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 Private Car 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 Mumbai 414, ICICI LOMBARD HOUSE, VEER

Servicing IL SAVARKAR MARG, NEAR SIDDHI
Branch : Address of the IL Branch : VINAYAK TEMPLE MAIN GATE,
Customer ID 102125009211 PRABHADEVI, MUMBAI, 400025,
: MAHARASHTRA
Correspondence Office Name MUMBAI ­ VASHI
Name : RISHABH VINOD GIRI
:
Address : A 604 ROHAN MITHILA UPPER PARIJAT, VIMAN
Policy Number : 3001/350423378/00/B00
NAGER, SAKORE NAGER, PUNE, INDIA
MAHARASHTRA PUNE PIN ­ 411014 Period of Insurance : From: 30/06/2024
Time: 00:00 Hours
Contact No :
To Midnight of 29/06/2025
Invoice 100724111094
Endorsement No : 3001/350423378/00/B01
Number :
Effective time and date: 00:00 Hours ­ 02/07/2024
Customer
GSTIN No : Date of issue : 02/07/2024
Intermediary Code : 202147670867
Agreement
Financier Name Branch
Type
AU SMALL FINANCE BANK SATARA Hypothecation
LTD
Registration Number Engine Number Chassis Number
MH11CQ9058 G4FLKV004979 MZBEP812LKN020501
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 :
It is hereby understood and agreed that as from 02/07/2024 the interest in the policy is transferred to and vested in RISHABH VINOD
GIRI who shall be deemed to be the insured and whose proposal and declaration dated 02/07/2024 shall be deemed to be incorporated
in and to be the basis of this contract.
Transfer of Vehicle

The following groups are modified :

Group Risk Item Changed to Description Old New
Covers Risks : VehicleSIComponent : Vehicle Base Value Cover Groups : Basic ­ OD Premium 9510 9510
Covers Risks : VehicleSIComponent : Vehicle Base Value Cover Groups : Basic ­ TP Premium 3416 3416
Covers Risks : VehicleSIComponent : Vehicle Base Value Cover Groups : Paid Driver Premium 50 50
Covers Risks : VehicleSIComponent : PA Cover for Owner­ Cover Groups : PA ­ Owner Premium
675 675
Driver
Covers Risks : VehicleSIComponent : UnNamed PA Cover Cover Groups : Personal Accident Cover Premium 250 250
Covers Risks : VehicleSIComponent : Road Side Cover Groups : Road Side Assistance Cover Premium
699 699
Assistance
Ri s k s VehicleSIComponent : Vehicle Base Value IDV /Capital
851500 851500
SI
Ri s k s VehicleSIComponent : PA Cover for Owner­ IDV /Capital
1500000 1500000
Driver SI
Ri s k s VehicleSIComponent : UnNamed PA Cover IDV /Capital
500000 500000
SI
Ri s k s VehicleSIComponent : Road Side Assistance IDV /Capital
0 0
SI

The following(s) are modified :

Description Old Value New Value
Transfer of Vehicle ASHOK KHUSHALCHAND OSWAL RISHABH VINOD GIRI
The following(s) are modified :
Description New Value Old Value
Ownership Serial Number 1 1

Name transfer Endorsement premium 50.00

GSTIN Reg. No: 27AAACI7904G1ZN

Receipt No. & Date : 1210991295 ­ 02/07/2024
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.1000

In witness whereof this policy has been signed at MUMBAI on 02/07/2024

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 [email protected] 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.
In witness whereof this policy has been signed at MUMBAI on 02/07/2024

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 [email protected] 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.