I/WeherebycertifythatthisCoverNoteisissuedinaccordancewiththeprovisionsofChapterXIoftheMotorVehiclesAct,1988

PRIVATECARINSURANCECOVERNOTE
CoverNoteNo:W31423934

Theinsured,describedinForm'52'referredtobelow,havingproposedforinsurancein
respectofMotorVehicle(s)describedthereinandhavingpaidthesumofRs.4676as
premium,theriskisherebyheldcoveredunderthetermsoftheCompany'susualformof
PackagePolicyapplicablethereto(subjecttoanySpecialConditionmentionedbelow)
unlessthecoverbeterminatedbytheCompanybynoticeinwritinginwhichcasethe
insurancewillthereuponceaseandaproportionatepartofthepremiumotherwisepayable
forsuchinsuranceshallbechargedforthetimetheCompanyhadbeenatrisk.
Make,Model
&Reg.No.of
thevehicle
Yearof
Manufacture
Cubic
Capacity
Gross
Vehicle
Weight
(GVW)
(Good
Carrying
Vehicle)
Licensed
Carrying
Capacity
(LCC)
InsuredDeclaredValue
(IDV)
For
Vehicle
Rs.
Accessories
notincludedin
Mfr'slisted
sellingpriceRs.
HYUNDAI,I10
SPORTZ,
UP16AF5579
2011 1197 5 283970 0
TheCoverNotewordingsprovidedontheothersideconstitutethelegaldocumentwith
regardtothecoverage.Inordertohelpyouunderstandthecovernotebetter,weare
providingyouwiththiscommentary.Theexplanation,interpretation,commentaryprovided
hereshallnotbeconstruedaspartoftheCoverNoteattachedalongside.Wearenotliable
byanyinterpretationinthiscommentaryandthecontractisrestrictedtothewordings
providedalongside.Foranyfurtherclarification,pleasecontactourCallCentres.Asper
yourdeclarationintheproposalformwithreferencetoyourvehicledescribedbelowandthe
premiumpaidbyyou,wearecommencinganinsurancecoverforyourvehicleunder
PRIVATECARPackagePolicyfromthedateandtimementionedbelow(subjecttospecial
conditionsdescribedbelow,ifapplicable).Thecoverwouldbeprovidedfortheduration
describedbelowunlessduetosomecircumstances,wehavetocancelthepolicy.Insucha
case,wewouldsendyouawrittennoticeandcancelthepolicybyproportionatelyrefunding
premiumtoyoufortheunexpiredperiodofcover
EngineNo:G4LADM685215 ChassisNo:963659 Thedetailsofyourvehicleareasdescribedalongside.
AdditionalRisks,ifany:
SpecialConditions: Specialconditionsifapplicabletoyourpolicyareasdescribedhere.
HypothecatedTo:NTPCLTD
Form52(SeeRule142(1)ofCentralMotorVehicleRules,1989)
1.Registrationmarkandnumberordescriptionofthe
vehicleinsured
UP16AF5579 Thisrepresentsyourvehicle,forwhichweare
providingtheinsurancecover
2.Nameandaddressofinsured MRSHEOPAL,B783,NtpcVidyutNagar,Dadri,Noida201008,
GHAZIABAD,UTTARPRADESH,201008
YourNameandaddressasmentionedbyyouinthe
proposalform
3.Effectivedateandtimeofcommencementof
insuranceforthepurposeofthisAct
Time:12:00Date:06Nov2014 Thedateandtimeofthecommencementofthis
insurancecover.
4.Dateofexpiryofinsurance 05Nov2015 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
05Jan2015 ThevalidityofthisCoverNoteistillthedate
mentioned
Dateofissue:06Nov2014
Timeofissue:12:00
ForICICILombardGeneralInsuranceCompanyLtd

N.B.:Intheeventofdishonourofcheque,insurancecoverprovidedunderthis
documentautomaticallystandscancelledfrominceptionirrespectiveofwhethera
separatecommunicationissentornot.
Pleasenotethatincasethechequeoranyotherinstrumentgivenbyyouforpremiumgets
dishonoured,theinsurancecoverprovidedtoyourvehicleautomaticallygetscancelledfromthe
dateofcommencementofyourpolicy.
N.B.:Intermediaryorrelevantcontactdetailswillbeprovidedinthepolicyschedule
ICICILombardGeneralInsuranceCompanyLimited
Regd.Office:ICICIBankTowers,BandraKurlaComplex,Bandra(East),Mumbai400051
ServiceTaxReg.No.:GIS/MumbaiI/1528/2001