Dear Mr. . SHANMUGAM A ,

Greetings from Harita Insurance Broking LLP!!!

It gives us an immense pleasure to welcome and thank you for choosing our services.

As you are aware that Vehicle Insurance in India is mandated by the Indian Motor Vehicles Act *, 1988.

The primary reason to mandate motor insurance is third party liability. Unlike any other property, a two-wheeler in a public space can cause damage to
the life and property of others. This liability for death, bodily injury or damage to property of third party is borne by the insurer. This third party liability is
part of every motor insurance policy and no vehicle in India will be allowed to run on the road without it.

We wish you to have great and memorable travelling experiences with your two-wheeler . However, some of us may face few unforeseen events causing
inconvenience and additional financial burden. In case of such eventualities, we would like you to leave all your worries related to your vehicle with us and
relax during such occurrences. You just need to inform the nearest authorized workshop of your choice OR toll free number of insurer and workshop team
will take care of everything from picking up the two-wheeler , claim intimation with insurance company, survey arrangements, vehicle repair, salvage
management and hassle free nearly cash less claims settlement.

we offer you an insurance policy with unique benefits such as:-

1. Instant Online Policy Issuance by insurance company (less paper work needed).
2. Fast and hassle-free claim settlements at vehicles manufacturer dealers and approved garages of the insurance company.
3. Avail Special add on covers like Zero Depreciation, Consumable Cover, Return to invoice, Tyre Cover, Engine Protector, Loss of Key & other add on
covers by paying minimal additional premium.
We at Harita Insurance Broking LLP (herein after called as HIB) intend to provide absolute peace of mind and high level of satisfaction which will help
you forget the unforeseen events. Hereby we ensure that you get prompt and courteous service by insurers cashless tie-up garages/workshops using
network across the country.

Your Complete Satisfaction is prime objective of HIB and insurance company. We look forward to serve you. In this context, please find enclosed:-

1. A Policy Schedule cum Certificate of Insurance, containing details of your vehicle insurance cover and detailed premium break-up.
2. Summary of policy terms & conditions.
We once again thank you for choosing our services and look forward to your continued support and patronage. Wishing you safe & worry-free journeys
ahead!

Best Wishes & Regards,

Team HIB

For any service related queries, please contact us:

at toll free 04428214232. Email-id: [email protected]
Harita Insurance Broking LLP
Regd. Office:Jayalakshmi Estates No 29, Haddows Road, Nungambakkam, Chennai, TN – 600006
IRDAI License Number: 623 . Direct Broker Valid till: 12th October 2023 | LLP Identification No.: AAH 5778
INSURANCE IS A SUBJECT MATTER OF SOLICITATION
 ICICI LOMBARD GENERAL INSURANCE COMPANY LIMITED (ISO 9001:2015 Certified Company)
BUNDLED - TWO WHEELER POLICY - CERTIFICATE CUM POLICY SCHEDULE
(FORM 51 OF THE CENTRAL MOTOR VEHICLE RULES *,1989)
Product Code: 3005 UIN No: IRDAN115RP0020V01202122
IRDAI Registration No: 115 HSN: 997134 Description of Services: Motor Vehicle insurance services
Toll Free No.: 1800 2666 Website: www.icicilombard.com Email: [email protected]

Policy & Owner Details Policy Type- New Product Name- Bundled - Two wheeler Policy

Policy Number Proposal Number & Date Insured GSTIN Number

3005/HT-203421/00/000 PR1026391DADADF5 & 08/12/2022
Policy Tenure (OD Tenure) Policy Tenure (TP Tenure) Policy Issued On
1 YEAR 5 YEAR 08/12/2022 18:10:24
Period Of Insurance (OD Tenure) Period Of Insurance (TP Tenure)
From: 08/12/2022 18:10:24 08/12/2022 18:10:24 To
To: 07/12/2023 23:59:59 07/12/2027 23:59:59
Insured Name Insured Address
Mr. . SHANMUGAM A NO. 125, NEAR SAMUDHAYA BHAVANA VIBHUTHIPURA BANGALORE NORTH BANGALORE Bangalore karnataka 560037
Nominee Name Nominee Relationship Appointee Name Relation with Appointee
- -
Tax Invoice Number
18122282407

Vehicle Details
Make Model Variant Cubic Capacity Seating Capacity Body Type
TVS TVS NTORQ 125 RACE XP BSVI TVS NTORQ 125 RACE XP BSVI DISC 125 2 SOLO
RED+BLK -
Manufacturing Year Registration Date Fuel Type RTO Registration Number Chassis Number
2022 08/12/2022 PETROL KA-03 New MD626BK32N2G04764
Engine Number CNG Elec.Accessories Non-Elec.Accessories Carrier Type CNG/LPG Kit
CK3GN2504709 0 0 0 No
Vehicle IDV Hypothecation/Lease/HP* (IMT-7) Hypothecation City Hypothecation Institute Financier Branch Geographical Extension
₹ 93381 HYPOTHECATION Bangalore Jana Small finance Bank Ltd -
CPA
Do not have valid license
Schedule Of Premium (Amount In Rs.)
OWN DAMAGE PREMIUM (A) LIABILITY PREMIUM (B)
Particular Total Particular Total
Basic Own Damage 797 Basic Third Party Liability 3851
Non-Elec. Accessories 0 Third Party Liability For Bi-Fuel Kit 0
Elec. Accessories (IMT-24) 0 PA Cover For Owner Driver (IMT-15) 0
CNG / LPG Kit (IMT-25) 0 PA Paid Driver 0
Geographical Extension (IMT-1) 0 PA Cover For Unnamed Persons (IMT-16) 0
Sub Total (Basic Premium) 797 Legal liability Paid Driver (IMT-28) 0
ADD ON COVERAGE Legal liability Unnamed Persons (IMT-29) 0
Sub Total (Addons) 0 Geographical Areas Extension (IMT-1) 0
DISCOUNTS Net Liability Premium (B) 3851
AntiTheft Discount (IMT-10) 0 Total Premium (A+B) 4648
AA Membership Discount (IMT-8) 0 SGST Premium (9%) 418.5
Handicapped Discount (IMT-12) 0 CGST Premium (9%) 418.5
No Claim Bonus 0 Total GST 837
Sub Total (Discounts) 0
Net Own Damage Premium (A) 797 Gross Premium 5485

• Policy insurance is subject to realization of premium/payment. • Consolidated Stamp duty Paid vide Letter of Authorization No: CSD0820211460 dated: 12/04/2021 The policy is subject to compulsory deductible
NOTE: (IMT-22) of Rs.100. • Geographical Area-India. • You agree to receive the policy document (without enclosing the terms & conditions) from the company and the company will display terms & conditions on its
website which can be accessed by you online. * Subject to IMT Endt. Nos. & Memorandum: 22,7.
Limitations as to use: The policy covers use of the vehicle for any purpose other than
(1) Hire or Reward (2) Carriage of goods (other than samples or personal luggage) (3) Organized racing (4) Pace making (5) Speed testing (6) Reliability trials (7) Any purpose in connection with motor trade (8) Tuition.
Drivers Clause: Any person including the insured: Provided that the person driving holds an effective driving license at the time of the accident and is not disqualified from holding or obtaining such license.Provided also that
the person holding an effective learners license may also drive the vehicle & that such a person satisfies the requirements of Rule 3 of the Central Motor Vehicle Rules *, 1989.
Limits of Liability Clause: (a) Under Section II (1)(I) of the Policy-Death of or bodily injury - Such amount as is necessary to meet the requirements of the Motor Vehicle Act *, 1988. (b) Under Section II (1)(ii) of the Policy-
Damage to property other than property belonging to the insured or held in trust or in the custody of control of the insured up to the limits specified- (TPPD Sum Insured - ` 1,00,000/-) .
No Claim Bonus : No Claim Bonus will only be allowed, provided the policy is renewed within 90 days of the expiry of the previous policy. No Claim Bonus is subject to no claim on the previous policy. Benefits under the policy
stands forfeited if claim is/was made in previous policy.
Geographical Area: Any accidental loss damage and/or liabilty caused sustained or insured within India shall be covered subject to policy Terms and Conditions, unless specially agreed and endorsed.
Important Notice: The insured is not indemnified if the vehicle is used or driven otherwise than in accordance with the schedule. Any payment made by the company by reasons 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 & RIGHT OF RECOVERY" For legal interruption, English version will hold good.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. "As per section 146 of
the motor vehicle act *, 1988 it is mandatory to have your vehicle insured against third party risk". As per section 196 of the above act,driving a vehicle without valid insurance is punishable with fine upto Rs 2000/- or
imprisonment upto 3 months or both. Pre-existing Damages: All types of pre-existing damages or cost of rapair of such damage will be excluded at the time of claim settlement. Updating Registration Number of vehicles within
15 days of policy inception is MANDATORY as per IRDAI. Kindly provide the same to your Agent/Our Call centre/Policy issuing Branch (Applicable for policies booked without Registration No of vehicles).
Grievance Clause: Insured is advised to go through the policy schedule cum certificate of insurance which is issued based on your declaration and if any error/ discrepancy is found in respect of vehicle details, No Claim Bonus
or any other material information, it should be brought to our notice within 15 days of receipt of this policy for necessary correction along with the supporting documents, otherwise it will be deemed correct. In the unfortunate
event of a claim, please call quoting your Policy No. on 1800 2666 (toll free) and register your claim immediately within 7 days from the date of loss. You may visit company website at www.icicilombard.com for detailed
benefits, terms & conditions & exclusions of the policy. You may also reach us at our 24*7 helpline 1800 2666 or [email protected] in case you desire to have a printed copy of policy wording or any other
assistance required. Our grievance redressal procedure and details about ombudsman is also available in our policy wording and company website. Please note that any misrepresentation, non disclosure or withholding of
material facts will lead to cancellation of policy void ab initio with forfeiture of premium and non consideration of claim, if any. In the event of unsatisfactory response from the Head Grievance Officer, he/she may, subject to
vested jurisdiction, approach the Insurance Ombudsman for the redressal of grievance. Details of Insurance Ombudsman are available at IRDAI website www.irdai.gov.in or on company website www.icicilombard.com or on
General Insurance Council: http://www.cioins.co.in/ombudsman.html
 
MISP:PRAKRUTHI MOBIKES | HIB/TVS/10970 | [email protected]
DP:RAJESHWARI
 
BS | HIB_002142 | [email protected] | 9972365719
Broker Name & Address: Harita Insurance Broking LLP, Jayalakshmi Estates, No.29, Haddows Road, Nungambakkam, Chennai,TN-600006 | Broker Code : IM-565761

For & On Behalf of

ICICI LOMBARD GENERAL INSURANCE COMPANY LIMITED

Authorized Signatory

For Renewal/Claims assistance - please contact Insurance.Co./HIB through : PRAKRUTHI MOBIKES at 9972365719
Introduction to Motor Insurance Policy Schedule of Depreciation for fixing IDV of the vehicle
A Motor Insurance Policy is mandatory under the Motor Vehicle Act * ensuring that the two-wheeler owner is
protected from financial losses, caused by damage or theft to the vehicle and third party liability Age of the vehicle % of Depreciation
What does the Policy Cover?
1. Legal Liability due to accidental damage for any permanent injury/death of a person. Not exceeding 6 months 5%
2. Any damage caused to the property.
Optional Extensions
Exceeding 6 months but not exceeding 1 year 15%
1. Loss of Electrical/Non-Electrical accessories.
2. Loss or damage to Bi-fuel system.
3. Legal Liability to paid driver, cleaner or any workman. Exceeding 1 year but not exceeding 2 years 20%
4. Personal Accident cover for the occupants
Other Salient Features Exceeding 2 years but not exceeding 3 years 30%
1. No Claim Bonus available on subsequent renewals in lieu of claims free experience.
2. Discount for opting higher voluntary excess. Exceeding 3 years but not exceeding 4 years 40%
3. Discount for AAI membership.
4. Premium Concession for specially designed/modified vehicle for blind, handicapped and mentally
challenged persons. Exceeding 4 years but not exceeding 5 years 50%
5. Depreciation is applicable for the parts needing replacement in accident.
What is not covered in the policy?
In the case of painting, the depreciation rate of 50% shall be applied only on the material cost of total painting
1. Mechanical/Electrical breakdown. charges. In the case of a consolidated bill for painting charges, the material component shall be considered as
2. Manufacturing defect. 25% of total painting charges for the purpose of applying the depreciation.
3. Consequential loss, depreciation, wear & tea.
4. Any contractual liability.
5. Intoxicated driving. Age of the vehicle
6. Deliberate accidental loss.
7. Damages due to nuclear weapons material or war. Rubber, Nylon/ Plastic parts,and Air bags 50%
8. Accidents outside the Geographical Area.
9. Policy Excess.
Fibre glass components 30%
Voluntary Deductible Discount
Rest all parts including wooden parts
Rs. 500 5% on the OD premium of the two wheeler, subject to a maximum of Rs. 50/-.
Vehicle Age % Depreciation
Rs. 750 10% on the OD premium of the two wheeler, subject to a maximum of Rs.75/-
Not Exceeding 6 months Nil
Rs. 1000 15% on the OD premium of the two wheeler, subject to a maximum of Rs.125/-
Exceeding 6 months but not exceeding 1 year 5%
Rs. 1500 20% on the OD premium of the two wheeler, subject to a maximum of Rs.200/-
Exceeding 1 year but not exceeding 2 years 10%
Rs. 3000 25% on the OD premium of the two wheeler, subject to a maximum of Rs.250/-
Exceeding 2 year but not exceeding 3 years 15%

Exceeding 3 year but not exceeding 4 years 25%

Exceeding 4 year but not exceeding 5 years 35%

Exceeding 5 year but not exceeding 10 years 40%

Exceeding 10 years 50%

Period Of Insurance % of NCB on OD

Premium

No claim made or pending during the preceding full year of insurance. 20%

No claim made or pending during the preceding 2 consecutive years of 25%

insurance.

No claim made or pending during the preceding 3 consecutive years of 35%

insurance.

No claim made or pending during the preceding 4 consecutive years of 45%

insurance.

No claim made or pending during the preceding 5 consecutive years of 50%

insurance.

 
Perils covered
1. Own damage - Coverage's.
2. Risks indemnified against loss / damage to vehicle (including accessories, if covered)
3. Fire, explosion, self ignition, lightening
4. Burglary, housebreaking, theft
5. Riot & strike
6. Earthquake,(Fire & Shock)
7. Flood, typhoon, hurricane, storm, tempest, inundation, cyclone, hailstorm, frost
8. Accidental external means
9. Malicious act
10. Terrorist activity
11. Landslide, rockslide
12. In transit
Statutory Provision
1. Note: In the event of dishonor of cheque, this policy document automatically stands cancelled from inception irrespective of whether a separate communication is sent or not.
2. The policy has been issued based on the information provided by you and the policy is not valid if any of the information provided is incorrect, subject otherwise to the terms, conditions and exclusions of the Bundled - Two
wheeler Policy POLICY Schedule.
FASTag
1. Government of India has mandated electronic toll payments using FASTag to reduse vehicle 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.
PUC
1. We have issued the policy basis your confirmation that you hold a valid PUC and/or fitness certificate, as applicable.
2. 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.
Disclaimers
1. The policy wording with detailed terms, conditions and exclusions are available on our website www.icicilombard.com.
2. It is hereby declared and agreed that all pre-existing damages to the vehicle having occurred prior to the commencement of cover are excluded from the scope of the policy.
Grievance Redressal
1. 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
Warranty statement pro-rata
1. 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.
2. Warranted that NCB under this policy is based on representation regarding NCB and absence of claim under the previous policy.It is hereby warranted the coverage under this Policy commences only from the Risk Start
time and Date as mentioned in the Policy schedule. No Liability shall attach under this Policy in respect of any Accident/Loss prior to the time and date of commencement of Period of Insurance.
 
 
ICICI LOMBARD GENERAL INSURANCE COMPANY LIMITED.
IRDAI Reg. No. 115. CIN: L67200MH2C00PLC129408.
Registered & Corporate Office: ICICI Lombard House, 414 Veer Savarkar Marg, Near Siddhi Vinayak Temple, Prabhadevi, Mumbai - 400 025..
Policy Issuing/ Customer Happiness Center: ICICI Lombard General Insurance Company United, Interface Building No.: 16, 601 / 602, 6th Floor, New link Road, Malad (West), Mumbai - 400 064.
For Claim/Policy related queries call us at 1800 2666 or for Visit Help Section on www.icicilombard.com for policy copy/tax certificate/ make changes/ register & track claim.
 PAYIN SLIP

Payment - Policy

Payin Slip No.: PA00000018472194 Receipt Date: 08/12/2022 18:10:24

Broker Code : IRDA/DB 708/17. Broker Name : Harita Insurance Broking LLP
MISP Code : HIB/TVS/10970 MISP Name : PRAKRUTHI MOBIKES
DP Code : HIB_002142 DP Name : RAJESHWARI BS
Insurance Company : ICICI LOMBARD GENERAL INSURANCE COMPANY LIMITED

Unique Ref. Proposal Number Policy Number Policy Date Insured Cheque/Ref Number Cheque/Ref Payment Drawn Premium
Number Name Date Mode On

26391DADADF5E1 PR1026391DADADF5 3005/HT- 08/12/2022 Mr. . pay_KpQ3AWuNLzw9U4 08/12/2022 WALLET 5485

203421/00/000 SHANMUGAM
A

Total : 5485

Note :
1. This is a computer generated receipt and does not require a signature.
2. Upon issuance of this Receipt, all previously issued temporary receipts, if any related to this Policy shall be considered null or void.
3. Amounts received by cheque shall be subjected to realisation.
4. Any amount received in excess of the Premium is being/shall be refunded by the Company.