policy schedule il

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9/10/2015file://C:\Users\1003835\AppData\Local\Temp\VGJSD2H0.htm

<TR> <TD align=right> <TABLE id=table1 class=fontStyle width="100%"> <TBODY> <TR style="VISIBILITY: hidden" id=tr1> <TD align=right><INPUT style="VISIBILITY: hidden" id=Button2 class=button onclick=doprint(); value=Print type=button name=Button2> <INPUT style="VISIBILITY: hidden" id=Button1 class=button onclick=window.close(); value=Close type=button></TD></TR></TBODY></TABLE></TD></TR></TBODY></TABLE><TABLE id=TblSchedule border=0 width="100%"> <TBODY> <TR> <TD> <META name=GENERATOR content="Microsoft Visual Studio .NET 7.1"> <META name=CODE_LANGUAGE content="Visual Basic .NET 7.1"> <META name=vs_defaultClientScript content=JavaScript> <META name=vs_targetSchema content=http://schemas.microsoft.com/intellisense/ie5> <TABLE style="Z-INDEX: 102; POSITION: relative; DISPLAY: inline-block; designtimeurl: DESIGNTIMEURL" id=Label11> <TBODY> <TR> <TD><SPAN id=_ctl2_lblduplicate></SPAN><B></B><!---------------------------------------------------------------------------------------------- <TABLE id=Table0 class=baseTable1 border=0 cellSpacing=0 cellPadding=0 width="100%"> <TBODY> <TR> <TD colSpan=2> <TABLE border=0 cellSpacing=0 cellPadding=0 width="100%" cols=2> <TBODY> <TR id=_ctl2_rowoldsign> <TD></TD> <TD align=right><IMG style="WIDTH: 302px; HEIGHT: 69px" id=_ctl2_Image2 border=0 src="../HTMLReportSource/Image1/Baseline%20with%20Colour.jpg"> </TD></TR> <TR id=_ctl2_trMailingAddress> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 10pt" colSpan=2> Mailing Add. Office: <SPAN style="FONT-SIZE: 10pt" id=_ctl2_lblmailaddress>ICICI Lombard General Insurance Company LTD , ICICI LOMBARD HOUSE , 414, Veer Savarkar Marg, Near Siddhi Vinayak Temple, Prabhadevi, Mumbai 400 025</SPAN> . </TD></TR> <TR id=_ctl2_trCorpAddress> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 10pt" colSpan=2> <BR>Corporate Office: <SPAN style="FONT-SIZE: 10pt" id=_ctl2_lblcorpaddress>ICICI Lombard General Insurance Company LTD , ICICI LOMBARD HOUSE , 414, Veer Savarkar Marg, Near Siddhi Vinayak Temple, Prabhadevi, Mumbai 400 025</SPAN> . </TD></TR></TBODY></TABLE></TD></TR> <TR class=fontstyle> <TD style="HEIGHT: 13px" colSpan=2 align=middle><BR><SPAN style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt; FONT-WEIGHT: bold" id=_ctl2_LblHeading>Endorsement Schedule of Private Car Package Policy</SPAN> </TD></TR> <TR> <TD style="HEIGHT: 5px"></TD></TR> <TR> <TD></TD></TR> <TR> <TD style="TEXT-ALIGN: justify; FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" align=left>We value your relationship with ICICI Lombard. We thank you for preferring us as your <SPAN style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" id=_ctl2_LblDeptName>motor</SPAN> insurance partner. We write to this on the basis of your request vide letter for correction in respect of below subject matter. </TD></TR></TBODY></TABLE><BR> <TABLE id=Table0.1 class=baseTable1 border=1 cellSpacing=0 cellPadding=0 width="100%"> <TBODY> <TR> <TD vAlign=top width="50%"> <TABLE id=Table2 border=0 cellSpacing=1 cellPadding=1 width="100%"> <TBODY> <TR id=_ctl2_rowcust> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" vAlign=top width="35%"> Customer ID : </TD> <TD vAlign=top><SPAN style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt; FONT-WEIGHT: bold" id=_ctl2_LblCustId>101068882627</SPAN> </TD></TR> <TR> <TD vAlign=top><SPAN style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" id=_ctl2_Category></SPAN></TD> <TD vAlign=top><STRONG><SPAN style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt"

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id=_ctl2_lblcategory></SPAN></STRONG></TD></TR> <TR id=_ctl2_trInsuredName> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" vAlign=top> Name : </TD> <TD vAlign=top><SPAN style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt; FONT-WEIGHT: bold" id=_ctl2_LblName>SHERLOCK HOLMES</SPAN> </TD></TR> <TR id=_ctl2_trInsuredAddress> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" vAlign=top> Address : </TD> <TD vAlign=top><SPAN style="FONT-FAMILY: Zurich BT; WORD-WRAP: normal; FONT-SIZE: 11pt; WORD-BREAK: break-all; FONT-WEIGHT: bold" id=_ctl2_LblAdd>DSDS IUHWE MUMBAI MAHARASHTRA PIN - 400064, MOBILE NO. - 918879971451</SPAN> </TD></TR> <TR id=_ctl2_TrContact> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" vAlign=top> Contact No : </TD> <TD vAlign=top><SPAN style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt; FONT-WEIGHT: bold" id=_ctl2_Lblmobile>Mobile Number 918879971451</SPAN><BR><SPAN style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt; FONT-WEIGHT: bold" id=_ctl2_lbllandline></SPAN></TD></TR> <TR id=_ctl2_rowfinance> <TD id=_ctl2_rowfin colSpan=2 align=left></TD></TR></TBODY></TABLE></TD> <TD vAlign=top> <TABLE id=Table3 border=0 cellSpacing=1 cellPadding=1 width="100%"> <TBODY> <TR> <TD width="1%"></TD> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" width="45%" align=left><SPAN id=_ctl2_lbl_OfficeName_1079>Correspondence Office Name</SPAN> : </TD> <TD vAlign=top><SPAN style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt; FONT-WEIGHT: bold" id=_ctl2_LblOffice>MUMBAI - FORT</SPAN> </TD></TR> <TR> <TD width="1%"></TD> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" vAlign=top width="45%">Policy Number : </TD> <TD><SPAN style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt; FONT-WEIGHT: bold" id=_ctl2_LblPolicy>3001/51797784/00/000</SPAN> </TD></TR> <TR> <TD width="1%"></TD> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" vAlign=top width="45%">Period of Insurance : </TD> <TD><SPAN style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt; FONT-WEIGHT: bold" id=_ctl2_LblPeriod>From: 08/08/2015 <BR>Time: 15:23 Hours <BR>To Midnight of 07/08/2016</SPAN> </TD></TR> <TR> <TD width="1%"></TD> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" vAlign=top width="45%">Endorsement No : </TD> <TD vAlign=top><SPAN style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt; FONT-WEIGHT: bold" id=_ctl2_LblEndtNo>3001/51797784/00/002</SPAN> </TD></TR> <TR> <TD width="1%"></TD> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" width="50%">Effective time and date: </TD> <TD vAlign=top><SPAN style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt; FONT-WEIGHT: bold" id=_ctl2_LblEff>10:34 Hours - 10/09/2015</SPAN> </TD></TR> <TR> <TD width="1%"></TD> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" width="45%">Date of issue : </TD> <TD vAlign=top><SPAN style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt; FONT-WEIGHT: bold" id=_ctl2_LblIssue>10/09/2015</SPAN> </TD></TR> <TR id=_ctl2_rowinter> <TD width="1%"></TD> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" width="45%">Intermediary Code : </TD> <TD vAlign=top><SPAN style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt; FONT-WEIGHT: bold" id=_ctl2_LblICode>0</SPAN> </TD></TR></TBODY></TABLE></TD></TR> <TR id=_ctl2_rowreginfo width="100%"> <TD vAlign=top colSpan=2> <TABLE id=tableReg border=1 cellSpacing=0 cellPadding=0 width="100%"> <TBODY> <TR> <TD align=middle><B>Registration Number</B> </TD> <TD align=middle><B>Engine Number</B> </TD> <TD align=middle><B>Chassis Number</B> </TD></TR> <TR>

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<TD align=middle><SPAN id=_ctl2_LblRegNo>MH-11-MH-1111</SPAN> </TD> <TD align=middle><SPAN id=_ctl2_LblEngineNo>123456</SPAN> </TD> <TD align=middle><SPAN id=_ctl2_LblChassisNo>123456</SPAN> </TD></TR></TBODY></TABLE></TD></TR> <TR> <TD style="TEXT-ALIGN: justify; FONT-FAMILY: Zurich BT; HEIGHT: 36px; FONT-SIZE: 11pt" vAlign=top colSpan=2><SPAN style="WIDTH: 95%; FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt; FONT-WEIGHT: bold" id=_ctl2_LblStatus>Not withstanding anything to the contrary contained in the policy, it is hereby declared and agreed that the policy stands amended for the reasons given below:</SPAN><BR><STRONG>Endorsement wording :</STRONG> <SPAN style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" id=_ctl2_LblEWord></SPAN> <TABLE style="BORDER-RIGHT-WIDTH: 0px; BORDER-COLLAPSE: collapse; BORDER-TOP-WIDTH: 0px; BORDER-BOTTOM-WIDTH: 0px; FONT-SIZE: 11pt; BORDER id=_ctl2_Dgrid2 class=fontStyle border=0 rules=all cellSpacing=0> <TBODY> <TR style="FONT-FAMILY: Zurich BT"> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" align=left>RTI INCLUSION</TD></TR></TBODY></TABLE></TD></TR><BR> <TR id=_ctl2_rowgrpchange> <TD vAlign=top colSpan=2> <TABLE style="BORDER-COLLAPSE: collapse" id=_ctl2_grdGrpChangeNodesN border=0 cellSpacing=0> <TBODY> <TR> <TD></TD> <TD>The following Covers are added : Return To Invoice</TD></TR></TBODY></TABLE><SPAN style="WIDTH: 373px; FONT-SIZE: 12pt; FONT-WEIGHT: bold; TEXT-DECORATION: none" id=_ctl2_lbl_NumNewRTI1>The following covers are added : Return to Invoice</SPAN> <BR></ASP:DATAGRID><SPAN style="WIDTH: 260px; FONT-SIZE: 11pt; FONT-WEIGHT: bold; TEXT-DECORATION: underline" id=_ctl2_Lblmod>The following groups are modified :</SPAN><BR> <TABLE style="BORDER-BOTTOM-STYLE: none; BORDER-RIGHT-STYLE: none; WIDTH: 100%; BORDER-COLLAPSE: collapse; BORDER-TOP-STYLE: none; BORDER id=_ctl2_grdGrpChangeNodes border=1 rules=all cellSpacing=0> <TBODY> <TR style="FONT-SIZE: 10px; FONT-WEIGHT: bold" align=middle><TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt">Group</TD> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt">Risk Item</TD> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt">Changed to</TD> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt">Description</TD> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt">Old</TD> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt">New</TD></TR> <TR> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" vAlign=top align=middle>Covers</TD> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" vAlign=top>Risks : VehicleSIComponent : Vehicle Base Value</TD> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" vAlign=top align=left>Cover Groups : Basic - OD </TD> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" vAlign=top align=middle>Premium</TD> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" vAlign=top align=right>15357</TD> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" vAlign=top align=right>15357</TD></TR> <TR> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" vAlign=top align=middle>Covers</TD> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" vAlign=top>Risks : VehicleSIComponent : Vehicle Base Value</TD> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" vAlign=top align=left>Cover Groups : Basic - TP </TD> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" vAlign=top align=middle>Premium</TD> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" vAlign=top align=right>1332</TD> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" vAlign=top align=right>1332</TD></TR> <TR> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" vAlign=top align=middle>Covers</TD> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" vAlign=top>Risks : VehicleSIComponent : Vehicle Base Value</TD> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" vAlign=top align=left>Cover Groups : Paid Driver </TD> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" vAlign=top align=middle>Premium</TD> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" vAlign=top align=right>50</TD> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" vAlign=top align=right>50</TD></TR> <TR> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" vAlign=top align=middle>Covers</TD> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" vAlign=top>Risks : VehicleSIComponent : PA Cover for Owner-Driver</TD>

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<TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" vAlign=top align=left>Cover Groups : PA - Owner </TD> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" vAlign=top align=middle>Premium</TD> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" vAlign=top align=right>100</TD> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" vAlign=top align=right>100</TD></TR> <TR> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" vAlign=top align=middle>Covers</TD> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" vAlign=top>Risks : VehicleSIComponent : Zero Depreciation</TD> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" vAlign=top align=left>Cover Groups : Zero Depreciation </TD> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" vAlign=top align=middle>Premium</TD> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" vAlign=top align=right>4009</TD> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" vAlign=top align=right>4009</TD></TR> <TR> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" vAlign=top align=middle>Risks</TD> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" vAlign=top> </TD> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" vAlign=top align=left>VehicleSIComponent : Vehicle Base Value </TD> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" vAlign=top align=middle>IDV /Capital SI</TD> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" vAlign=top align=right>668235</TD> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" vAlign=top align=right>668235</TD></TR> <TR> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" vAlign=top align=middle>Risks</TD> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" vAlign=top> </TD> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" vAlign=top align=left>VehicleSIComponent : PA Cover for Owner-Driver </TD> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" vAlign=top align=middle>IDV /Capital SI</TD> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" vAlign=top align=right>200000</TD> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" vAlign=top align=right>200000</TD></TR> <TR> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" vAlign=top align=middle>Risks</TD> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" vAlign=top> </TD> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" vAlign=top align=left>VehicleSIComponent : Zero Depreciation </TD> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" vAlign=top align=middle>IDV /Capital SI</TD> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" vAlign=top align=right>668235</TD> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" vAlign=top align=right>668235</TD></TR></TBODY></TABLE></TD></TR></TBODY> <TBODY> <TR> <TD vAlign=top colSpan=3> <TABLE id=tableReg1 border=1 cellSpacing=0 cellPadding=0 width="100%"> <TBODY></TBODY></TABLE></TD></TR> <TR> <TD vAlign=top colSpan=3></TD></TR> <TR id=_ctl2_rowendor> <TD colSpan=2><STRONG> <U style="FONT-SIZE: 11pt">The following(s) are modified</U> :</STRONG> <BR> <TABLE class=baseTable1111 border=0 cellSpacing=0 cellPadding=0 width="100%"> <TBODY> <TR> <TD> <TABLE style="BORDER-BOTTOM-STYLE: solid; BORDER-RIGHT-STYLE: solid; WIDTH: 100%; BORDER-COLLAPSE: collapse; BORDER-TOP id=_ctl2_grdChangeNodes border=1 rules=all cellSpacing=0> <TBODY> <TR style="FONT-WEIGHT: bold; TEXT-DECORATION: underline" align=middle> <TD style="WIDTH: 35%; FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt">Description</TD> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt">Old Value</TD> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt">New Value</TD></TR> <TR> <TD style="WIDTH: 35%" align=middle>Net TP Premium</TD> <TD style="WIDTH: 35%; FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" align=middle>1,482.00</TD> <TD style="WIDTH: 35%; FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt"

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align=middle>1,482.00</TD></TR> <TR> <TD style="WIDTH: 35%" align=middle>Net OD Premium</TD> <TD style="WIDTH: 35%; FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" align=middle>20,168.00</TD> <TD style="WIDTH: 35%; FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" align=middle>22,039.00</TD></TR></TBODY></TABLE></TD></TR></TBODY></TABLE></TD></TR></TBODY></TABLE> <TABLE id=_ctl2_tbmainpre border=1 cellSpacing=0 cellPadding=0 width="100%"> <TBODY> <TR id=_ctl2_rowendt> <TD style="WIDTH: 100%"> <TABLE style="WIDTH: 100%" id=_ctl2_Table6 border=0 cellSpacing=1 cellPadding=1> <TBODY> <TR id=_ctl2_rowEPremiumT> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt"><STRONG>Endorsement Premium</STRONG> </TD> <TD align=middle><SPAN style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" id=_ctl2_lblcurrency2></SPAN></TD> <TD align=right><SPAN style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" id=_ctl2_LblEPremium>2,673.00</SPAN> </TD></TR> <TR id=_ctl2_rowSTaxT> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt"><STRONG>Endorsement Service Tax<SPAN id=_ctl2_LblServiceTax1></SPAN></STRONG> </TD> <TD align=middle><SPAN style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" id=_ctl2_lblcurrency4></SPAN></TD> <TD align=right><SPAN style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" id=_ctl2_LblSTax>374.22</SPAN> </TD></TR> <TR id=_ctl2_rowTotalPT> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt"><STRONG>Endorsement Total Premium</STRONG> </TD> <TD align=middle><SPAN style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" id=_ctl2_lblcurrency9></SPAN></TD> <TD align=right> <SPAN style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" id=_ctl2_LblTotalP>3047.00</SPAN> </TD></TR></TBODY></TABLE></TD></TR></TBODY></TABLE> <TABLE id=_ctl2_tb1 border=0 cellSpacing=0 cellPadding=0 width="100%"> <TBODY> <TR> <TD colSpan=2> <TABLE cellSpacing=0 cellPadding=0 width="100%"></FONT> <TBODY></TBODY></TABLE></TD></TR></TBODY></TABLE> <TABLE width="100%"> <TBODY> <TR id=_ctl2_trNewRTI1 align=justify> <TD vAlign=top width="1%"><SPAN id=_ctl2_lbl_NumNewRTI2></SPAN></TD> <TD><B>Return To Invoice Coverage:</B> Sum Insured under this add-on, determined as the difference between the Insured's Declared Value (IDV) and the total actual expenses incurred towards acquisition of a new vehicle of same make and model , as specified in the on-road price listed by the manufacturer/dealer upon the occurrence of Total Loss including Theft / Constructive Total Loss as defined in the Policy. </TD></TR></TBODY></TABLE> <TABLE border=1 cellSpacing=0 cellPadding=0 width="100%"> <TBODY> <TR> <TD style="WIDTH: 553px"><STRONG><SPAN style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt; FONT-WEIGHT: bold" id=_ctl2_lblTaxRate>Service Tax Registration No. : GIS/MUMBAI-I/1528/2001<BR>Service Tax Code Number : AAACI7904GST001<BR>Category: General Insurance Business Services 00440005.</SPAN></STRONG> </TD> <TD style="WIDTH: 40%"> <SPAN style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt; FONT-WEIGHT: bold" id=_ctl2_LblSC>Receipt No. & Date : </SPAN> <SPAN style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt; FONT-WEIGHT: bold" id=_ctl2_LblSV>1012142542 - 10/09/2015</SPAN> </TD></TR> <TR style="FONT-FAMILY: Zurich BT"> <TD style="FONT-FAMILY: Zurich BT; FONT-WEIGHT: bold" class=style1><B><SPAN style="FONT-SIZE: 11pt" id=_ctl2_LabelIRDA>IRDA Registration no.115</SPAN></B> </TD></TR> <TR> <TD style="TEXT-ALIGN: justify; FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" colSpan=2>Subject otherwise to the terms, conditions, exclusions, limitations and warranties attached to the within mentioned policy. </TD></TR></TBODY></TABLE> <TABLE width="100%"> <TBODY> <TR id=_ctl2_tr_1206 class=fontstyle align=justify> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" align=left>Compulsory Deductibles :<SPAN id=_ctl2_LblDeduct>Rs.1000</SPAN> </TD></TR></TBODY></TABLE> <TABLE border=0 cellSpacing=0 cellPadding=0 width="100%" cols=2> <TBODY> <TR> <TD colSpan=2> </TD></TR> <TR> <TD><SPAN style="WIDTH: 50%" id=_ctl2_Lblcommand></SPAN>

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</TD> <TD align=middle> <IMG style="HEIGHT: 55px" id=_ctl2_Image6 border=0 src="../HTMLReportSource/image1/Sanjay%20Datta.jpg"> </TD></TR> <TR> <TD colSpan=2> </TD></TR> <TR> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt"><SPAN style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" id=_ctl2_lblamountinRs>All amounts are in Rs. </SPAN></TD> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" align=middle><STRONG>Authorised Signatory</STRONG> </TD></TR> <TR> <TD></TD> <TD align=middle><SPAN style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" id=_ctl2_LblICICI>ICICI Lombard General Insurance Company Ltd, IRDA Regn. No. 115</SPAN> </TD></TR> <TR> <TD style="HEIGHT: 10px" colSpan=2></TD></TR> <TR> <TD colSpan=2></TD></TR> <TR id=_ctl2_trICICIAddress> <TD style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" vAlign=baseline colSpan=3 align=left>At ICICI Lombard we are always at your service. If you have any questions, you are welcome to: 1. Visit us at our nearest branch, or 2. Email us at [email protected] or 3. Write to us at Customer Support Team, <SPAN id=_ctl2_lblcorpaddress1>ICICI Lombard General Insurance Company LTD , ICICI LOMBARD HOUSE , 414, Veer Savarkar Marg, Near Siddhi Vinayak Temple, Prabhadevi, Mumbai 400 025</SPAN><BR>Now one number for all your Insurance needs call us on<B> <SPAN style="FONT-FAMILY: Zurich BT; FONT-SIZE: 11pt" id=_ctl2_LblTollFreeNo>1800 2 666</SPAN></B> (toll free) also accessible from your mobile phone. </TD></TR></TBODY></TABLE></TD></TR></TBODY></TABLE></IMG></TD></TR></TBODY></TABLE><INPUT id=__VIEWSTATEGENERATOR value=DA63C21C type=hidden name=__VIEWSTATEGENERATOR> <INPUT id=__VIEWSTATEENCRYPTED type=hidden name=__VIEWSTATEENCRYPTED></FORM></BODY></HTML>

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