PRIVATE CAR PACKAGE POLICY
Certificate cum Policy Schedule
Certificate cum Policy No: 3001/W-12825804/00/000
For CLAIMS : Call 1800 2666 (Toll free from all phones)
For RENEWALS : Visit www.icicilombard.com or call 1800 2666
DETAILS OF POLICY HOLDER POLICY DETAILS
Insured Name KOCHURANI JACOB ICICI Lombard General Insurance
Kollithottathil House, Kuravilangad, Post Company Ltd.ICICI Lombard House,
Insured Address Office Kottayam , KOTTAYAM, 686633, Policy Issuing Office 414, Veer Savarkar Marg, Near Siddhi
KERALA Vinayak Temple, Prabhadevi, Mumbai
400 025
Contact No. 9809800296
From 00:00:00 hrs of 18-Dec-2012 to
Email Address
[email protected] Period of Insurance
Midnight of 17-Dec-2013
Policy Issuing on 05-Dec-2012
Cover Note No W-12825804
RTO Location KOTTAYAM
Hypothecated to N/A
Type of Agreement None
VEHICLE DETAILS
Registration Number Make Model Type of body CC Mfg. Year Seating Capacity Chassis Number Engine Number
KL35B7375 HYUNDAI SANTRO GLS 5STR Saloon 1086 2010 5 1611936l 1161312
INSURED DECLARED VALUE
Vehicle IDV (in Rs.) Trailer Non-Electrical Acc (in Rs.) Elec/Electronic Acc (in Rs.) CNG / LPG Unit (in Rs.) Total Value (in Rs.)
259141 0 0 0 0 259141
SCHEDULE OF PREMIUM(IN RS.)
Own Damage(A) Liability(B)
Basic Premium 4755 Basic Premium including premium for TPPD vehicle 925
Total : 4755 Total : 925
Add Add
Less PA cover for Owner Driver 100
Anti-theft Discount 119 Legal Liability To Paid Driver 50
Sub Total(Deductions) : 119 Sub Total(Additions) : 150
Deduct 25 % for NCB 1159 Less
Total : -1278 Sub Total(Deductions) : 0
Total Own Damage Premium 3477 Total Liability Premium 1075
Total Package Premium ( A + B ) 4552
Service Tax(Incl Edu.Cess And Higher Edu.Cess) 563
Total Premium Payable(in Rs.) 5115
Compulsory deductibles : Rs. 1000/-
Geographical Area : India
LIMITS OF LIABILITY: (a) Under Section II - 1 (i) of the policy -> Death of or bodily injury : Such amount as is necessary to meet there
requirements of the motor vehicles Act.1988.
(b) Under Section II - 1 (i) of the policy -> Damage to Third Party Property Rs 7,50,000 ; PA Cover for Owner-Driver under section III-CSI
Rs 2,00,000 ;Voluntary Deductible Rs.0
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 or personal luggage), Organized racing, Pace making, Speed testing,Reliability trials,Any purpose in connection with Motor Trade.
DRIVER'S CLAUSES : 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 is 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'.For legal
interpretation, English version will hold good.
Subject to IMT Endorsement Nos. & Memorandum printed herein / attached hereto : 22,28
Premium Collection Details :-[Collection No/Amount/ReceiptDate] NA/Rs. 5115 / 05/12/2012
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.
Grievance Clause
For resolution of any query or grievance, Insured may contact the respective branch office of the Company or may call toll free no.1800-
2666 or may approach us at the sub section "Grievance Redressal" on our website www.icicilombard.com (Customer Support section).
However, if the resolution provided by us is not satisfactory you may approach Insurance Regulatory and Development Authority (IRDA)
through the Integrated Grievance Management Section (IGMS) or IRDA Grievance Call Centre(IGCC) at their toll free no.155255. You may
also approach Insurance Ombudsman, subject to vested jurisdiction, for the redressal of grievance. Details of Insurance Ombudsman
offices are available at IRDA website: www.irdaindia.org,or on the Company's website at www.icicilombard.com.
Policy is valid subject to realization of cheque. We accept premium only via legally recognized modes except for cash. If our
representative request you to pay in cash, kindly report it to us.
For information on ombudsman you may visit our website www.icicilombard.com
I/We here by certify that the policy to which the certificate relates as well as the certificate of For ICICI Lombard General Insurance
insurance are issued in accordance with the provision of chapter X,XI of M.V Act 1988 Company Ltd
Service Tax Registration No. :GIS/ MUMBAI-I /1528 /2001
Service Tax Code Number :AAACI7904GST001
Category: - General Insurance Business Services 00440005.
In Witness whereof this policy has been signed at Mumbai this 18-Dec-2012 in lieu of covernote
No W-12825804 The stamp duty of Rs. 0.50 paid in cash or by demand draft or by pay Duly Constituted Attorney(s)
order,vide Receipt/Challan no. 29168 dated 30-Nov-2012 Copy of policy
