IDEMNITY CUM DECLARATION UNDERTAKING

THIS IDEMNITY CUM DECLARATION UNDERTAKING (Undertaking) made at

__________ on the ____Day of _________ 2007 BETWEEN M/s. ______________
_____________________(herein after called the insured which term and
expression shall include his representatives, executors, administrators) is made
in favor of

ICICI Lombard General Insurance Limited, a company incorporated under the

Companies Act, 1956 and having its registered office at ICICI Bank Towers, Bandra
Kurla Complex, Mumbai - 400 051 and corporate office at IInd Floor, Zenith House,
Mahalaxmi, Keshav Rao Khade Marg, Mumbai 400 034, (hereinafter called the
Insurer which term and expression shall include its executors, administrators and
assigns).
WHEREAS

The Insured is the registered owner of a motor vehicle bearing Registration

Number
----------- Bearing engine number -------------------------and chassis number
----------------- (hereinafter referred to as the said motor vehicle).

AND WHEREAS the said motor vehicle is insured with the Insurer under the policy of
motor insurance / cover/policy note bearing Number -------------------------- (the
said Policy) for a period of 12 months from -------------- to ---------------- covering,
inter alia, the risk of loss of or damage to the motor vehicle and / or its
accessories whilst thereon by burglary, housebreaking or theft.

AND WHEREAS the said motor vehicle has been stolen on -------------- and the same
has not been recovered.

NOW IN CONSIDERATION of the payment of the said sum of Rs. ---------------

(Rupees
) By the Insurer to the Insured as cash loss
settlement for the amount of loss and damage suffered by the Insured pertaining
to said motor vehicle resulting from theft and the Insured has accepted the same
as the full, fair and final settlement. THE INSURED HEREBY SOLEMNLY AFFIRMS,
DECLARS, UNDETAKES AND STATES AS FOLLOW:

1. By virtue of such payment, the insurer has been subrogated to all the insureds
rights remedies and in respect of subject matter insured in accordance with the
said policy. In the event of recovery of the said motor vehicle by any means
whatsoever, or in the event that the insured recovers the amount of loss from any
third party, the insured shall pay the said sum of Rs. --------------------------
(Rupees ----------------------------) to the insurer within a period of thirty 30 days
from the date of recovery which shall mean and be computed from the date of
delivery to the possession of the recovered said motor vehicle by the competent
authority or court either to the insured or to the insured. In case of default on the
part of the insured, the insurer shall be entitled to recover the said sum of Rs.
--------------------- (Rupees --------------------------------) with interest at the rate 14%
per annum from the date of recovery of the said motor vehicle till the entire
amount is realized.

2. The insured shall at his own instance pursue the recovery proceedings of the
said motor vehicle, and if necessary, shall extend all co- operation to the insurer
for the same. The insurer shall be entitled to use the name of the insured for the
purpose of recovery of the said motor vehicle including for giving discharge on
behalf of the insured for the receipt of the said motor vehicle to the competent
authority or court which shall be treated as valid and binding on the insured.

3. In case of non-compliance with the terms herein by the insured and/or if any
hindrance is caused of the part of the insured, the insured shall be liable to repay
the said amount of Rs. ------------------------ (Rupees ----------------------------) to the
insurer on demand together with interest @ 14% per annum from the date of
payment by the insurer as aforesaid.

4. The insured hereby undertakes to indemnify, in full the insurer and keep and
hold the insurer harmless in the event of any claim, which may arise by the insured
and/or any third party against the insurer, on account of the said motor vehicle.

5. The insured further affirms and undertakes that the aforesaid declarations and
statement s made by the insured are true and the insurer has agreed to pay the
amount of Rs. -------------(Rupees --------------------------) in respect of the said
motor vehicle on the faith and strength thereof.

6. The insured agrees and understands that this undertaking shall not stand in
derogation of any of the rights, or part of parts thereof, available to the insurer by
virtue of the said policy, all of which are expressly reserved by the insurer
notwithstanding anything contained herein.

Signed and Delivered by ______________________,

The within named Claimant in the presence of :
1)
2)