TWOWHEELERINSURANCECOVERNOTE

CoverNoteNo:W30806174

TheCoverNotewordingsprovidedontheothersideconstitutethelegaldocumentwith
Theinsured,describedinForm'52'referredtobelow,havingproposedforinsurancein
regardtothecoverage.Inordertohelpyouunderstandthecovernotebetter,weare
respectofMotorVehicle(s)describedthereinandhavingpaidthesumofRs.1566as
providingyouwiththiscommentary.Theexplanation,interpretation,commentaryprovided
premium,theriskisherebyheldcoveredunderthetermsoftheCompany'susualformof
hereshallnotbeconstruedaspartoftheCoverNoteattachedalongside.Wearenotliable
PackagePolicyapplicablethereto(subjecttoanySpecialConditionmentionedbelow)
byanyinterpretationinthiscommentaryandthecontractisrestrictedtothewordings
unlessthecoverbeterminatedbytheCompanybynoticeinwritinginwhichcasethe
insurancewillthereuponceaseandaproportionatepartofthepremiumotherwisepayable providedalongside.Foranyfurtherclarification,pleasecontactourCallCentres.Asper
yourdeclarationintheproposalformwithreferencetoyourvehicledescribedbelowandthe
forsuchinsuranceshallbechargedforthetimetheCompanyhadbeenatrisk.
premiumpaidbyyou,wearecommencinganinsurancecoverforyourvehicleunderTWO
Gross
InsuredDeclaredValue WHEELERPackagePolicyfromthedateandtimementionedbelow(subjecttospecial
Vehicle
(IDV)
Licensed
conditionsdescribedbelow,ifapplicable).Thecoverwouldbeprovidedfortheduration
Make,Model&
Weight
Yearof
Cubic
Carrying
describedbelowunlessduetosomecircumstances,wehavetocancelthepolicy.Insucha
Accessories
Reg.No.ofthe
(GVW)
Manufacture Capacity
Capacity For
notincludedin case,wewouldsendyouawrittennoticeandcancelthepolicybyproportionatelyrefunding
vehicle
(Good
(LCC) Vehicle Mfr'slisted
premiumtoyoufortheunexpiredperiodofcover
Carrying
Rs.
sellingpriceRs.
Vehicle)
BAJAJ,
PULSAR220
DTSI,
MH12KH2775

2013

220

EngineNo:DE73717

65724

ChassisNo:CE77286

AdditionalRisks,ifany:
SpecialConditions:
HypothecatedTo:BAJAJFINANCELTD.

N.B.Intheeventofanaccident,theInsuredshouldinformtheCompanytoarrangespot
survey.
Thedetailsofyourvehicleareasdescribedalongside.
Specialconditionsifapplicabletoyourpolicyareasdescribedhere.

Form52(SeeRule142(1)ofCentralMotorVehicleRules,1989)
1.Registrationmarkandnumberordescriptionofthe
vehicleinsured
2.Nameandaddressofinsured
3.Effectivedateandtimeofcommencementof
insuranceforthepurposeofthisAct
4.Dateofexpiryofinsurance
5.Personsorclassesofpersonsentitledtodrive

6.AnylimitationsastouseofMotorvehicle

7.Theperiodofvalidityofthiscovernotewillexpire
on

MH12KH2775

Thisrepresentsyourvehicle,forwhichweare
providingtheinsurancecover
VIJAYMAURYA,S.NO18/2/6BVISHNUSHREEBLDGNAVCHAITNYA YourNameandaddressasmentionedbyyouinthe
SOCWARJE,,PUNE,MAHARASHTRA,411058
proposalform
Time:12:00Date:04Oct2014
Thedateandtimeofthecommencementofthis
insurancecover.
03Oct2015
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
03Dec2014
ThevalidityofthisCoverNoteistillthedate
mentioned

I/WeherebycertifythatthisCoverNoteisissuedinaccordancewiththeprovisionsofChapterXIoftheMotorVehiclesAct,1988
ItbringsuspleasureinannouncingthatouroperationsfunctionhasbeenISO9001:2000certifiedwitheffectfrom7thSeptember2004.ThecertifyingagencywasDetNorskeVeritas
(DNV).Thiswouldmeanthatwewouldmeettheservicerelatedpromisesthatwemaketoourcustomers.
Dateofissue:04Oct2014
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