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Product Code: 3001/O UIN: IRDAN115RP0001V02201920
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Reference No.: W445354841
Date: Mar 26, 2025
MR. VIJAY KAMALAKAR SUKTHANKAR
#168 DREAM MEADOWS NEAR RYAN
INTL SCHOOL KUNDALAHALLI
BANGALORE
KARNATAKA 560037
Mobile No: 98******17
Sub: Risk Assumption Letter
Dear MR. VIJAY KAMALAKAR SUKTHANKAR,
We value your relationship with ICICI Lombard General Insurance Company Limited and thank you for choosing us as your preferred insurance
provider.
Please find enclosed Policy No. 3001/O/386203927/00/000, The same has been issued based on below mentioned details, provided by you at
the time of policy purchase.
Insured & Vehicle Details
Name of the Insured MR. VIJAY KAMALAKAR SUKTHANKAR
Period of Insurance - Own Damage May 08, 2025 to May 07, 2026
Vehicle Make / Model KIA MOTORS / CARENS 1.5 LUXURY PLUS DCT
RTO City KARNATAKA-BANGALORE
Vehicle Registration No. KA53MM1306
Vehicle Registration Date May 07, 2024
Engine No. G4LHRM948263
Chassis No. MZBGC815VRN172291
Current Year NCB(%) 20%
Previous Policy Details
Previous Policy No. 3001/345205936/00/000
Previous Policy Period 08-05-2024 to 07-05-2025
Previous Year NCB(%) 0%
Claims Made Under Previous Policy 0
Previous Insurer Name ICICI LOMBARD
Previous Policy Type Bundled Package Policy
Third Party Insurance Details
Third Party Policy No. 3001/345205936/00/000
Third Party Insurance Period May 08, 2024 to May 07, 2027
Third Party Insurer Name ICICI LOMBARD
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The commencement of coverage of risk under the policy is subject to realisation of payment of premium in full. In case the premium is not
realised due to cheque dishonour or any other reason, the insurance cover shall be void ab-initio.
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We have issued the policy basis your confirmation that you hold a valid PUC and/or Fitness certificate, as applicable.
Government of India has mandated electronic toll payments using FASTag to reduce vehicular traffic at toll plazas. Customers are advised to
comply with the direction of the government and get their FASTag from Point of Sale locations at Toll Plazas or from Issuer Agency. Please
visit [Link] for details.
Please check the policy details for accuracy. Should you find any discrepancy / require any changes in the Certificate of Insurance cum Policy
Schedule, please contact us immediately at our toll free number 1800 2666 or email us at customersupport@[Link], so that we can
rectify the same. Absence of any communication within a period of 15 days of the date mentioned on this letter, would mean that the issued
policy is in order and as per your proposal.
Important Points:
a. Any accidental loss, damage and/or liability caused, sustained or incurred, while vehicle not being registered permanently will not be
covered.
b. Any minor scratches to the vehcile, paint fading, wear and tear arising out of normal use and requiring touch-up or minor repair under
routine maintenance will not be covered.
c. Any liability of whatsoever nature caused by, contributed by or arising due to the vehicle being driven by a person without having valid
driving license will not be covered.
d. In case of total loss / constructive total loss / Total theft / cash loss of the vehicle, the claim will be settled at invoice price i.e amount paid by
the insured / policyholder at the time of purchasing the vehicle, excluding subsidy amount, if included in the invoice, or the Insured declared
value (IDV) whichever is lower, subject to terms and conditions of the policy and admissibility of claims.
( Please visist [Link] for the policy wordings, for complete details on terms and conditions governing the coverage and NCB)
The information provided is merely illustrative and shall not be construed to be an evidence of existence of a contract of insurance. The Risk
Assumption Letter is to be read in conjunction with the policy and shall be considered null and void without the same.
CORP/SUP/OPI/2014/1777
ILOM0000000000000000 Jul 20, 2025
CERTIFICATE OF INSURANCE CUM POLICY SCHEDULE 0
Stand-Alone Own Damage Private Car Insurance Policy 1
Product Code: 3001/O UIN: IRDAN115RP0001V02201920
0
Name of the Insured : MR. VIJAY KAMALAKAR SUKTHANKAR Policy No. : 3001/O/386203927/00/000
Address : #168 DREAM MEADOWS NEAR RYAN, INTL SCHOOL Period of Insurance - Own : May 08, 2025 00:00 to
KUNDALAHALLI, BANGALORE, KARNATAKA 560037 Damage Midnight of May 07, 2026
Telephone No : ******-****** Mobile No: 98******17 Tenure : 1 Year
Email Address : VS*********@[Link] E-Policy No. : EC2311W202503260905292154389
Nominee Name : VANDITAVIJAYSUK Named Passenger's Nominee: Policy Issued On : Mar 26, 2025
THANKAR
Relationship : SPOUSE - Covernote No. : 386203927
Age : 51 - RTO Location : KARNATAKA-BANGALORE
GSTIN No. (Customer) : Hypothecated To : ,
Servicing Branch Name : Bangalore Invoice No. : 1003252445553
:
This policy covers only Own Damage Risk with no other liability in connection with Private Car vehicle including third party cover and is issued basis following : Third Party
Policy No. - 3001/345205936/00/000 valid from May 08, 2024 to May 07, 2027, Insured byICICI LOMBARD
Servicing Branch Address : 27, Third And Fourth Floor, Sjr Tower, Bannerghatta Main Road, 3rd Phase, JP Nagar, Bangalore, Bengaluru Urban,
Karnataka-560078
Are you or any of the proposed applicants/beneficial owner a PEP* or Family member/ Close relatives/Associates of PEPs*? No
Vehicle Registration Make Model Type of CC/KW Mfg Yr Seating Chassis No. Engine No.
No. Body Capacity
KIA CARENS 1.5 LUXURY PLUS DCT MZBGC815VRN17229
KA53MM1306 MUV 1482 2024 7 G4LHRM948263
MOTORS Private Car 1
Vehicle IDV Trailer Non Electrical Accessories (`) Electrical / Electronic Accessories CNG / LPG Unit Total IDV
(`) (`) (`) (`) (`)
15,15,920.00 0.00 0.00 0.00 0.00 15,15,920.00
Premium Details
OWN DAMAGE(A) (`)
Basic OD Premium 4,977.00
Engine Protect Plus 3,487.00
Tyre Protect 2,297.00
Sub Total 10,761.00
Less:
No Claim Bonus 20% 995.00
Sub-Total Deductions 995.00
Total Own Damage Premium(A) 9,766.00
% 9.00
CGST
` 878.94
% 9.00
SGST
` 878.94
% 0.00
UTGST
` 0.00
% 0.00
IGST
` 0.00
Total Tax Payable in ` 1,758.00
Total Premium Payable In ` 11,524.00
Unique Identification Number (UIN) Details IR
Tyre Protect Engine Protect Plus
IR
IRDAN115RP0001V01201920/A0012V01201920 IRDAN115RP0001V01201920/A0009V01201920
Geographical Area: India Applicable IMT Clauses: 28 , 22.00
Compulsory Deductible: ` 1,000.00 Voluntary Deductible: ` 0.00
Premium Collection No. 1233324015 Premium Amount (`) ` 11,524.00 Receipt Date 26-03-2025
GSTIN [Link] 29AAACI7904G1ZJ HSN/SAC code 997134 / GENERAL INSURANCE SERVICES
We hereby declare that though our aggregate turnover in any preceding financial year from 2017-18 onwards is more than the aggregate turnover notified under
sub-rule (4) of rule 48, we are not required to prepare an invoice in terms of the provisions of the said sub-rule.
CORP/SUP/OPI/2014/1777
ILOM0000000000000000 Jul 20, 2025
CERTIFICATE OF INSURANCE CUM POLICY SCHEDULE 0
Stand-Alone Own Damage Private Car Insurance Policy 1
Product Code: 3001/O UIN: IRDAN115RP0001V02201920
0
Limitations as to Use: The Policy covers use of the vehicle for any purpose other than: Hire or Reward, Carriage of goods (other than samples of personal luggage),
Organised racing, Pace Making, Reliability trails or Speed testing, any purpose in Connection with Motor Trade. Driver's Clause: Any person including the insured:
Provided that a person driving holds an effective driving license at the time of the accident and is not disqualified from holding or obtaining such a license. Provided also that
the person holding an effective learner's license may also drive the vehicle and that such a person satisfies the requirements of Rule 3 of the Central Motor Vehicles Rules,
1989. Important Notice: The insured is not indemnified if the vehicle is used or driven otherwise than in accordance with this schedule. Any payment made by the Company
by reason of wider terms appearing in the Certificate in order to comply with the Motor Vehicle Act, 1988 is recoverable from the insured. See the clause headed
"AVOIDANCE OF CERTAIN TERMS AND RIGHT OF RECOVERY".
In consideration of the premium for this extension being calculated at a pro-rata proportion of the annual premium, it is hereby declared and agreed by the insured that upon
expiry of this extension, this policy shall be renewed for a period of twelve months, failing which the difference between the extension premium now paid on pro rata basis
and the premium at short period rate shall become payable by the insured.
For Legal interpretation, English version will hold good. Disclaimer: Please visit [Link] for the policy wordings, for complete details on terms and conditions
governing the coverage and NCB. This document is to be read with the policy wordings. The policy is valid subject to realization of cheque. We accept premium only via
legally recognized modes. In case of dishonour of premium cheque, the company shall not be liable under the policy and the policy shall be void ab-initio. In case of any
discrepancy with respect to the policy, please revert within 15 days from the policy start date. This policy is underwritten on the basis of the information provided by you and
as detailed in the Risk Assumption Letter shared with you along with the policy. On renewal, the benefits provided under the policy and/or terms and conditions of the policy
including premium rate may be subject to change. Grievance Redressal: For resolution of any query or grievance you may contact us on our toll free no. 1800 2666, or visit
any of our branch offices. You can also write to us at customersupport@[Link]. For detailed grievance redressal mechanism please visit the "Grievance Redressal"
section on our website [Link].
The Company reserves the right to cancel this Policy immediately upon becoming aware of any mis-representation, fraud, non-disclosure of material facts or
non-cooperation by or on behalf of the Insured; the Company is not obliged to refund the premium paid under this Policy
In case of total loss / constructive total loss / Total theft / cash loss of the vehicle, the claim will be settled at invoice price i.e amount paid by the insured / policyholder at the
time of purchasing the vehicle, excluding subsidy amount, if included in the invoice, or the Insured declared value (IDV) whichever is lower, subject to terms and conditions of
the policy and admissibility of claims.
I/We hereby certify that the Policy to which this Certificate relates, as well as, this Certificate of Insurance are issued in accordance with the provisions of Chapter X and
Chapter XI of Motor Vehicle Act, 1988. In witness whereof, this Policy has been signed at Mumbai on this date of Mar 26, 2025 in lieu of Covernote No. 386203927. The
stamp duty of ` 0.50 paid vide deface no. CSD10520244764 dated Oct 04, 2024.
Policy Issuing Office: ICICI Lombard General Insurance Company Limited, ICICI LOMBARD HOUSE, 414, Veer Savarkar Marg, Near Siddhi Vinayak Temple, Prabhadevi,
Mumbai 400 025.
Warranted that the insured named herein/owner of the vehicle holds a valid Pollution Under Control (PUC) Certificate and/or valid fitness certificate, as applicable, on the
date of commencement of the Policy and undertakes to renew and maintain a valid and effective PUC and/or fitness Certificate, as applicable, during the subsistence of the
Policy. Further, the Company reserves the right to take appropriate action in case of any discrepancy in the PUC or fitness certificate.
Agency Code DB27204 :
SMC INSURANCE BROKERS
Agency Name :
PRIVATE LIMITED
Agent's Contact No 9310863677
:
Contact Person :
Click here or scan the QR code to view the Customer Information Sheet (CIS). It provides an
overview of the policy features, service and claim processes, as well as other important terms.
Signature Not Verified
Digitally signed by DS ICICI
LOMBARD GENERAL
INSURANCE CO LTD 1
Date: 2025.07.20 [Link] IST
CORP/SUP/OPI/2014/1777
ILOM0000000000000000 Jul 20, 2025
