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Toll Free no: 1800 209 8888TWO WHEELER - INSURANCE COVER NOTE

Cover Note No. : e-60185435The 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 termsof 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 ceaseand a proportionate part of the premium otherwise payable for such insurance shall be charged for the time theCompany had been at risk.

The Cover note wordings provided on the other sideconstitute the legal document with regard to thecoverage. In order to help you understand the covernote better, we are providing you with thiscommentary. The explanation, interpretation,commentary provided here shall not be construed aspart of the Cover Note attached alongside. We arenot liable by any interpretation in this commentaryand the contract is restricted to the wordingsprovided alongside. For any further clarifications,please contact our Call Centres.As per yourdeclaration in the proposal form with reference toyour vehicle described below and the premium paidby you, we are commencing an insurance cover foryour vehicle under Two Wheeler Package Policyfrom the date and time mentioned below (subject tospecial conditions described below, if applicable).The cover would be provided for the durationdescribed below unless due to some circumstances,we have to cancel the policy. In such a case, wewould send you a written notice and cancel thepolicy by proportionately refunding premium to youfor the unexpired period of cover.

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

CubicCapacity GrossVehicleWeight(GVW)(GoodCarryingVehicle)

LicensedCarryingCapacity(LCC)(PassengerCarrying Vehicle)

Insured’s Declared Value(IDV)For Vehicle Rs. Accessories

not includedin Mfr’slisted sellingprice Rs.

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

2005 2 25,564.00 0

Engine No. : 30428 Chassis No.: 31645 N.B. In the event of an accident,the Insured shouldinform Company to arrange spot survey.The detailsof 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 asdescribed here.

Form 52 (See Rule 142 (1) of Central Motor Vehicle Rules, 1989)1. Registration mark andnumber or description ofthe vehicle insured

UP-70-AH-4138 This represents your vehicle, for which we are providing this insurancecover

2. Name and address ofinsured

Mr. MR ANKIT BANSAL701, SPRINGHILL HOUSING SOC., HIRANANDANI ESTATE,PATLIPADA, THANE WEST THANE MAHARASHTRA 400607,

Your name and address as mentioned by you in the proposal form

3. Effective date and timeof commencement ofinsurance for the purposeof this Act

Time : 0:12:0Date :6-7-2011

The date and time of the commencement of this insurance cover.

4. Date of expiry ofinsurance

Midnight of 5-7-2012 The date and time of the expiry of this insurance cover.

5. Persons or classes ofpersons entitled to drive

Any person including the insured:Provided that a person driving holdsan effective Driving Licence at the time of the accident and is notdisqualified from holding or obtaining such a licence. Provided also thatthe person holding an effective Learner’s Licence may also drive thevehicle and such a person satisfies the requirements of Rule 3 of theCentral Motor Vehicles Rules, 1989.

For the cover to be valid, the driver of your vehicle must have a validlicense.It also becomes void if the driver of your vehicle, at the time ofaccident was disqualified from holding or obtaining a driver’s license.Thiscover also allows a driver of your vehicle holding a learner’s licenseprovided that such a driver satisfies the requirements of Central MotorVehicle Rules as prescribed by the government.

6. Any limitations as touse of motor vehicle

The Policy covers use for any purpose other than (a)Hire or reward(b)Carriage of goods (other than samples or personal luggage)(c)Organised racing (d) Pace making (e) Speed testing (f) Reliability trials(g) Any purpose in connection with Motor Trade

This insurance cover is not valid if your vehicle is used for the purpose of(a)Hire or reward(b)Carriage of goods (other than samples or personalluggage)(c) Organised racing (d)Pace making (e) Speed testing (f)Reliability Trials (g) Any purpose in connection with Motor Trade

7. The period of validity ofthis cover note will expireon

05-Aug-2011 The validity of this Cover Note is till the date mentioned

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 NorskeVeritas (DNV). This would mean that we would meet the service related promises that we make to our customers.Date of issue : 04-Jul-2011Time of issue : 22:12:0

For ICICI LOMBARD GENERAL INSURANCE CO. LTD

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 sendseparate 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 7877Coimbatore : 0422-538 7877 Delhi : 0981817 7877 Gujarat : 989827 7877 Hyderabad : 040-23128511 Indore : 0731-502 7877 Karnataka : 984557 7877Kerala : 989547 7877Kochin : 0484-2384511 Lucknow : 0522-2294511M.P. : 989304 7877Maharashtra : 989001 7877 Mumbai : 022-28307711 Pune : 020- 26103511 Rajasthan : 9829796547 Tamil Nadu : 989447 7877

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

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