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Product Code: 3004 UIN: IRDAN115RP0014V01200203 1
Reference No. W457465114
Date: Aug 25, 2025
AKASHSINH KISHORSINH THAKUR
H NO 4 4 313 MAHARANA PRATAPSINGH MARG GADIPIRA
NANDED
MAHARASHTRA 431604
Mobile No: 90******23

Sub: Risk Assumption Letter

Dear AKASHSINH KISHORSINH THAKUR,

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. 3004/405226291/00/000, 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 AKASHSINH KISHORSINH THAKUR
Period of Insurance Aug 25, 2025 to Aug 24, 2026
Vehicle Make / Model MONTRA ELECTRIC / EPL 2.0
RTO City MAHARASHTRA-NANDED
Vehicle Registration No. NEW
Vehicle Registration Date Aug 25, 2025
Engine No. T4810D112506130011
Chassis No. P60G2512500001863
Current Year NCB(%) 0%
Vehicle Usage AUTO RICKSHAW
1
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 0
realised due to cheque dishonour or any other reason, the insurance cover shall be void ab-initio.
1
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 http://www.fastag.org/ 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@icicilombard.com, 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 www.icicilombard.com 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

Aug 25, 2025

 1
CERTIFICATE OF INSURANCE CUM POLICY SCHEDULE 1
0 1
Passenger Carrying Vehicles Package Policy 1
Product Code: 3004 UIN: IRDAN115RP0014V01200203 1
Name of the Insured : AKASHSINH KISHORSINH THAKUR Policy No. : 3004/405226291/00/000
Address : H NO 4 4 313 MAHARANA PRATAPSINGH MARG GADIPIRA, Period of Insurance : Aug 25, 2025 13:26 to
NANDED, MAHARASHTRA 431604 Midnight of Aug 24, 2026
Telephone No : - Mobile No: 90******23 E-Policy No. :
Email Address : SH******************@MONTRAELECTRIC.COM Policy Issued on : Aug 25, 2025
Nominee Name : - Named Passenger's Nominee: Covernote No. : 405226291
Relationship : - RTO Location : MAHARASHTRA-NANDED
Age : Hypothecated to : Shriram finance limited ,-
GSTIN No. (Customer) : Category :
Servicing Branch Name : Mumbai Invoice No. : 1008252146296
Servicing Branch Address : 414, ICICI LOMBARD HOUSE, VEER SAVARKAR MARG, NEAR SIDDHI VINAYAK TEMPLE MAIN GATE, PRABHADEVI, MUMBAI, 400025,
MAHARASHTRA

Are you or any of the proposed applicants/beneficial owner a PEP* or Family member/ Close relatives/Associates of PEPs*? No
Vehicle Make Vehicle SubClass Model Model Type of CC Mfg Seating
Battery
Registration Build Body Yr Capacity
No.
No.
ELECTRIC - 3 WHEELED VEHICLE WITH
MONTRA FULLY
NEW CARRYING CAPACITY NOT EXCEEDING 6 EPL 2.0 Open 10 2025 4 F0719A36
ELECTRIC BUILT
PASSENGER
Carrying Chassis No. Engine No. Body IDV Chassis IDV Electrical / Electronic Non Electrical CNG / LPG Total IDV
Capacity (`) (`) Accessories (`) Accessories (`) Unit (`)
(`)
P60G25125000
3 T4810D112506130011 0 3,65,000.00 0.00 0.00 0.00 3,65,000.00
01863

Premium Details
OWN DAMAGE(A) (`) LIABILITY(B) (`)
Basic OD Premium 1,380.00 Basic Third Party Liability 3,750.00
Zero Depreciation (ZD -) 1,095.00 Total 3,750.00
Road Side Assistance (Additional Towing) 938.00 Add:
IMT-23 Loading 207.00 PA Cover for Owner Driver 599.00
Battery Protect Premium 657.00 Legal Liability for Paid Driver 50.00
Sub Total 4,277.00 Sub-Total 649.00
Total Own Damage Premium(A) 4,277.00 Total Liability Premium(B) 4,399.00
Total Package Premium(A+B): 8,676.00
% 9
CGST
` 780.84
% 9
SGST
` 780.84
Total Tax Payable in ` 1,562.00
Total Premium Payable In ` 10,238.00

Unique Identification Number (UIN) Details IR

Zero Depreciation Road Side Assistance Battery Protect
IR
IRDAN115RP0014V01200203/A0366V01200910 IRDAN115RP0014V01200203/A0025V01201213 IRDAN115RP0014V01200203/A0095V01202425
IR

Geographical Area: India Applicable IMT Clauses: 7 , 40 , 21

Compulsory Deductible: ` 500.00 Voluntary Deductible: ` 0.00

Features of Add-on Covers: 0 0 9 1 0

1.List of services for Road Side Assistance :ing

2.Zero Depreciation Coverage : Zero Depreciation covers only the depreciation on the replaced parts. Consumables and HydroStatic Lock are not coverd under Zero
Depreciation unless opted as separate add-on.
Premium Collection No. 1244964314 Premium Amount (`) 10238 Receipt Date 25-08-2025
GSTIN Reg.No 27AAACI7904G1ZN 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

Aug 25, 2025

 1
CERTIFICATE OF INSURANCE CUM POLICY SCHEDULE 1
0 1
Passenger Carrying Vehicles Package Policy 1
Product Code: 3004 UIN: IRDAN115RP0014V01200203 1
Limits of Liability: (a) Under Section II-I(i) of the policy: Death of or bodily injury & (b) Under Section II-I(ii) of the policy: Damage to Third Party Property- Such amount as is
necessary to meet the requirements of the Motor Vehicles (Amendment) Act, 2019 ; PA Cover for Owner-Driver under Section III: CSI 15,00,000.00/-. Limitations as to Use:
The Policy covers use only under a permit within the meaning of the Motor Vehicles Act,1988 or such a carriage falling under sub section (3) of Section 66 of the Motor
Vehicles Act, 1988. The policy does not cover 1) Use for organised racing, pace making, reliability trails or speed testing, 2) Use whilst drawing a trailer except the towing
(other than for reward) of any one disabled mechanically propelled vehicle. 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 when not used for the transport of passengers at the time of the accident 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 www.icicilombard.com 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@icicilombard.com. For detailed grievance redressal mechanism please visit the "Grievance Redressal"
section on our website www.icicilombard.com.
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 M.V. Act, 1988. In witness whereof, this Policy has been signed at Mumbai on this date of Aug 25, 2025 in lieu of Covernote No. 405226291. The stamp duty of
` 0.50 paid vide deface no. CSD4920251428 dated Apr 24, 2025.
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 DB56713 :

Agency Name :
TURTLEMINT INSURANCE
BROKING SERVICES PVT LTD
Agent's Contact No 8142592688
:

Contact Person : D:/CLICK/images/Gaurav_Arora.png

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: 2025.08.25 15:38:53 IST
CORP/SUP/OPI/2014/1777

Aug 25, 2025