I/WeherebycertifythatthisCoverNoteisissuedinaccordancewiththeprovisionsofChapterXIoftheMotorVehiclesAct,1988

TWOWHEELERINSURANCECOVERNOTE
CoverNoteNo:W25943585

Theinsured,describedinForm'52'referredtobelow,havingproposedforinsurancein
respectofMotorVehicle(s)describedthereinandhavingpaidthesumofRs.1069as
premium,theriskisherebyheldcoveredunderthetermsoftheCompany'susualformof
PackagePolicyapplicablethereto(subjecttoanySpecialConditionmentionedbelow)
unlessthecoverbeterminatedbytheCompanybynoticeinwritinginwhichcasethe
insurancewillthereuponceaseandaproportionatepartofthepremiumotherwisepayable
forsuchinsuranceshallbechargedforthetimetheCompanyhadbeenatrisk.
Make,Model&
Reg.No.ofthe
vehicle
Yearof
Manufacture
Cubic
Capacity
Gross
Vehicle
Weight
(GVW)
(Good
Carrying
Vehicle)
Licensed
Carrying
Capacity
(LCC)
InsuredDeclaredValue
(IDV)
For
Vehicle
Rs.
Accessories
notincludedin
Mfr'slisted
sellingprice
Rs.
HONDA
MOTORCYCLE,
ACTIVA.,
KA05HT235
2012 109 2 33082 0
TheCoverNotewordingsprovidedontheothersideconstitutethelegaldocumentwith
regardtothecoverage.Inordertohelpyouunderstandthecovernotebetter,weare
providingyouwiththiscommentary.Theexplanation,interpretation,commentaryprovided
hereshallnotbeconstruedaspartoftheCoverNoteattachedalongside.Wearenotliable
byanyinterpretationinthiscommentaryandthecontractisrestrictedtothewordings
providedalongside.Foranyfurtherclarification,pleasecontactourCallCentres.Asper
yourdeclarationintheproposalformwithreferencetoyourvehicledescribedbelowandthe
premiumpaidbyyou,wearecommencinganinsurancecoverforyourvehicleunderTWO
WHEELERPackagePolicyfromthedateandtimementionedbelow(subjecttospecial
conditionsdescribedbelow,ifapplicable).Thecoverwouldbeprovidedfortheduration
describedbelowunlessduetosomecircumstances,wehavetocancelthepolicy.Insucha
case,wewouldsendyouawrittennoticeandcancelthepolicybyproportionatelyrefunding
premiumtoyoufortheunexpiredperiodofcover
EngineNo:JC44E5269689 ChassisNo:ME4JC448CC7270150
N.B.Intheeventofanaccident,theInsuredshouldinformtheCompanytoarrangespot
survey.
Thedetailsofyourvehicleareasdescribedalongside.
AdditionalRisks,ifany:
SpecialConditions: Specialconditionsifapplicabletoyourpolicyareasdescribedhere.
HypothecatedTo:N/A
Form52(SeeRule142(1)ofCentralMotorVehicleRules,1989)
1.Registrationmarkandnumberordescriptionofthe
vehicleinsured
KA05HT235 Thisrepresentsyourvehicle,forwhichweare
providingtheinsurancecover
2.Nameandaddressofinsured TSNKALYANCHAKRAVARTHY,456/B9THCRS2NDPHS,
BANGALORE,KARNATAKA,560078
YourNameandaddressasmentionedbyyouinthe
proposalform
3.Effectivedateandtimeofcommencementof
insuranceforthepurposeofthisAct
Time:12:00Date:04Apr2014 Thedateandtimeofthecommencementofthis
insurancecover.
4.Dateofexpiryofinsurance 03Apr2015 Thedateandtimeoftheexpiryofthisinsurancecover.
5.Personsorclassesofpersonsentitledtodrive Anypersonincludingtheinsured:Providedthatapersondrivingholds
aneffectiveDrivingLicenceatthetimeoftheaccidentandisnot
disqualifiedfromholdingorobtainingsuchalicence.Providedalsothat
thepersonholdinganeffectiveLearner'sLicencemayalsodrivethe
vehicleandsuchapersonsatisfiestherequirementofRule3ofthe
CentralMotorvehiclesRules,1989.
Forthecovertobevalid,thedriverofyourvehicle
musthaveavalidlicense.Italsobecomesvoidifthe
driverofyourvehicle,atthetimeofaccidentwas
disqualifiedfromholdingorobtainingadriver's
license.Thiscoveralsoallowsadriverofyourvehicle
holdingalearner'slicenseprovidedthatsuchadriver
satisfiestherequirementsofCentralMotorVehicle
Rulesasprescribedbythegovernment.
6.AnylimitationsastouseofMotorvehicle ThePolicycoversuseforanypurposeotherthan(a)Hireorreward(b)
Carriageofgoods(otherthansamplesorpersonalluggage)(c)Organised
racing(d)Pacemaking(e)Speedtesting(f)Reliabilitytrials(g)Any
purposeinconnectionwithMotorTrade
Thisinsurancecoverisnotvalidifyourvehicleisused
forthepurposeof(a)Hireorreward(b)Carriageof
goods(otherthansamplesorpersonalluggage)(c)
Organisedracing(d)Pacemaking(e)Speedtesting(f)
ReliabilityTrials(g)Anypurposeinconnectionwith
MotorTrade
7.Theperiodofvalidityofthiscovernotewillexpire
on
03Jun2014 ThevalidityofthisCoverNoteistillthedate
mentioned
ItbringsuspleasureinannouncingthatouroperationsfunctionhasbeenISO9001:2000certifiedwitheffectfrom7thSeptember2004.ThecertifyingagencywasDetNorskeVeritas
(DNV).Thiswouldmeanthatwewouldmeettheservicerelatedpromisesthatwemaketoourcustomers.
Dateofissue:04Apr2014
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