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:: ICICI Lombard :: Covernote Motor Vehicle

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Toll Free no: 1800 209 8888 TWO WHEELER - INSURANCE COVER NOTE Cover Note No. : e-60185435 The insured, described in Form ‘52’ referred to below; having proposed for insurance in respect of Motor Vehicle (s) described therein and having paid the sum of Rs. 882.00/- as premium, the risk is hereby held covered under the terms of the Company’s usual form of Package policy applicable thereto (subject to any Special Condition mentioned below) unless the cover be terminated by the Company by notice in writing in which case the insurance will thereupon cease and a proportionate part of the premium otherwise payable for such insurance shall be charged for the time the Company had been at risk.

Make & Reg. No. of the Vehicle Year of Mfg.

PULSAR 150 DTSI ES UG 2 ,BAJAJ, UP-70-AH-4138

2005

The Cover note wordings provided on the other side constitute the legal document with regard to the coverage. In order to help you understand the cover note better, we are providing you with this commentary. The explanation, interpretation, commentary provided here shall not be construed as part of the Cover Note attached alongside. We are not liable by any interpretation in this commentary and the contract is restricted to the wordings CubicCapacity Gross Licensed Insured’s Declared Value provided alongside. For any further clarifications, Vehicle CarryingCapacity (IDV) please contact our Call Centres.As per your Weight (LCC)(Passenger For Vehicle Rs. Accessories declaration in the proposal form with reference to (GVW)(Good Carrying Vehicle) not included your vehicle described below and the premium paid Carrying in Mfr’s by you, we are commencing an insurance cover for Vehicle) listed selling your vehicle under Two Wheeler Package Policy price Rs. from the date and time mentioned below (subject to special conditions described below, if applicable). The cover would be provided for the duration 2 25,564.00 0 described below unless due to some circumstances, we have to cancel the policy. In such a case, we would send you a written notice and cancel the policy by proportionately refunding premium to you for the unexpired period of cover.

Engine No. : 30428

Chassis No.: 31645

N.B. In the event of an accident,the Insured should inform Company to arrange spot survey.The details of your vehicle are as described alongside.

Additional Risks, if any : PA Cover for Owner-Driver Special Conditions : Hypothecated To :- ,

Special conditions if applicable to your policy are as described here.

Form 52 (See Rule 142 (1) of Central Motor Vehicle Rules, 1989)

1. Registration mark and UP-70-AH-4138 This represents your vehicle, for which we are providing this insurance number or description of cover the vehicle insured 2. Name and address of Mr. MR ANKIT BANSAL Your name and address as mentioned by you in the proposal form insured 701, SPRINGHILL HOUSING SOC., HIRANANDANI ESTATE, PATLIPADA, THANE WEST THANE MAHARASHTRA 400607, 3. Effective date and time Time : 0:12:0 The date and time of the commencement of this insurance cover. of commencement of Date :6-7-2011 insurance for the purpose of this Act 4. Date of expiry of Midnight of 5-7-2012 The date and time of the expiry of this insurance cover. insurance 5. Persons or classes of Any person including the insured:Provided that a person driving holds For the cover to be valid, the driver of your vehicle must have a valid persons entitled to drive an effective Driving Licence at the time of the accident and is not license.It also becomes void if the driver of your vehicle, at the time of disqualified from holding or obtaining such a licence. Provided also that accident was disqualified from holding or obtaining a driver’s license.This the person holding an effective Learner’s Licence may also drive the cover also allows a driver of your vehicle holding a learner’s license vehicle and such a person satisfies the requirements of Rule 3 of the provided that such a driver satisfies the requirements of Central Motor Central Motor Vehicles Rules, 1989. Vehicle Rules as prescribed by the government. 6. Any limitations as to The Policy covers use for any purpose other than (a)Hire or reward(b) This insurance cover is not valid if your vehicle is used for the purpose of use of motor vehicle Carriage of goods (other than samples or personal luggage)(c) (a)Hire or reward(b)Carriage of goods (other than samples or personal Organised racing (d) Pace making (e) Speed testing (f) Reliability trials luggage)(c) Organised racing (d)Pace making (e) Speed testing (f) (g) Any purpose in connection with Motor Trade Reliability Trials (g) Any purpose in connection with Motor Trade 7. The period of validity of 05-Aug-2011 The validity of this Cover Note is till the date mentioned this cover note will expire on I/We hereby certify that this Cover Note is issued in accordance with the provisions of Chapter XI of the Motor Vehicles Act, 1988. It brings us pleasure in announcing that our operations function has been ISO 9001:2000 certified with effect from 7th September 2004. The certifying agency was Det Norske Veritas (DNV). This would mean that we would meet the service related promises that we make to our customers. Date of issue : 04-Jul-2011 For ICICI LOMBARD GENERAL INSURANCE CO. LTD Time of issue : 22:12:0

In the event of dishonour of cheque, insurance cover provided under this document automatically stands cancelled Ab-initio. The company is under no obligation to send separate communication informing the said dishonour of cheque. Track your status online at www.icicilombard.com N.B.: Intermediary or relevant contact details will be provided in the policy schedule Ahmedabad : 079-55309877 Andhra P'desh : 984957 7877 Bangalore : 080-5118 7464 Calcutta : 983137 7877 Chandigarh : 0172-505 5707 Chennai : 044-4201 7877 Coimbatore : 0422-538 7877 Delhi : 0981817 7877 Gujarat : 989827 7877 Hyderabad : 040-23128511 Indore : 0731-502 7877 Karnataka : 984557 7877Kerala : 989547 7877 Kochin : 0484-2384511 Lucknow : 0522-2294511 M.P. : 989304 7877Maharashtra : 989001 7877 Mumbai : 022-28307711 Pune : 020- 26103511 Rajasthan : 9829796547 Tamil Nadu : 989447 7877

ICICI Lombard General Insurance Company Limited Regd. Office: ICICI Bank Towers, Bandra-Kurla Complex, Bandra (East), Mumbai - 400 051

04-07-2011 22:15