BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LTD.

Policy Servicing Office
Policy Number
Period Of Insurance
Insured Name
Insured Address
Customer Id
Application No

Bajaj Finserv,1st Floor , Survey # 208/1-B, Behind Weikfield IT-Park, Viman Nagar 411014, Pune-411014
PH:020-66495000
OG-13-9906-1802-00022827
Product
Two Wheeler - Package Policy
Policy issued on
19-NOV-2012
From: 23-NOV-2012 (Hrs)
Cover Note No.
To: 22-NOV-2013 Midnight
JANYA ASSOCIATES
Zone
B
FLAT NO 103, UJWALA APTS, TIRUMALGIRY OPP BIRYANI DARBAR , , , -500010
47305549
Premium Payer Id
47305549
0
Scrutiny No
21958170
Policy Status
ISSUED

Coinsurance Details : NA.

Registration No
AP10AG8362
Vehicle IDV
22609

Make
BAJAJ

Model
DISCOVER 125

Elec. Accessories
0

SubType
ELECTRIC
START

Non-Elec. Acc.
0

CC
125

Year Of Mfg
2006

Side Car
0

Seat Cap
2

Chassis number.
MD2DSDSZZMCL57320

Trailer Reg No
-,-

CNG/LPG Unit
0

Engine No.
DSGBML33339
Total Sum Insured
22609

SCHEDULE OF PREMIUM
Own Damage
Total Own Damage Premium

Liability
169 Basic Third Party Liability
PA Cover for Owner-Driver of Rs. 100000
Total Act Premium:
576
0
576
69
2
647 *** All Premium Figures are in Rupees

Total Premium
Special Discount
Net Premium
Service Tax
Edu Cess
Final Premium Rs.

357
50
407

Geographical Area : India

No Claim Bonus : -50%
Voluntary Excess : Nil
Compulsory Deductible : Rs. 100
Additional Compulsory Deductible : Rs. 0
Previous Insurer - ICICI Lombard General Insurance CO. Ltd. Previous Policy No - 30056213632901000 Expiry On - 22-NOV-12
The above Total OD Premium is inclusive of all applicable Loading/Discounts viz (Automobile Association Membership,Voluntary Excess,Anti-Theft,Handicap Person,Driver Tution,Fibre Glass,Cng/Lpg Unit,Geographical Extn,Imported Vehicle etc wherever applicable)
LIMITS OF LIABILITY: Under section II-I(i) of the policy -> Death of or bodily injury : Such amount is necessary to meet there requirements of the Motor Vehicles Act,1988. Under
section II-I(ii) of the policy -> Damage to Third Party Property : Rs. 100000
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 disqualified 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.
Past Claim Reference :
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: 22 & Policy wordings attached herewith
Premium Collection Details :- [Receipt No/Collection No/Amount] 9906-00130730,/21958170,/ Rs.647,
*** If premium paid through cheque, the policy is void ab-initio in case of dishonor of cheque.
This certificate of insurance is issued in accordance with the provision of Chapter X and Chapter XI of M.V.Act, 1988.

In case of any claim, please contact our 24 Hour Call centre at 1800-22-5858, 1800-102-5858 ,1800-102-5858,1800-209-5959(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'
21958170/-/55555557/99060001/Damage Details : PIN NO :
Remarks :
PDA MODULE
Kindly contact our nearest / local office(s) for No Claim Bonus Confirmations.
This is a pre signed document and will not be valid unless QC Verified and Signed/Countersigned by an authorized signatory of Bajaj Allianz General Insurance Co.Ltd.

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

Stamp
Duty Rs.
0.5
Authorized Signatory
Printed , Signed and Executed at Pune

QC Verified and Signed/Countersigned by

Consolidated stamp Duty paid vide Receipt No: .15346 dated 02-AUG-12

Regd Office : GE Plaza,Airport Road, Yerwada Pune-411006 (India)

.
Bajaj Allianz General Insurance Company Ltd.
Regd. Office : GE Plaza, Airport Road, Yerawada,Pune - 411006 (India)

Service Tax Reg. No. AABCB5730G-ST-001

-Latest Schedule- 19-Nov-2012 17:22:58 PM (Web)
Generated by Silent_Printing

 


Bajaj Finserv,1st Floor , Survey # 208/1-B, Behind Weikfield IT-Park, Viman Nagar 411014, Pune411014 Contact No:020-66495000,

RECEIPT
Receipt Number

9906-00130730

Receipt Date

19/11/2012

Business Channel

Received with thanks from

JANYA ASSOCIATES

(Customer ID : 47305549 ) a total sum of Rupees Six Hundred Forty Seven Only by,

Instrument Instrument No.

Type

Instrument
Date

Credit Card

19/11/2012

Bank Name

Branch Name

Amount
647

Total Amount

Rs.

647.00

Issuance of this receipt does not amount to acceptance of the risk by Bajaj Allianz General Insurance Company Limited. The insurance cover for the risk shall be as per the terms and conditions of the Insurance Policy if and when issued.
* Receipt Subject to realisation of cheque(s)

For & on behalf of

Bajaj Allianz General Insurance Company Ltd.

Authorised Signatory

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

Regd. Office : GE Plaza, Airport Road, Yerawada,Pune - 411006 (India)

Service Tax Reg. No. AABCB5730G-ST-001

-Latest Schedule- 19-Nov-2012 17:22:58 PM (Web)
Generated by Silent_Printing