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TWOWHEELERINSURANCECOVERNOTE CoverNoteNo:W21540385 TheCoverNotewordingsprovidedontheothersideconstitutethelegaldocumentwith Theinsured,describedinForm'52'referredtobelow,havingproposedforinsurancein regardtothecoverage.Inordertohelpyouunderstandthecovernotebetter,weare respectofMotorVehicle(s)describedthereinandhavingpaidthesumofRs.1225as providingyouwiththiscommentary.Theexplanation,interpretation,commentaryprovided premium,theriskisherebyheldcoveredunderthetermsoftheCompany'susualformof hereshallnotbeconstruedaspartoftheCoverNoteattachedalongside.Wearenotliable PackagePolicyapplicablethereto(subjecttoanySpecialConditionmentionedbelow) byanyinterpretationinthiscommentaryandthecontractisrestrictedtothewordings unlessthecoverbeterminatedbytheCompanybynoticeinwritinginwhichcasethe insurancewillthereuponceaseandaproportionatepartofthepremiumotherwisepayable providedalongside.Foranyfurtherclarification,pleasecontactourCallCentres.

.Asper yourdeclarationintheproposalformwithreferencetoyourvehicledescribedbelowandthe forsuchinsuranceshallbechargedforthetimetheCompanyhadbeenatrisk. premiumpaidbyyou,wearecommencinganinsurancecoverforyourvehicleunderTWO InsuredDeclaredValue Gross WHEELERPackagePolicyfromthedateandtimementionedbelow(subjecttospecial (IDV) Vehicle conditionsdescribedbelow,ifapplicable).Thecoverwouldbeprovidedfortheduration Licensed Make,Model& Weight Accessories describedbelowunlessduetosomecircumstances,wehavetocancelthepolicy.Insucha Yearof Cubic Carrying Reg.No.ofthe (GVW) notincludedin case,wewouldsendyouawrittennoticeandcancelthepolicybyproportionatelyrefunding Manufacture Capacity Capacity For vehicle (Good premiumtoyoufortheunexpiredperiodofcover (LCC) Vehicle Mfr'slisted Carrying Rs. sellingprice Vehicle) Rs. HONDA MOTORCYCLE, 2012 110 2 39984 0 DREAMYUGA, KA05HV8521 EngineNo:JC58E1072332 AdditionalRisks,ifany: SpecialConditions: HypothecatedTo:N/A ChassisNo:ME4JC583JC8072369 N.B.Intheeventofanaccident,theInsuredshouldinformtheCompanytoarrangespot survey. Thedetailsofyourvehicleareasdescribedalongside. Specialconditionsifapplicabletoyourpolicyareasdescribedhere.

Form52(SeeRule142(1)ofCentralMotorVehicleRules,1989) 1.Registrationmarkandnumberordescriptionofthe vehicleinsured 2.Nameandaddressofinsured KA05HV8521 T.V.SATYANARAYANA,NO302,7TH'B'MAIN,NARAYANNAGAR 2NDBLOCK,KANAKAPURAROAD,NEARDODDAKALLA SANDRA,BANGALORE,560062,KARNATAKA Time:12:00Date:30Oct2013 Thisrepresentsyourvehicle,forwhichweare providingtheinsurancecover YourNameandaddressasmentionedbyyouinthe proposalform

3.Effectivedateandtimeofcommencementof insuranceforthepurposeofthisAct 4.Dateofexpiryofinsurance 5.Personsorclassesofpersonsentitledtodrive

6.AnylimitationsastouseofMotorvehicle

7.Theperiodofvalidityofthiscovernotewillexpire on

Thedateandtimeofthecommencementofthis insurancecover. 29Oct2014 Thedateandtimeoftheexpiryofthisinsurancecover. Anypersonincludingtheinsured:Providedthatapersondrivingholds Forthecovertobevalid,thedriverofyourvehicle aneffectiveDrivingLicenceatthetimeoftheaccidentandisnot musthaveavalidlicense.Italsobecomesvoidifthe disqualifiedfromholdingorobtainingsuchalicence.Providedalsothat driverofyourvehicle,atthetimeofaccidentwas thepersonholdinganeffectiveLearner'sLicencemayalsodrivethe disqualifiedfromholdingorobtainingadriver's vehicleandsuchapersonsatisfiestherequirementofRule3ofthe license.Thiscoveralsoallowsadriverofyourvehicle CentralMotorvehiclesRules,1989. holdingalearner'slicenseprovidedthatsuchadriver satisfiestherequirementsofCentralMotorVehicle Rulesasprescribedbythegovernment. ThePolicycoversuseforanypurposeotherthan(a)Hireorreward(b) Thisinsurancecoverisnotvalidifyourvehicleisused Carriageofgoods(otherthansamplesorpersonalluggage)(c)Organised forthepurposeof(a)Hireorreward(b)Carriageof racing(d)Pacemaking(e)Speedtesting(f)Reliabilitytrials(g)Any goods(otherthansamplesorpersonalluggage)(c) purposeinconnectionwithMotorTrade Organisedracing(d)Pacemaking(e)Speedtesting(f) ReliabilityTrials(g)Anypurposeinconnectionwith MotorTrade 29Dec2013 ThevalidityofthisCoverNoteistillthedate mentioned

I/WeherebycertifythatthisCoverNoteisissuedinaccordancewiththeprovisionsofChapterXIoftheMotorVehiclesAct,1988 ItbringsuspleasureinannouncingthatouroperationsfunctionhasbeenISO9001:2000certifiedwitheffectfrom7thSeptember2004.ThecertifyingagencywasDetNorskeVeritas (DNV).Thiswouldmeanthatwewouldmeettheservicerelatedpromisesthatwemaketoourcustomers. Dateofissue:30Oct2013 Timeofissue:12:00 ForICICILombardGeneralInsuranceCompanyLtd

Intheeventofdishonourofcheque,insurancecoverprovidedunderthisdocumentautomaticallystandscancelledAbinitio.Thecompanyisundernoobligationtosendseparate communicationinformingthesaiddishonourofcheque. N.B.:Intermediaryorrelevantcontactdetailswillbeprovidedinthepolicyschedule Ahmedabad:07955309877AndhraP'desh:9849577877Bangalore:08051187464Calcutta:9831377877Chandigarh:01725055707Chennai:04442017877Coimbatore:04225387877 Delhi:09818177877Gujarat:9898277877Hyderabad:04023128511Indore:07315027877Karnataka:9845577877Kerala:9895477877Kochin:04842384511Lucknow:05222294511 M.P.:9893047877Maharashtra:9890017877Mumbai:02228307711Pune:02026103511Rajasthan:9829796547TamilNadu:9894477877 ICICILombardGeneralInsuranceCompanyLimited Regd.Office:ICICIBankTowers,BandraKurlaComplex,Bandra(East),Mumbai400051 ServiceTaxReg.No.:GIS/MumbaiI/1528/2001