ICICI Lombard General Insurance Company Limited.

Servicing Office : Chamber I, Fourth Floor, Eldeco Corporate, Gomti Nagar, Lucknow, Uttar Pradesh 226024, , , LUCKNOW,
UTTAR PRADESH (State Code:09) -226024
Stand-Alone Own Damage Private Car Insurance Policy UIN --IRDAN115RP0001V02201920
Certificate Cum Policy Schedule (FORM 51 OF THE CENTRAL MOTOR VEHICLE RULES, 1989)
PAN :AAACI7904G GSTIN: 09AAACI7904G1ZL CIN :U67200MH2000PLC129408 IRDAI Reg:115

Policy No: 3001/O/HY-20277227/00/000 Proposal No. & Date: HIIB14689595, 26-MAR-2025

Policy Issued On: 26-MAR-2025 14:08 HRS Previous Policy No.: 3001/O/HY-19029696/00/000
Insured Name: MR. PANKAJ SHARMA Previous Insurer: ICICI Lombard General Insurance Company Limited.
Period of Own Damage : 31-MAR-2025 (00:00) To 30-MAR-2026 (1 YEAR)
S/O SHRI NIWAS SHARMA R/O VILL BHAMSOI HUSENPUR , Period of Liability Cover: NA
Insured Address:
DUDHMA , ALIGARH , UTTAR PRADESH (State Code:09) -202131
Period of Compulsory NA
Personal Accident Cover:
Customer Type PAN GSTIN Name Age (Yr.) Relation
Customer Details Nominee Details
INDIVIDUAL NA

Vehicle Details
Make Model Variant Cubic Capacity Manufacturing Year Seating capacity
HYUNDAI VENUE 1.2 KAPPA MT S 1197 2023 5
Body Type Registration No. RTO Hypothecation/Lease* Fuel Type VIN/Chassis No.
SUV UP 81 DC 6127 ALIGARH YES PETROL MALFB81BLPM449687
Vehicle IDV Electrical Accessories Non-Electrical Accessories BI Fuel Kit Total IDV Engine No
685,000 0 0 0 685,000 G4LAPM490192

Own Damage Premium (A) Amount(INR) Pre-Existing Third-Party Policy Details

Basic Own Damage Premium TP Insurance Company Name Cholamandalam MS General Insurance Co. Ltd.
Vehicle 12,023 TP Policy No 3311/00956475/000/00
Non-Elec. Accessories (IMT-24) 0 TP Risk Inception Date 31 Mar 2023
Elec. Accessories (IMT-24) 0 TP Risk Expiry Date 30 Mar 2026
Bi-Fuel Kit (IMT-25) 0
Geographical Area Extension (IMT-1) 0
IMT 23 Premium 0
Sub Total (Basic Premium) 12,023
Discount/Deductibles
Voluntary Deductibles (0) (IMT-22A) 0
Anti Theft Device (IMT-10) 0
AA Membership (IMT-8) 0

No Claim Bonus (0%) 0

Handicapped Discount (IMT-12) 0

Notes: 1. New Challan /Deface Number: CSD10520244764, Challan Date: 04/10/24

And this challan will be effective from: 01/02/2025

Sub Total (Deductibles) 0
Note: This challan number is not applicable for Jammu & Kashmir policies

2.This policy has been issued upon declaration by the Insured that a valid Pollution Under Control (PUC)
Total Own Damage Premium 12,023 Certificate is held on the date of commencement of the Policy. The insured undertakes to renew and maintain
a valid and effective PUC and/or fitness Certificate, as applicable, during the subsistence of the Policy.
Add On Coverages ( ZD,CM,EP,RTI,KP,PB ) 5436 3.Geographical Area Ext. extended to (IMT-1): NA
Net Own Damage Premium (A) 17,459 4. Policy issuance is subject to realization of cheque if premium is paid by cheque
SGST(9%) 1,572 5.The policy is subject to compulsory deductible of INR 1,000 (IMT-22) & Voluntary Deductible of INR 0 .
6. This policy is to be read in conjunction with the Policy /Add-on wordings T&C available on the insurer
CGST(9%) 1572 website http://www.icicilombard.com
7. The Coverage under this policy is only for Own Damage and no other liability in connection with the
Gross Premium Paid 20,603 vehicle.
Add-on Cover Opted in the Policy: Zero Depreciation(IRDAN115RP0001V01201920/A0035V01201819), Consumables Cover(IRDAN115RP0001V01201920/A0008V01201920), Engine Protect
Plus Cover(IRDAN115RP0001V01201920/A0009V01201920), Return To Invoice Cover(IRDAN115RP0001V01201920/A0036V01201819), Key Protect Cover
(IRDAN115RP0001V01201920/A0010V01201920), Loss of Personal Belongings Cover(IRDAN115RP0001V01201920/A0011V01201920)

*Hypothecation Details: INDUSIND BANK LTD. - ALIGARH - ALIGARH Payment Mode: Online
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.
Driver's 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: 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.Under Section II-1 (ii) of
the policy-Damage to third party property is INR 7.5 Lakhs, PA Cover Under Section III for Owner-Driver is INR 0.
No Claim Bonus: The insured is entitled for a No Claim Bonus (NCB) on the own damage section of the policy, if no claim is made or pending during the preceding year(s) - 20%, preceding
two consecutive years - 25%, preceding three consecutive years - 35%, preceding four consecutive years - 45%, preceding five consecutive years - 50% of NCB on OD Premium.
NCB is allowed provided the policy is renewed within 90 days of the expiry date of the previous policy.
Declaration on Tax Invoice 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.
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.
Grievance Clause: For resolution of any query or grievance, Insured may check Grievance redressal policy at https://www.icicilombard.com/grievance-redressal or connect with the respective servicing
office of insurance company. In the event of unsatisfactory response,he/she may approach the insurance ombudsman for the redressal of grievance at www.irdai.gov.in or on website of General Insurance
Council: www.gicouncil.in
HSN/SAC : 997134, Description of Service : Motor Vehicle Insurance Services, Place of Supply : UTTAR PRADESH(State Code : 09), Insurer Invoice Number : 180325307666
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 XI of Motor Vehicle Act, 1988.
Insurance Broker Name : Hyundai India Insurance Broking Pvt. Ltd. For & On Behalf of
Corporate Office:16th Floor, Building No. 9A, DLF Cybercity, Phase III, Gurugram, Scan for Renewal ICICI Lombard General Insurance Company
Haryana 122001 (Valid from 90 Days Prior to Limited.
Expiry)

Broker Code: 822 (Valid UPTO:30/05/2025) MISP NAME-SHIVA AUTO SALES

CIN No.: U67200HR2021PTC098982 PRIVATE LIMITED
GST: 06AAGCH0310P1ZP MISP CODE-HIIB-MHY-0235
Email ID: [email protected] DP NAME-ASHWANI KUMAR
Contact No: 0124-6833000
Authorized Signatory
For Claims, Policy Servicing & Renewal, Kindly contact (SHIVANG AUTO SALES PRIVATE LIMITED ) at +91-7535010044