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Bajaj Allianz General Insurance Company Ltd.
GE Plaza, Airport Road, Yerwada, Pune - 411006(India)
CERTIFICATE CUM POLICY SCHEDULE

Policy Servicing Off: Bajaj Finserv Building, 1st Floor, Behind Weikfield IT-Park, Viman Nagar, Pune-411014 Phone No :1800-209-0144
Policy Number OG-18-9906-1805-00011848 Product Private Car - Liability Only Policy
Period Of Insurance From: 16-Dec-2017 Policy issued on 15-Dec-2017 -
To: 15-Dec-2018 Midnight Cover Note No /
Application No 78871692 Scrutiny No
Insured Name PADMENDRA SINGH B Zone
Insured Address H.NO. 201 MITHEY PUR PO. LAWAR MEER-
UT, MEERUT, UTTAR PRADESH, ,, - 250110
Customer ID 110527531 Premium Payer ID 110527531
Transaction Id
Policy Status ISSUED
GSTIN / UIN NA STATE CODE / NAME 09 - Uttar Pradesh
Registration Make SubType Model CC Mfg year Seat Cap Vehicle/Trailer Engine Number
No. Chassis No
UP15AJ2389 MARUTI LXI ALTO 796 2008 5 MA3EYD81S01266 F8DN1262330
667

Vehicle IDV Elec Acc Non Elec Acc Trailer Trailer Reg No CNG/LPG Unit Total Sum Insured
0 0 0 0 0
SCHEDULE OF PREMIUM
OWN DAMAGE LIABILITY
Total Own Damage Premium: Basic Third Party Liability 2055
PA Cover For Owner-Driver Of Rs. 200000 100
Total Liability Premium: 2155
Additional loading @ 0% 0

Total premium 2155


Special Discount 0
Net Premium 2155
Integrated GST (18%) 388
Final Premium Rs. 2543 ***All premium Figures are in Rupees
Geographical Area : INDIA No Claim Bonus : 0%
Previous Insurer - National Insurance Company LimitedPrevious Policy No -PPN82189281982918291 Ex-
piry On - 15-DEC-17
LIMITS OF LIABILITY: Under Section II-1(i) of the policy -> Death of or bodily injury : Such amount as is necessary to meet there requirements of the Motor
Vehicles Act,1988. Under Section II-1(ii) of the policy -> Damage to Third Party Property : Rs.750000/-
LIMITATION AS TO USE: The Policy covers use of the vehicle for any purpose other than : Hire or reward, Carriage of goods(other than samples or personal
luggage), Organised racing, Pace making, Speed testing, Reliability trials, Any purpose in connection with Motor Trade.
DRIVER : : Any person including the insured :Provided that a person driving holds an effective driving licence at the time of the accident and is not disquali-
fied from holding or obtaining such a licence. Provided also that the person holding an effective Learner's licence 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".
Subject To IMT Endorsement Nos : & Policy wordings attached herewith

Contact No : 0/1800-103-3999
Email -
Damage Details as per Annexure I
Premium Collection Details :- [Receipt No/Collection No/Amount] 9906-01566625 / 78871692 / Rs. 2543 ,
*** If premium paid through cheque, the policy is void ab-initio in case of dishonour of cheque.
This certificate of insurance is issued in accordance with the provision of Chapter X and Chapter XI of M.V. Act, 1988.
Damage Details Annexure : - NA
Remarks PDA MODULE

In case of any claim, please contact our 24 Hour Call centre at 1800-22-5858, 1800-102-5858 (Toll Free) / 91-020-30305858
(chargeable, add area code before this number in case of mobile call) or email us at 'customercare@bajajallianz.co.in'.
78871692/-/10043080/99060001/-
This is a one page Policy Document [without enclosing the Terms and Conditions (T&C) of the Policy] issued by the Company, pursuant to the authorization of Insured to display the T&C of the Policy on its website (www.bajajallianz.com) that enables access by the In-
sured. The T&C of the Policy are available on the Company's website and can be accessed by the Insured.
Kindly contact our nearest / local office(s) for No Claim Bonus Confirmations.

null

For & On Behalf of Bajaj Allianz General Insurance Company Ltd.


Stamp
Duty Rs.
0.5

Authorized Signatory
Printed , Signed and Executed at Pune null Consolidated stamp Duty paid vide Receipt No: .49 dated 27-NOV-17

Generated by Silent_Printing

Regd. Office : GE Plaza, Airport Road, Yerawada,Pune - 411006 (India),A Company incorporated under Indian Companies Act, 1956 and licensed by Insurance Regulatory
and Development Authority of India [IRDA] vide Reg No.113, Corporate Identification Number U66010PN2000PLC015329.BAGIC GST No : 27AABCB5730G1ZX | Princip-
al Location : GE Plaza, Airport Road, Yerwada, Pune - 411006 PH:66026666 | Services Accounting Code : 997134 - Motor vehicle insurance services. No reverse charge
is payable on these services. | Invoice No. : 91401689/1 - Latest Schedule - 15-Dec-2017 19:15:35 PM (Web)
Bajaj Allianz General Insurance Company Ltd.
Bajaj Finserv Building, 1st Floor, Behind Weikfield IT-Park, Viman Nagar, Pune - 411014
Contact No:Contact No: 1800-209-0144

RECEIPT

Receipt Number 9906-01566625


Receipt Date 15/12/2017
Business Channel WS

Received with thanks from PADMENDRA SINGH


(Customer ID : 110527531 ) a total sum of Rupees Two Thousand Five Hundred Forty Three
Only by,

Instrument Instrument No. Instrument Bank Name Branch Name Amount


Type Date
Online Pay- PBP1077852 15/12/2017 2,543
ment

Total Amount Rs. 2,543.00


Issuance of this receipt does not amount to acceptance of the risk by Bajaj Allianz General In-
surance Company Limited. The insurance cover for the risk shall be as per the terms and con-
ditions of the Insurance Policy if and when issued.
* Cheque/DD/PO receipt is valid subject to realisation of the instrument.

For & on behalf of


Bajaj Allianz General Insurance Company Ltd.

Authorised Signatory

Regd.Office: GE Plaza,Airport Road, Yerwada, Pune - 411006