*141841606*

BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LIMITED

(A Company incorporated under Indian Companies Act, 1956 and licensed by Insurance Regulatory and Development Authority of India [IRDAI] vide Regd. No.113)
Regd. Office: Bajaj Allianz House, Airport Road, Yerwada, Pune 411006 (India)

AVIATION PA TO CREW MEMBER AND AVIATION LOSS OF LICENSE POLICY SCHEDULE

Policy issuing office and Correspondence address for communication by policyholder for Bajaj Allianz General Insurance Co Ltd,952/954 Appasaheb Marathe Marg,Next to
claim, service request, notice, summons, etc. : Saraswat Bhavan,MUMBAI-400025,Phone No :02266628666
Insured Name CAPT. ROHIT JOSHI Child Certificate Number OG-20-1919-6101-00003143

INSURED DETAILS POLICY DETAILS

Policy Issued on 31-DEC-2019
TELEC CHS, PLOT NO 30, ,SECTOR 17, VASHI NAVI MUMBAI,
BUILDING NO 2 FLAT NO 2, ,,, From: 01-JAN-2020 00:00
Insured Address Period of Insurance
THANE - 400703, To : 31-DEC-2020 Midnight
MAHARASHTRA
Endorsement NA
Customer ID 172786409 Previous Policy Number NA
GSTIN / UIN NA
Policy Status ISSUED STATE CODE / NAME 27 - Maharashtra
Company GST No : 27AABCB5730G1ZX
Invoice No : 139011531/0 Company PAN : AABCB5730G
Master Policy Number OG-20-9999-9960-00000069 Plan Chosen Federation of Indian Pilots : LOL AND PA (AVIATION)
Cover Details
PLAN RISK COVERED RATES/SUM INSURED
AGE :- 29
SECTION1 Loss of License and PA SUM_INSURED:-Rs.1,75,00,000
Premium Details
Discounts ( if Any ) Rs.0
Net Premium. Rs.57,146
Final Premium Rupees Sixty Seven Thousand Four Hundred and Thirty Two only. State GST (9%) Rs.5143
Central GST (9%) Rs.5143
Gross Premium. Rs.67,432

Other Details
Deductible 35 DAYS COOLING PERIOD
Membership No O - 6823
Company / Airline Name GO AIRLINES (INDIA) LTD.
Employment Status PERMANENT EMPLOYEE
Licence Type ATPL
Licence No 8562
Cummulative Bonus 5
Percentage
Cummulative Bonus Amount 0
Nominee 1 SNEHA JHA - 100% - WIFE
Nominee 2
Nominee 3
S P Code
BAJAJ ALLIANZ GENERAL INSURANCE CO. LTD. - LEAD SHARE - 70% RELIANCE GENERAL INSURANCE CO. LTD. - FOLLOW SHARE - 20% FUTURE
Coinsurance Details GENERALI GENERAL INSURANCE CO. LTD. - FOLLOW SHARE - 10%

Receipt Number:1919-00077302 | Date:31-DEC-19 | Premium Payer ID:172786409 | Float: CF

Premium Details ** If Premium paid through Cheque, the Policy is void ab-initio in case of dishonour of Cheque.
Financial Institution Ref. No. N/A

Broker Code 10004279,Marsh India Contact No. 9538199971

& Name Insurance Brokers Pvt. Ltd E-Mail ID. vinutha@marsh.com
For & on the behalf
Bajaj Allianz General Insurance Company Ltd. QR Code

Authorized Signatory
(This is system generated document and need not be countersigned.)
Consolidated Stamp Duty of Rs.0.5/- paid towards Insurance Stamps vide Challan No. MH006357478201920M Defaced No. 0003534430201920 ORDER NO.CSD/169/2019/4519
ORDER DATED 03.10.2019DEFACED DATE dated 03-OCT-19 timing 11:07:41 of General Stamp Office,Mumbai,India.
Principal Location : Bajaj Allianz House, Airport Road, Yerwada, Pune - 411006 PH:66026666 | Services Accounting Code : NA. No reverse charge is payable on these services.
Schedule (1) | Printed on : 31-Dec-2019 03:46:32 pm |Silent Print|WEB|NA

For help and more information: Page 1 of 1

Contact our 24 Hour Call Centre at 1800-209-5858, 1800-102-5858 (Toll Free)
Email: Bagichelp@bajajallianz.co.in , Website www.bajajallianz.com Corporate Identification Number: U66010PN2000PLC015329

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