadu-600006 yes

Politically Exposed Person (PEP)/close relative of PEP: No

Vehicle Registration Make Model Type of Body CC/KW Mfg Yr Seating Chassis No. Engine No.
No. Capacity
Solo With
TN15F0580 YAMAHA CYGNUS RAY ZR DISC 113 2023 2 ME1SEK758P0022597 E33SE0416164
Pillion
Vehicle IDV Side Car Additional Accessories (`) Electrical / Electronic Non Electrical CNG / LPG Unit Total IDV
(`) (`) Accessories (`) Accessories (`) (`) (`)
66,725.00 0.00 0.00 0.00 0.00 0.00 66,725.00

Premium Details
OWN DAMAGE(A) (`)
Basic OD Premium 954.00
Sub Total 954.00
Less:
No Claim Bonus 20% 191.00
Sub-Total Deductions 191.00
Total Own Damage Premium(A) 763.00
% 9
CGST
` 68.67
% 9
SGST
` 68.67
Total Tax Payable in ` 137.00
Total Premium Payable In ` 900.00

Geographical Area: India Applicable IMT Clauses: 22

Compulsory Deductible: ` 100.00 Voluntary Deductible: ` 0.00

Premium Collection No. 1213714272 Premium Amount (`) 900.00 Receipt Date 10-08-2024
GSTIN Reg.No 33AAACI7904G2ZT HSN/SAC code 997134 / GENERAL INSURANCE SERVICES
We hereby declare that though our aggregate turnover in any preceding financial year from 2017-18 onwards is more than the aggregate turnover notified under sub-rule (4) of
rule 48, we are not required to prepare an invoice in terms of the provisions of the said sub-rule.

CORP/SUP/OPI/2014/1777

Aug 10, 2024

CERTIFICATE OF INSURANCE CUM POLICY SCHEDULE
no
Stand-Alone Own Damage Two wheeler Insurance Policy
Product Code: 3005/O UIN: IRDAN115RP0002V02201920

Limitations as to Use: The Policy covers use of the vehicle for any purpose other than: Hire or Reward, Carriage of goods (other than samples of personal luggage),
Organised racing, Pace Making, Reliability trails or Speed testing, any purpose in Connection with Motor Trade. Driver's Clause: Any person including the insured:
Provided that a person driving holds an effective driving license at the time of the accident and is not disqualified from holding or obtaining such a license. Provided also
that the person holding an effective learner's license may also drive the vehicle and that such a person satisfies the requirements of Rule 3 of the Central Motor Vehicles
Rules, 1989. Important Notice: The insured i s not indemnified if the vehicle is used or driven otherwise than in accordance with this schedule. Any payment made by the
Company by reason of wider terms appearing in the Certificate in order to comply with the Motor Vehicle Act, 1988 is recoverable from the insured. See the clause headed
"AVOIDANCE OF CERTAIN TERMS AND RIGHT OF RECOVERY".
In consideration of the premium for this extension being calculated at a pro-rata proportion of the annual premium, it is hereby declared and agreed by the insured that upon
expiry of this extension, this policy shall be renewed for a period of twelve months, failing which the difference between the extension premium now paid on pro rata basis
and the premium at short period rate shall become payable by the insured.For Legal interpretation, English version will hold good. Disclaimer: Please visit
www.icicilombard.com for the policy wordings, for complete details on terms and conditions governing the coverage and NCB. This document is to be read with the policy
wordings. The policy i s valid subject to realization of cheque. We accept premium only via legally recognized modes. In case of dishonour of premium cheque, the
company shall not be liable under the policy and the policy shall be void ab-initio. In case of any discrepancy with respect to the policy, please revert within 15 days from
the policy start date. This policy i s underwritten on the basis of the information provided by you and as detailed in the Risk Assumption Letter shared with you along with
the policy. On renewal, the benefits provided under the policy and/or terms and conditions of the policy including premium rate may be subject to change. Grievance
Redressal: For resolution of any query or grievance you may contact us on our toll free no. 1800 2666, or visit any of our branch offices. You can also write to us at
[email protected]. For detailed grievance redressal mechanism please visit the "Grievance Redressal" section on our website www.icicilombard.com.
The Company reserves the right to cancel this Policy immediately upon becoming aware of any mis-representation, fraud, non-disclosure of material facts or
non-cooperation by or on behalf of the Insured; the Company is not obliged to refund the premium paid under this Policy
I/We hereby certify that the Policy to which this Certificate relates, as well as, this Certificate of Insurance are issued in accordance with the provisions of Chapter X and
Chapter XI of Motor Vehicle Act, 1988. In witness whereof, this Policy has been signed at Mumbai on this date of Aug 10, 2024 in lieu of Covernote No.. 355571863. The
stamp duty of ` 0.50 paid vide deface no. CSD0220242018 dated Apr 10, 2024.
Policy Issuing Office: ICICI Lombard General Insurance Company Limited, ICICI LOMBARD HOUSE, 414, Veer Savarkar Marg, Near Siddhi Vinayak Temple, Prabhadevi,
Mumbai 400 025.
Warranted that the insured named herein/owner of the vehicle holds a valid Pollution Under Control (PUC) Certificate and/or valid fitness certificate, as applicable, on the
date of commencement of the Policy and undertakes to renew and maintain a valid and effective PUC and/or fitness Certificate, as applicable, during the subsistence of
the Policy. Further, the Company reserves the right to take appropriate action in case of any discrepancy in the PUC or fitness certificate.

Agency Code : ILG54273

Agency Name : HASINA BEGUM

Agent's Contact No : 9500007786

Contact Person :

Signature Not Verified

Digitally signed by DS ICICI
LOMBARD GENERAL
INSURANCE CO LTD 1
Date: 2024.08.10 13:22:09 IST
CORP/SUP/OPI/2014/1777

Aug 10, 2024