Bundled - Two Wheeler Policy (1 Yr OD + 5 Yrs TP)

Policy No. Issued at HERO INSURANCE BROKING INDIA PVT LTD.

ICICI Lombard General Insurance IRDA Registration No.: 649
3005/55545273/40281/000
First floor,445, Block no.1, World Trade Tower, Rajpur road, Toll-Free No.: 1800 102 4376
Dehradun ,District Dehradun Pin code - 248001, Uttrakhand 264, Okhla Ind. Estate, Phase-III, Delhi-110020
Tel:1800 2666
customersupport@icicilombard.com

Insured Business/Profession Address of The Insured TP Valid From TP Valid To

S/O ANAND KISHOR THAKUR, 198, GALI NO,3, KHA
13-04-2025
Mr ARYAN KUMAR Self Employed LAPAR, MUZAFFAR NAGAR UTTAR PRADESH 2510 Midnight of 12-04-2030
10:53:23
02
Cubic GSTIN No.
Vehicle Regn No. Engine No. Chassis No. Make & Model Year of Mfg
Capacity (Customer)
Hero MotoCorp Xtreme
New KC01AEPHL00480 MBLKCU124PHL00451 2023 160
160R 4V
Declared Value (IDV) of Side Car IDV Non-Electrical Electrical Accessories CNG/LPG/Bi- Total IDV
Vehicle Accessories IDV IDV Fuel IDV
130910.00 NA 0.00 0.00 0.00 130910
Place of Regn. Body Type HP/Lease/Hire-Purchase Branch Office of Seating Premium
Agreement With HP/Lease/Hire-Purchase Capacity
MUZAFFAR NAGAR Solo , --- 2 10823.00
Section A B. Liability Premium Computation (Section II) in Rs.
Basic OD Premium : 1152.00 Basic Third Party Liability : 7365.00
Non-Electrical-Fitting Premium : 0.00 TPPD Discount : 0.00
Electronic & Electrical Accessories(IMT-24) : 0.00 Total : 7365.00
Geographical Extension : 0.00 CNG/LPG/Bi-Fuel Kit : 0.00
ND Cover : 655.00 Geographical Extension : 0.00
Less : Add
Handicapped Discount : 0.00 Compulsory PA Cover (Owner Driver) : 0.00
For Anti-Theft Discount : 0.00 Optional PA Cover(Un Named Passenger) : 0.00
NCB : 0.00 Optional PA Cover(Un Named Driver) : 0.00
Total Own Damage Premium(A) : 1807.00 Legal Liability Cover (Paid Drivers, Cleaners) : 0.00
Legal Liability Cover (Per Licensed Passenger) : 0.00
Total Liablity Premium (B) : 7365.00
Total Premium (A + B) : 9172.00
For any other extra : 0.00
IGST @ 18.00% : 1650.96
Gross Premium : 10823.00
RegistrationNo.:115||CINNo.:L67200MH2000PLC29408||HSN/SAC:997134|| GSTIN No.:05AAACI7904G1ZT ||UIN No.-IRDAN115RP0019V01202122||IRDAN115RP0007V012
01819/A0030V01201819
13-04-2025 To 12-04- 13-04-2026 To 12-04- 13-04-2027 To 12-04- 13-04-2028 To 12-04- 13-04-2029 To 12-04-
OD Policy Period
2026 2027 2028 2029 2030
IDV 130910 NIL NIL NIL NIL
CPA Sum Insured(SCPA) NIL NIL NIL NIL NIL
Sum Insured of Optional PA Cover:-Sum Insured of Optional PA Cover "Unnamed Passenger"-NA and "Unnamed Driver"-NA
LIMITATIONS AS TO USE:--The Policy covers use of the vehicle for any purpose other than: a) Hire Or Reward b) Carriage of goods (other than samples or
personal luggage) c) Organized Racing d) Pace Making e) Speed Testing f) Reliability Trials g) Any purpose in connection with Motor Trade.
DRIVER: Any person including insured: Provided that a person driving holds an effective driving licence at the time of the accident and is not disqualified from
Holding or obtaining such a licence.Provided also that the person holding an effective Learner's Licence may also drive the vehicle and that such a person
satisfies the requirements of Rule 3 of the Central Motor Vehicle Rules, 1989.
LIMIT OF LIABILITY: Limit of the amount of the Company's liability under the Section II-I(i) in respect of any one accident as per M.V. Act 1988. Limit of the
amount of the Company's liability under Secion II-I(ii) in respect of any one claim or series of claims arising out of one event : Upto Rs - 100000/
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 RIGHTS OF RECOVERY'
I/We certify that the policy to which the certificate relates as well the certificate of insurance are issued in accordance with this provisions of Chapter X & XI of M.V. Act 1988
Broker : Hero Insurance Broking India Pvt. Ltd.
Received Vide
Premium of Rs. 10823.00 CASH
Cash/Cheque No.
ANAND KISHOR The policy is subject to a compulsory excess of Rs. 100/- &
Dated Nominee Name Depreciation is applicable as per policy terms & conditions*
THAKUR
(Please turn overleaf for details)
Drawn on Nominee Age 48 Consolidated Stamp Duty Paid Endorsements : IMT - 22
Scan to Renew / Acknowledgement 13-04- Nominee Relation Father
View Policy Dt 2025
FOR RENEWALS CONTACT: RAJ SINGH Ph.No- 817-1251050, POS0200678 On behalf of ICICI Lombard General Insurance Company Ltd
13-Apr-2025
Date & Signature of
proposer
Dealer's Stamp & Signature Duly Constituted Attorney
# : Received with Thanks Rs 10823.00 from Mr ARYAN KUMAR as premium against the money receipt no 02180425148760
Regd. & Head Office : ICICI Lombard House, 414 Veer Savarkar Marg, Near Siddhi Vinayak Temple, Prabhadevi, Mumbai- 400025 The stamp duty of
Re. 0.5 paid in cash or by demand draft or pay order, vide Receipt / Challan No. CSD10520244764, Challan Date: 04/10/24
For further information about motor insurance policy please also visit www.irdai.gov.in >> Grievances >> Policyholder Handbooks