GATE WAY

GATE WAY
PREMIUM AUTO CALUCULATION
PREMIUM AUTO CALCULATION (DE - TARIFF SPECIAL)

PRODUCT NAME
VERSION 5.5 (DE-TARIFF SPECIAL) TWO WHEELERS
Developed By :
FOUR WHEELERS
N. SATEESH KUMAR
Executive Operations, Vizag
COMMERCIAL VEHICLES
(Passenger & Good Carrier)

COMMERCIAL VEHICLES
(Buses etc.,)

TRACTORS

CONSTRUCTION EQUIPMENTS

MOTOR TRADE ROAD RISK

MOTOR TRADE ROAD TRANSIT

OWNERSHIP TRANSFER

STAND ALONE TP PREMIUMS

FIRE INSURANCE

FIRE LONG TERM

SHOP KEEPERS

HOUSE KEEPERS

OFFICE PACKAGE

PERSONAL GUARD

HEALTH GUARD

HOSPITAL CASH

TRAVEL COMPANION

MOTOR DEALERS

WORKMEN COMPENSATION
TO
Mr. N. Satish, QUOTATION FOR TWO WHEELERS Date : 12/07/2021
Visakhapatnam

TWO WHEELERS :
1.676 1.676 1.76 1.844
NCB VEHICLE IDV Upto 75 cc
Upto 75CC 7675CC
cc to 150CCcc
to 150 151
150cc
CCto 350CCcc
to 350 Above 350CCcc
Above 350
RATE RATE RATE RATE
Select NCB :- 20 19885 (%)
CALCULATION
(%)
CALCULATION
(%)
CALCULATION
(%)
CALCULATION

Select Zone :- B 21 1.676 333 1.676 333 1.76 350 1.844 367
Select Age :- < 5 Yrs 0 0 0 0 0 0 0 0 0
(-) De-Tariff Discount :- 0 0 0 0 0 0 0 0 1
Total OD (After De-Tariff Disc):- 333 333 350 367 2
Additional Opitions :-
(-) No Claim Bonus : 20 67 20 67 20 70 20 73 3
P.A Cover : Total Own Damage : 267 267 280 293 4

Loading : 0 Public Liability :- Basic T.P : 300 300 300 620 5

Voluntary Dec : (+) Compulsory PA : 50 50 50 50
Total Premium :- 617 617 630 963 6
De-Tariff Ratings :-
(+) Additional Loading :- 0 0 0 0 0 0 7
Discount allowed : No FCV 617 617 630 963 8
Enter Discount % : 15 15 Service Tax :- 10.3 64 10.3 64 10.3 65 10.3 100 9
. FINAL PREMIUM :- 681 681 695 1063 10
626 640 1008

Thank You,
For Bajaj Allianz General Insurance Co. Ltd.,
(Authorised Signatory)
To
Mr. P. Prabhakar
QUOTATION OF FOUR WHEELER Date : 12/07/2021
Chitoor

PRIVATE CAR :-
Ex-Showroom : 0 5%idv: 0
3.039 3.191 3.343
NCB VEHICLE IDV
IDV Upto 1000 cc
< 1000CC 1001
> 1000cc
CC to
to <1500 cc
1500 CC Above 1500
> 1500 CC cc
NCB SUM INSURED
RATE RATE RATE
Enter here :- 0 550000 (%)
CALCULATION
(%)
CALCULATION
(%)
CALCULATION

Zone :- B 3.039 16715 3.191 17551 3.343 18387

Age of Vehicle :- < 5 Yrs (+) Electronic Accessories : 4 0 4 0 4 0
(+) Own Damaga CNG KIT : 4 0 4 4 0
(-) Voluntary Deductible : 0 0 0 0 0 0
Additional Coverages :-
(-) De-Tariff Discount :- 15 2507 35 6143 15 2758
P.A Cover : 0 Total OD (After De-Tariff Disc):- 14207 11408 15629
Elec Accessories : 0 (-) No Claim Bonus : 0 0 0 0 0 0
CNG KIT : 0 (+) Total Own Damage : 14207 11408 15629
Voluntary Decd : 0 Public Liability :- Basic T.P : 670 800 2500
Additional Loading : (+) Compulsory PA : 1 100 1 100 1 100
(+) LL to Employee : 1 25 1 25 1 25
De-Tariff Ratings :- (+) Public Liability of CNG/LPG Kit : 0 0 0 0 0 0
Discount allowed : Yes (+) Additional P.A : 1 100 2 0
Enter Discount % : 15 (+) Additional Loading : 0 0 0 0 0 0
Net Premium : 15102 12333 18254
Service Tax : 10.3 1556 10.3 1270 10.3 1880
FINAL PREMIUM :- 16658 13603 20134

Thank You,
For Bajaj Allianz General Insurance Ltd.,
(Authorised Signatory)
To
Mr. Amit Mohanty QUOTATION FOR COMMERCIAL VEHICLE Date : 12/07/2021
Visakhapatnam.

HEAVY GOODS VEHICLES (LORRIES / MAX /ACE / JEEP etc) :-

1.726

NCB SUM INSURED AMOUNT

PASSENGER CARRIER

NCB :- 45 1000000 RATE CALCULATION

Actual Weight :- 40200 Own Damage :- Basic OD : 1.726 17260

Add Passenger :- (+) Surcharge for G.V.W : 28200 7614
Age of Vehicle :- < 5 Years (-) De-Tariff Discount :- 20 4975
Zone :- C Total OD (After De-Tariff Disc):- 19899
De-Tariff Ratings :- (-) No Claim Bonus : 0
45 8955
Discount allowed : Yes TOTAL OD DAMAGE : 10945 20
Enter Discount % : 20 Liability :- Basic T.P : 6770 25
Yes (+) No. of Passengers : 3 300 35
No (+) Comp P.A. Cover : 0 100 45
(+) LL to Employee : 3 50 50
Net Premium : . 18165
Service Tax : 10.3 1871
FINAL PREMIUM :- 20036

Thank You,
For Bajaj Allianz General Insurance Co. Ltd.,
(Authorised Signatory)
TO
Mr. N. Satish, QUOTATION OF MISC AND SPECIAL TYPE OF VEHICLE Date : 12/07/2021
Visakhapatnam.

NCB SUM INSURED

RATE AMOUNT AMOUNT
Select NCB Here :- 0 725000 % Rs. Rs.

Select Overturning here :- NO Own Damage :- Basic OD : 1.232 8932

Age of Vehicle :- 5 to 7 (+) Overturning : 0 0
Zone :- B (-) De-Tariff Discount :- 27.95 2496
De-Tariff Ratings :- Total OD (After De-Tariff Disc):- 6436
Discount allowed : YES (-) No Claim Bonus : 0 0
Enter Discount % : 27.95 TOTAL OD DAMAGE : 6436
Public Liability :- Basic T.P : 800
(+) LL to Employee : 1 25
(+) Comp P.A. Cover : 1 100
YES Net Premium : 7361
NO Service Tax : 10.3 759
FINAL PREMIUM :- 8120
INCLUDING EXTENDED WARRANT PREMIUM :-

Thank You,
For Bajaj Allianz General Insurance Co. Ltd.,
(Authorised Signatory)
To
QUOTATION FOR COMMERCIAL VEHICLES Date : 12/07/2021
(PASSENGER CARRIER MORE THAN 6 NOS. BUSES, ETC.,)

COMMERCIAL VEHICLES (BUSES, TOURIST VEHICLES etc.,) :-

1.672 1.672 1.672 1.672
NCB SUM INSURED < 18 Passengers 19 to 36 Passengers 37 to 60 Passengers > 60 Passengers
RATE RATE RATE RATE
NCB Percentage :- 0 846600 (%)
CALCULATION
(%)
CALCULATION
(%)
CALCULATION
(%)
CALCULATION

Zone :- B Own Damage :- Basic OD : 1.672 14155 1.672 14155 1.672 14155 1.672 14155
Age of vehicle :- > 5 Years (+) Basic OD amount : 350 350 450 450 550 550 680 680
(-) De-Tariff Discount :- 0 0 20 2921 0 0 0 0
Additional Coverages :- Total OD (After De-Tariff Disc):- 14505 11684 14705 14835
(-) No Claim Bonus : 0 0 0 0 0 0 0 0
No. of Passengers:- 24 (+) Total Own Damage : 14505 11684 14705 14835
LL TO EMP :- 2 Liability :- Basic T.P : 3160 3160 3160 3160
PA COVER :- 1 (+) Comp P.A. Cover : 1 100 100 100 100
De-Tariff Ratings :- (+) LL to Employee : 50 50 50 50
Discount allowed : No (+) LL to passengers : 9 5640 24 5640 24 5640 24 5640
Enter Discount % : 0 Net Premium : 23455 20634 23655 23785
. Service Tax : 10.3 2416 10.3 2126 10.3 2437 10.3 2450
Yes FINAL Premium :- 25871 22760 26092 26235
No

Thank You,
For Bajaj Allianz General Insurance Co. Ltd.,
(Authorised Signatory)
 C
O
M
To M
Mr. N.Sateesh, QUOTATION FOR TRACTOR
E Date : 12/07/2021
Visakhapatnam
R
C
I
TRACTOR A
COMMERCIAL TRACTOR
SUM TRAILOR SUM INSURED AGRICULTURAL TRACTOR L
INSURED (With 25% Loading)

300000 RATE
TRACTOR CUM
TRACTOR TRAILOR
T DESCRIPTION
RATE
TRACTOR
CUM
ONLY
TRAILOR % TRACTOR
R TRAILOR

0 Tractor OD : A Tractor OD :
1.19 3570 3570 0 1.19 3570 3570
C
20 Trailor OD : 1.05 0 0 0 T Trailor OD : 1.05 0 0
> 5 Year (-) No Claim Bonus : 20 714 714 0 O TOTAL : 3570 3570
C TOTAL OWN DAMAGE : 2856 2856 0 R (-) No Claim Bonus: 20 714 714
Tractor Public Liability :- Basic T.P : 800 800 0 TOTAL : 2856 2856
(+) Comp P.A : 100 100 0 (+) Loading : 25 714 714
(+) LL to Employee : 25 25 0 TOTAL OD PREMIUM : 3570 3570
(+) Fire Contents/ burglary at Farmers 55 0 0 LIABILITY:- Basic T.P : 800 800
Trailor Public Liability :- Basic T.P : 400 0 400 (+) Comp P.A : 100 100
No. of Coolies : 0 0 0 0 (+) L.L.to Emp : 25 25
Net PREMIUM : 4236 3781 400 (+) Fire Content : 40 0
Service Tax : 10.3 436 389 41 (+) Basic Trailor T.P 550 0
FINAL PREMIUM :- 4672 4170 441 (+) No of Coolies : 0 0 0
NET PREMIUM : 5085 4495
365762 :- EX-Show room Price Service Tax 10.3 524 463
347474 :- 5% Dep IDV FINAL PREMIUM :- 5609 4958

Thank You,
For Bajaj Allianz General Insurance Co. Ltd.,
(Authorised Signatory)
To
Mr. N. Satish, QUOTATION FOR MOTOR TRADE ROAD TRANSIT Date : 12/07/2021
Visakhapatnam

MOTOR TRADE ROAD TRANSIT (CLASS E) :-

0.80
PASSE
NGER
DISTANCE SUM INSURED PREMIUM COMPUTATION
CARRIE
R
RATE
Enter Kms here :- 2500 2500000 %
CALCULATION

De-Tariff Ratings :- Own Damage :- Basic OD : 0.80 20000

Manual Rating : No (-) De-Tariff Discount :- 0 0
Enter Rate : 10 Total OD (After De-Tariff Disc):- 20000
Yes Liability :- Basic T.P : 500
No NET PREMIUM :- 20500
(+) Addl Loading :- 500
Service Tax : 10.3 2163
FINAL PREMIUM :- 23163

Thank You,
For Bajaj Allianz General Insurance Co. Ltd.,
(Authorised Signatory)
To
Mr. N. Satish, QUOTATION FOR MOTOR TRADE ROAD RISK Date : 12/07/2021
Visakhapatnam.

MOTOR TRADE (TWO WHEELERS) :-

PASSE
Add NGER
Details SUM INSURED PREMIUM COMPUTATION
CARRIE
R
RATE
No. of Add Certificates :- 1 100000 %
CALCULATION
Demonistration Usage :- YES Own Damage :- Basic OD : 0.45 450
(+) Additional Loss of Damage : 0 0
YES (+) OD of Additional Certificates : 1 85
NO TOTAL OD DAMAGE : 535
Liability :- Basic T.P : 300
(+) TP of Additional Certificates : 1 150
(+) L.L. to Employee : 0 0
12 TOTAL (OD + LIB) : 985
(+) Demonistration : 12 118
Net Premium : 1103
Service Tax : 10.3 114
FINAL PREMIUM :- 1217

Thank You,
For Bajaj Allianz General Insurance Co. Ltd.,
(Authorised Signatory)
 CALCULATION OF OWNERSHIP TRANSFER FEE

DESCRIPTION
DESCRIPTION FROM
FROM TO
TO DAYS

Enter Policy Effecting 11/2/2006 11/1/2007 Total days 364

Transfer Effecting 1/9/2007 11/1/2007 Remaing days 296
Enter Actual NCB Given in Policy :- 1666 Gross Amount 1355
S.T 10.30% 140

NCB Recovery Amount :-

1495 Net Amount
1494
Transfer Fee :- 50
Total Premium for Tranfer :- 1545
 BAJAJ ALLIANZ GENERAL INSURANCE CO LTD.,
AREA OFFICE, VISAKHAPATNAM
STANDALONE TP PREMIUMS
Motor Cycles/Scooters
TP Premium
TP Premium
Excl.
incl. Coverage
Base TP Coverage for
Two Wheelers for Owner
Premium Owner -Cum-
-Cum-Driver
Driver PA
PA incl. S.Tax
incl. S.Tax

Upto 350 cc 300 386 331

Above 350 cc 620 739 684

Private Cars
TP Premium
TP Premium
Excl.
incl. Coverage
Base TP Coverage for Incl. Paid Driver
Private Cars for Owner
Premium Owner -Cum- incl. S.Tax
-Cum-Driver
Driver PA
PA incl. S.Tax
incl. S.Tax

Upto 1000 cc 670 849 739 877

Between 1000cc & 1500 cc 800 993 882 1020
Above 1500 cc 2500 2868 2758 2895

Goods Carrying 3 Wheelers - Public Carriers

TP Premium
TP Premium
Excl.
incl. Coverage
Base TP Coverage for Incl. Paid Driver
Goods Carrying Vehicles Public Carriers for Owner
Premium Owner -Cum- incl. S.Tax
-Cum-Driver
Driver PA
PA incl. S.Tax
incl. S.Tax

Goods carrying Commercial ( 3 Wheelers) 1530 1798 1688 1825

Goods Carrying 3 Wheelers - Private Carriers

TP Premium
TP Premium
Excl.
incl. Coverage
Base TP Coverage for Incl. Paid Driver
Goods Carrying Vehicles Public Carriers for Owner
Premium Owner -Cum- incl. S.Tax
-Cum-Driver
Driver PA
PA incl. S.Tax
incl. S.Tax

Goods carrying Commercial ( 3 Wheelers) 1450 1710 1599 1737

Goods Carrying Otherthan 3 Wheelers - Public Carriers

TP Premium
TP Premium
Excl.
incl. Coverage
Base TP Coverage for Incl. Paid Driver
Goods Carrying Vehicles Public Carriers for Owner
Premium Owner -Cum- incl. S.Tax
-Cum-Driver
Driver PA
PA incl. S.Tax
incl. S.Tax

Not Exceeding 7500 Kgs 5580 6265 6155 6293

Exceeding 7500 Kgs but not exceeding 12000 Kgs 5920 6640 6530 6668
Exceeding 12000 Kgs but not exceeding 20000 Kgs 6090 6828 6717 6855
Exceeding 20000 Kgs but not exceeding 40000 Kgs 6260 7015 6905 7043
Exceeding 40000 Kgs 6770 7578 7467 7605

Goods Carrying Otherthan 3 Wheelers - Private Carriers

TP Premium
TP Premium
Excl.
incl. Coverage
Base TP Coverage for
Goods Carrying Vehicles Private Carriers for Owner
Premium Owner -Cum-
-Cum-Driver
Driver PA
PA incl. S.Tax
incl. S.Tax

Not Exceeding 7500 Kgs 5000 5625 5515 5653

Exceeding 7500 Kgs but not exceeding 12000 Kgs 5300 5956 5846 5984
Exceeding 12000 Kgs but not exceeding 20000 Kgs 5440 6111 6000 6138
Exceeding 20000 Kgs but not exceeding 40000 Kgs 5610 6298 6188 6326
Exceeding 40000 Kgs 6050 6783 6673 6811

Page 12 of 34
 BAJAJ ALLIANZ GENERAL INSURANCE CO LTD.,
AREA OFFICE, VISAKHAPATNAM
STANDALONE TP PREMIUMS

Passenger Carrying Autos

TP Premium
TP Premium
Excl.
incl. Coverage
Base TP Coverage for Incl. Paid Driver
3 wh Passenger Carrying Vehicles for Owner
Premium Owner -Cum- incl. S.Tax
-Cum-Driver
Driver PA
PA incl. S.Tax
incl. S.Tax

Upto 6 Passengers 510 673 563 700

Between 7 and 17 Passengers 1560 1831 1721 1859
Exceeding 17 Passengers 3160 3596 3485 3623
Add: Premium for LL to passengers @ 315 X
For Eg. If licenced carrying capacity is 3 then 315 x 3= Rs.945
Carrying Capacity (Upto below 17 Pass)
Add: Premium for LL to passengers @ 235 X
For Eg. If licenced carrying capacity is 10 then 235 x 10= Rs.2350
Carrying Capacity (Above 17 Pass)

Passenger Carrying -Taxis - Upto 6 Seaters

TP Premium
TP Premium
Excl.
incl. Coverage
4 wh Passenger Carrying Vehicles upto 6 Base TP Coverage for Incl. Paid Driver
for Owner
passengers Premium Owner -Cum- incl. S.Tax
-Cum-Driver
Driver PA
PA Incl.S.Tax
Incl.S.Tax

4 wh Upto 1000 cc 1650 1930 1820 1958

4 wh Between 1000cc & 1500 cc 2330 2680 2570 2708
4 wh Above 1500 cc 2840 3243 3133 3270

Add: Premium for LL to passengers @ 350 X

For Eg. If licenced carrying capacity is 5 then 350 x 5= Rs.1750
Carrying Capacity

Passenger/Employee Carrying Buses / School Buses

TP Premium
TP Premium
Excl.
4 or more Weheelers Passenger Carrying incl. Coverage
Base TP Coverage for Incl. Paid Driver
Vehicles Exceeding 6 passengers incl. School for Owner
Premium Owner -Cum- incl. S.Tax
Buses -Cum-Driver
Driver PA
PA Incl.S.Tax
Incl.S.Tax

Exceeding 6 passengers 3160 3596 3485 3623

Add: Premium for LL to passengers @ 235 X

For Eg. If licenced carrying capacity is 50 then 235 x 50= Rs.11750
Carrying Capacity

Tractors/Cranes/Excavators/Tippers/Dumpers etc
TP Premium
TP Premium
Excl.
incl. Coverage
Base TP Coverage for Incl. Paid Driver
Tractors etc for Owner
Premium Owner -Cum- incl. S.Tax
-Cum-Driver
Driver PA
PA Incl.S.Tax
Incl.S.Tax

Misc/ Agr / Commercial Tractors 800 993 882 1020

Agr / Commercial Trailors 550 607

Page 13 of 34
 FIRE SIMPLE RISK CALCULATION

Risk Description Building/ Content EARTH QUAKE

Select Risk here:- Dwellings, Places of worsh Building Zone - IV
TERRORISM
Nil

SUM INSURED FIRE CALCULATION

RATE AMOUNT
Enter Sum Insured here :- 200000 (%) (Rs.)

RATE : 3.8 760

EARTH QUAKE : 0.1 20

TERRORISM : 0.3 60

NET PREMIUM : 840

SERVICE TAX : 10.3 87

TOTAL PREMIUM :- 927

1 Zone - III :- West Godavari, Krishna, Khammam, Warangal, Karimnagar, Anantapur

Chitoor, Nellore, Cuddapah, Kurnool, Mahaboobnagar, Ranga Reddy, Medak, Nizambad, Adila
2 Zone - IV :- Nalgonda, Prakasam, East Godavari Dist, Kakinada, Visakhapatnam, Guntur, Vizianagaram,
Srikakulam, Hyderabad and Yanam ( Pondicherry )
ON GATEWAY

Sateesh, Vsp

Your Risk Description :-

DESCRIP
Building Contents
TION
Dwellings,
Places of 0.5 0.5 0
Dwellings, Places of worships,
Libraries, Museums, Schools, worships,
Cafes,
Libraries,
Colleges, Hospitals including X-ray 1.8 1.8 0
Restauran
Museums,
and other Diagnostic clinics, Office ts, Hotels,
premises, Meeting Rooms, Schools,
Shops
Confectio
Colleges,in 2.8 2.8 0
Auditoriums, Planetarium, Mess dealing
ner
Hospitals
goods &
Houses, Clubs, Marriage Halls, Shops
Sweet
including
otherwise 3.8 3.8 1
Showrooms and display centres dealing
meat in
where X-ray
not
hazardou and
sellers
other
provided
s goods EARTH QUAKE :-
Diagnosti
for
as per the
clist clinics,
including
below Nil
Office 0 0.1
Laundries
and Arms
premises,
, Battery
&
Meeting
Charging Zone - III 0.2
Ammuniti
Rooms,
Service
on
Auditoriu
Stations, Zone - IV 0.1
dealers,
nantapur ms,
Dry
Motor TERRORISM :-
Planetariu
Cleaning,
Vehicle
Reddy, Medak, Nizambad, Adilabad, m,
AmusemeMess
showroom
tnam, Guntur, Vizianagaram, Houses,
nt parks,
including Nil 0 0.3
Clubs,
Hoarding,
sales and
Marriage
Neon
service,
Halls,
signs and/ Industrial Risk
Petrol 0.3
Showroo
Sports
Diesel
ms
Kiosks and
Galleries,
display
Outdoor Non Industrial Risk 0.2
centres
stadiums.
where Residential 0.1
1 0.5 3.8

1 1.8

1 2.8

1 3.8
To QUOTATION FOR FIRE SPECIALDate
PERILS
Mr. N. Satish, : 12/07/2021
Visakhapatnam POLICY

PREMIUM
SUM INSURED
COMPUTATION
RATE AMOUNT
500000 (%) (Rs.)

RATE :
1.5 750
EARTH QUAKE :
0 0

TERRORISM :
0 0
NET PREMIUM :
750
SERVICE TAX : 10.3
77
FINAL PREMIUM :- 827

Thank You,
For Bajaj Allianz General Insurance Co. Ltd.,
(Authorised Signatory)
To
Mr. N.Satish,QUOTATION FOR LONG TERM DWELLING POLICY
Date : 12/07/2021
Visakhapatnam.

SUM PREMIUM
DISCOUNT
DISCOUNT
INSURED COMPUTATION
RATE AMOUNT
Enter here :- 1500000 50 (%) (Rs.)

Enter Years :- 10 RATE :

0.5 3750
EARTH QUAKE :
0.1 1500

TERRORISM :
0 0
NET PREMIUM :
5250
SERVICE TAX : 10.3
541
FINAL PREMIUM :- 5791

Thank You,
For Bajaj Allianz General Insurance Co. Ltd.,
(Authorised Signatory)
BACK FIRE TARIFF (INDUSTRIAL / MANUFACTURING RISK)
Section Risk Rate
Code Code
4 8 5

Earthquake
Zone Rate
1 1
2 0.5
3 0.2
4 0.1
FIRE TARIFF (INDUSTRIAL / MANUFACTURING RISK)
Rate
Description
1.5
Aluminium ,Zinc,Copper Factories
 QUOTATION FOR SHOP KEEPERS PACKAGE POLICY

NAME OF THE PNB A/C: M/s MAMTA ENTERPRISES, OPP- ORIENT DATE OF ISSUE OF
8/9/2007
CUSTOMER : BANK OF COMMERCE, AJMER ROAD, JAIPUR QUOTATION :

SECTION SECTION DESCRIPTION RATE SUM INSURED PREMIUM

SECTION 1 FIRE - BUILDING 2.25 0

FIRE - CONTENTS 2.25 315000 709

TERRORISM COVER EXTENSION 0.20 0 0

SECTION 2 BURGLARY & HOUSEBREAKING CONTENTS 2.25 315000 709

FIRST LOSS BASIS 3.37 0 0

SECTION 3 MONEY INSURANCE 1.50 4500 7

SECTION 4 PLATE GLASS 10.00 0

SECTION 5 BREAKDOWN OF APPLIANCES ( WINDOW/ SPLIT A/C ) 25.00 0 0

GENERATOR SET 15.00 0 0

OTHER EQUIPMENT 15.00 0 0

BAGGAGE 10.00 1000 50

SECTION 6 NEON / GLOW SIGN 10.00 0 0

TERRORISM COVER EXTENSION 0.20 0 0

SECTION 7 ELECTRONIC EQUIPMENTS 10.00 0 0

SECTION 8 FIDELITY GUARANTEE 10.00 0 0

SECTION 9 PERSONAL ACCIDENT 1.50 0

SECTION 10 A PUBLIC LIABILITY 0.50 1500 50

SECTION 10 B WORKMEN COMPENSATION 4.50 0 0

SECTION 11 BUSINESS INTERRUPTION 2.25 0 0

TERRORISM COVER EXTENSION 0.20 0 0

TOTAL PREMIUM 1524

TOTAL( EXCL. SECTION 1,7&11) 816
SECTIONAL DISCOUNT 5 15% 122
NET PREMIUM 1402

S.TAX. INCL. ECU. CESS @ 10.30% 10.30% 144

TOTAL AMOUNT PAYABLE 1547

Thank you,
For Bajaj Allianz General Insurance. Ltd.,
(Authorised Signature)
 QUOTATION FOR OFFICE PACKAGE POLICY

NAME OF THE DATE OF ISSUE OF

CUSTOMER : QUOTATION :

SECTION SECTION DESCRIPTION RATE SUM INSURED PREMIUM

SECTION 1 FIRE - BUILDING 0.50 150000 75

FIRE - CONTENTS 0.50 20000 10

TERRORISM COVER EXTENSION 0.20 0 0

SECTION 2 BURGLARY & HOUSEBREAKING CONTENTS 1.00 0 0

SECTION 3 MONEY INSURANCE 1.50 0 0

SECTION 4 PLATE GLASS 10.00 0 0

SECTION 5 BREAKDOWN OF APPLIANCES 15.00 0 0

SECTION 6 BAGGAGE 10.00 0 0

SECTION 7 ELECTRONIC EQUIPMENTS 10.00 0 0

TERRORISM PREMIUM 0.20 0 0

SECTION 8 FIDELITY GUARANTEE 10.00 100000 1000

SECTION 9 PERSONAL ACCIDENT 2.00 0 0

SECTION 10 A PUBLIC LIABILITY 5.00 0 0

SECTION 10 B WORKMEN COMPENSATION 0 0

SECTION 11 HOSPITAL CASH 0

SECTIONAL DISCOUNT 2 0% 0

NET PREMIUM 1085

S.TAX. INCL. EDU. CESS @ 10.30% 1030.00% 112

TOTAL AMOUNT PAYABLE 1197

NOTE : 1. PLEASE ENTER THE RATES FOR SECTION 1, SECTION 9, SECTION 10B AND SECTION 11 AS PER GUIDELINES
2. SECTION 1 & SECTION 2 ARE COMPULSARY

Thank you,
For Bajaj Allianz General Insurance. Ltd.,
(Authorised Signature)
 QUOTATION FOR WORK MEN COMPENSATION

NAME OF THE INSURED : DATE :

RATE
SALARY PER TOTAL NUMBER OF TOTAL SUM RATE NET
DESCRIPTION MONTH NO. MONTHS INSURED %o
ABOVE
PREMIUM
4000
1 12 0 30.00 0.0 0
1 3 0 6.25 2.0 0
1 3 0 67.10 2.0 0
1 3 0 12.15 2.0 0
1 3 0 12.15 2.0 0
1 3 0 67.10 2.0 0
1 3 0 67.10 2.0 0
1 3 0 30.15 2.0 0
1 3 0 30.15 2.0 0
1 3 0 30.15 2.0 0

TOTAL NET PREMIUM 0

SER.TAX INCL. EDU. CESS @ 10.30% 0

TOTAL AMOUNT PAYABLE ! 0

Thank you,
For Bajaj Allianz General Insurance. Ltd.,
(Authorised Signature)
 QUOTATION FOR MOTER DEALER PACKAGE POLICY

S.NO. DETAILS SECTION SUM INSURED RATE (Permile) PREMIUM

Fire (Buildings) I 1.9 0
1
Fire (Contents) I 3.9 0
2 Burglary II 2.5 0
3 Damage III 15 0
4 Neon Sign IV 10 0
5 Bussiness Interruption V 0 0
6 Breakdown of Bussiness Equip VI 15 0
7 Money Insurance VII 1.5 0
8 Plate Glass VIII 10 0
9 Elec.& Electronic IX 10 0
10 Fedility Guarantee X 7.5 0
11 Public Liablity XIV 5 0
TOTAL : 0 Net Premium :- 0
0
Special Discount @ 0% : 0
0
Service Tax @ 10.30% : 0
Final Premium :- 0

EXCEPT BELOW SEC :- SECTIONAL DISCOUNTS

1 FIRE Upto 5 10%
3 DAMAGE Above 5 15%
9 BREAK DOWN

Thank you,
For Bajaj Allianz General Insurance. Ltd.,
(Authorised Signature)
To
Mr. N. Sateesh,
Vizag.
QUOTATION FOR PERSONAL ACCIDENT POLICY Date : 12/07/2021

RISK 1 :-
RISK - 1
COVER RATE SUM SUM SUM SUM
PREMIUM PREMIUM PREMIUM
INSURED INSURED INSURED INSURED
Principle Spouse Child - 1 Child - 2
BASIC 0.45 0.00 0.00 0.00

WIDER 1 0.00 0.00 0.00

COMPREHENSIVE 1.5 300,000 450.00 0.00 0.00

INDIVIDUAL PREMIUM : 450.00 0.00 0.00

Base Premium : 450.00

Add :-Medical Expenses @ 25% : NO 0.00

Add:-Hospital Confinment (Rs.300/-) : NO 0.00

Gross Premium : 450.00

Less :Family discount @ 10 % : NO 0.00 RISK - 1 :-

Net Premium : 450.00 TOTAL PREMIUM PAYABLE : 496

Add :-Service Tax : 10.30% 46.35

FINAL PREMIUM :- 496.35

Thank you,
For Bajaj Allianz General Insurance. Ltd.,
(Authorised Signature)
 To
Mr. N. Sateesh,
Vizag.
QUOTATION FOR PERSONAL ACCIDENT POLICY Date : 12/07/2021

PREMIUM
Child - 2
0.00

0.00

0.00

0.00

Thank you,
For Bajaj Allianz General Insurance. Ltd.,
(Authorised Signature)
 QUOTATION FOR TRAVEL COMPANION

TRAVEL TYPE :- Travel Value USA/CANADA :- Including

DAYS TO TRAVEL 76-90

DOB INDVIDUAL
MEMBER AGE
DD-MMM-YYYY PREMIUM
PROPOSER 25-Aug-1947 0

Note :- WHOLE FAMILY PREMIUM

1) If Additional Family Member PROPOSER 1383
Please Check Their Individual
Premium and entered same SPOUSE 1610
into whole family table to get
Net Premium Payable
CHILD 1
CHILD 2
2) Travel Age Must be between
61 to 70 Yrs. Only NET PREMIUM PAYABLE :- 2993
Travel Value This policy offers high value benefits for the individual traveling abroad. Covers all
medical eventualities including Hospitalization and other incidental expenses with
enhance medical coverage of $5,00,000 and increased limit of $ 1,500 for emergency ca

Thank you,
For Bajaj Allianz General Insurance. Ltd.,
(Authorised Signature)
 QUOTATION FOR HOUSE HOLDERS PACKAGE POLICY

NAME OF THE DATE OF ISSUE OF

CUSTOMER : QUOTATION :

SECTION SECTION DESCRIPTION RATE SUM INSURED PREMIUM

SECTION 1 FIRE - BUILDING 0.50 1300000 650
FIRE - CONTENTS 0.50 80000 40
TERRORISM PREMIUM 0.30 0
SECTION 2 CONTENTS - BURGLARY 2.25 80000 180
FIRST LOSS BASIS 3.37 0
SECTION 3 JEWELLERY & VALUABLES 10.00 5000 50
SECTION 4 PLATE GLASS 10.00 0
SECTION 5A BREAKDOWN OF DOMESTIC APPLIANCES (NON A/C) 2.50 0
SECTION 5B WINDOW AIRCONDITIONER INCLUDING SPLIT UNITS 10.00 0
SECTION 6 ELECTRONIC EQUIPMENTS 10.00 0
TERRORISM PREMIUM 0.30 0
SECTION 7 PEDAL CYCLES 10.00 0
SECTION 8 BAGGAGE 7.50 0
SECTION 9 PERSONAL ACCIDENT 1.50 0
SECTION 10 A PUBLIC LIABILITY 0.50 0
SECTION 10 B WORKMEN COMPENSATION 0

TOTAL PREMIUM EXCLUDING SECTION 1 230

SECTIONAL DISCOUNT 3 0% 0
NET PREMIUM 920

S.TAX. INCL. ECU. CESS @ 10.30% 10.30% 95

TOTAL AMOUNT PAYABLE 1015

NOTE : 1. PLEASE ENTER THE RATES FOR SECTION 9 AND SECTION 10 B AS PER GUIDELINES
2. SECTION 1 & SECTION 2 ARE COMPULSARY

Thank you,
For Bajaj Allianz General Insurance. Ltd.,
(Authorised Signature)
 QUOTATION OF HEALTH GUARD INSURANCE

MEMBER DETAILS DOB AGE SUM INSURED

(DD-MMM-YYYY)

Proposer 10-Jan-1979 42 100000

Spouse 10-Jan-1981 40 100000
Child 10-Jan-2000 21 300000
Child 10-Jan-2002 19 300000
Employee 10-Jan-2002 19 150000

Loading (%) 11809

SMOKER NO 0 0
ASTHAMA PATIENT NO 0 0

BASE PREMIUM 11809

FAMILY DISCOUNT ** Y
NET PREMIUM 11219
SERVICE TAX @ 10.30 % 1156

TOTAL AMOUNT PAYABLE 12375

Thank you,
For Bajaj Allianz General Insurance. Ltd.,
(Authorised Signature)
BACK FIRE TARIFF - SIMPLE RISK
RISK RATE
SECTION DESCRIPTION
CODE CODE
Dwellings, Places of worships, Libraries, Museums,
Schools, Colleges, Hospitals including X-ray and other
Diagnostic clinics, Office premises, Meeting Rooms,
3 1 1 Auditoriums, Planetarium, Mess Houses, Clubs,
Marriage Halls, Showrooms and display centres where

Cafes, Restaurants, Hotels, Confectioner & Sweet

3 2 2
meat sellers
Shops dealing in goods otherwise not provided for
including Laundries, Battery Charging Service Stations,
3 3 21 Dry Cleaning, Amusement parks, Hoarding, Neon
signs and Sports Galleries, Outdoor stadiums.

Shops dealing in hazardous goods as per the list

below and Arms & Ammunition dealers, Motor Vehicle
3 4 22 showroom including sales and service, Petrol / Diesel
Kiosks
ISK
BUILDING CONTENT
RATE RATE
Sateesh, Vsp

0.5 0.5

1.8 1.8

1.8 2.8

1.8 3.8
 FIRE TARIFF - STORAGE RISK (Section - VI)
MATERIAL STORED IN
RISK GODOWN AND SILOS
DESCRIPTION
CODE
RATE RATE
CODE (Per Mile)

Storage of Non hazardous Goods Subject to warranty

18 that hazardous goods of Category I, II, III, Coir waster, 3 1
Coir firbre and Caddies are not stored therein

19 Storage of Category I hazardous Goods 9 2.5

Storage of hazardous Goods listed in Category II

20 Subject to Warranty that goods listed in Category III, 15 4.5
Coir waste, Coir Fibre and adies are not stored therein

Storage of hazardous Goods listed in Category III

21 subject to warranty that Coir waste, Coir fibre and, 18 5.5
Caddies are not stored therein
Transporter's godown & godown of clearing and
22 18 5.5
forwarding agents
23 Storage of Coir waste, Coir Fibre, Caddies 23 12
24 Cold Storage Premises 9 2.5
ection - VI)
TERIAL STORED IN
OPEN BACK
RATE RATE
CODE (Per Mile)

9 2.5
Sateesh, Vsp
19 6

21 8.5

22 10.5

22 10.5
25 17
- -
 QUOTATION FOR HOSPITAL CASH INSURANCE

MEMBER DETAILS DOB AGE SUM INSURED

DD-MMM-YYYY
30 DAYS :- Proposer 6-Oct-1973 48 2000
Spouse
Child2
Spouse
Child1

60 DAYS :- Proposer
Spouse
Child2
Child3
Child3

BASE PREMIUM 1700

FAMILY DISCOUNT ** Y
NET PREMIUM 1615
SERVICE TAX @ 10.30 % 166

TOTAL AMOUNT PAYABLE 1781

Thank you,
For Bajaj Allianz General Insurance. Ltd.,
(Authorised Signature)