TWOWHEELERINSURANCECOVERNOTE

CoverNoteNo:W40395761

Theinsured,describedinForm'52'referredtobelow,havingproposedforinsurancein TheCoverNotewordingsprovidedontheothersideconstitutethelegaldocumentwith
respectofMotorVehicle(s)describedthereinandhavingpaidthesumofRs.1250as regardtothecoverage.Inordertohelpyouunderstandthecovernotebetter,weare
premium,theriskisherebyheldcoveredunderthetermsoftheCompany'susualformof providingyouwiththiscommentary.Theexplanation,interpretation,commentaryprovided
PackagePolicyapplicablethereto(subjecttoanySpecialConditionmentionedbelow) hereshallnotbeconstruedaspartoftheCoverNoteattachedalongside.Wearenotliable
unlessthecoverbeterminatedbytheCompanybynoticeinwritinginwhichcasethe byanyinterpretationinthiscommentaryandthecontractisrestrictedtothewordings
insurancewillthereuponceaseandaproportionatepartofthepremiumotherwisepayable providedalongside.Foranyfurtherclarification,pleasecontactourCallCentres.Asper
forsuchinsuranceshallbechargedforthetimetheCompanyhadbeenatrisk. yourdeclarationintheproposalformwithreferencetoyourvehicledescribedbelowandthe
premiumpaidbyyou,wearecommencinganinsurancecoverforyourvehicleunderTWO
Gross InsuredDeclaredValue
WHEELERPackagePolicyfromthedateandtimementionedbelow(subjecttospecial
Vehicle (IDV)
Licensed conditionsdescribedbelow,ifapplicable).Thecoverwouldbeprovidedfortheduration
Make,Model& Weight Accessories describedbelowunlessduetosomecircumstances,wehavetocancelthepolicy.Insucha
Yearof Cubic Carrying
Reg.No.ofthe (GVW)
Manufacture Capacity Capacity For notincludedin case,wewouldsendyouawrittennoticeandcancelthepolicybyproportionatelyrefunding
vehicle (Good
(LCC) Vehicle Mfr'slisted premiumtoyoufortheunexpiredperiodofcover
Carrying Rs. sellingprice
Vehicle) Rs.
HONDA
MOTORCYCLE,
2014 110 2 38076 0
DIO.,
KA02JB5858
N.B.Intheeventofanaccident,theInsuredshouldinformtheCompanytoarrangespot
EngineNo:JF39E70254015 ChassisNo:ME4JF392ME7254005 survey.
Thedetailsofyourvehicleareasdescribedalongside.
AdditionalRisks,ifany:
SpecialConditions: Specialconditionsifapplicabletoyourpolicyareasdescribedhere.
HypothecatedTo:N/A

1.Registrationmarkandnumberordescriptionofthe
vehicleinsured
2.Nameandaddressofinsured
3.Effectivedateandtimeofcommencementof
insuranceforthepurposeofthisAct
4.Dateofexpiryofinsurance
5.Personsorclassesofpersonsentitledtodrive
6.AnylimitationsastouseofMotorvehicle
7.Theperiodofvalidityofthiscovernotewillexpire
on
Form52(SeeRule142(1)ofCentralMotorVehicleRules,1989)
KA02JB5858 Thisrepresentsyourvehicle,forwhichweare
providingtheinsurancecover
NAGARAJHEGDE,C/O.SATYANARAYANABHAT.#15,1STMAIN, YourNameandaddressasmentionedbyyouinthe
GELEYARABALAGALAYOUT,JCNAGARBANGALORE, proposalform
BANGALORE,KARNATAKA,560086
Time:12:00Date:17Dec2015 Thedateandtimeofthecommencementofthis
insurancecover.
16Dec2016 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
15Feb2016 ThevalidityofthisCoverNoteistillthedate
mentioned

I/WeherebycertifythatthisCoverNoteisissuedinaccordancewiththeprovisionsofChapterXIoftheMotorVehiclesAct,1988
ItbringsuspleasureinannouncingthatouroperationsfunctionhasbeenISO9001:2000certifiedwitheffectfrom7thSeptember2004.ThecertifyingagencywasDetNorskeVeritas
(DNV).Thiswouldmeanthatwewouldmeettheservicerelatedpromisesthatwemaketoourcustomers.
Dateofissue:17Dec2015 ForICICILombardGeneralInsuranceCompanyLtd
Timeofissue:12:00

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
RegisteredOffice:ICICILombardGeneralInsuranceCompanyLTD,ICICILombardHouse,414,VeerSavarkarMarg,NearSiddhiVinayakTemple,PrabhadeviMumbai4
ServiceTaxReg.No.:GIS/MumbaiI/1528/2001