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Bajaj Allianz General Insurance Company LTD
Bajaj Allianz General Insurance Company LTD
Registered and Head Office: Bajaj Allianz House, Airport Road, Yerwada, Pune
A. Proposer details
B.Vehicle Details
Registration Vehicle Vehicle Vehicle CC/KW Year Of Vehicle Vehicle/Trail- Vehicle Engine
Number Make SubType Model Manufac- Seating Ca- er Chassis Number
turing pacity Number
DL1RV7779 BAJAJ CNG 4 RE COM- 199 2018 3 D45256 D78902
STROKE PACT 4S
AUTO
RIKSHAW
Fuel Type Vehicle IDV Electrical Non- Trailer Trailer Re- CNG/LPG Total Sum In-
(in Rs.) Accessor- Electrical Ac- gistration Unit (Extra sured
ies IDV (in cessories IDV Number fitted) IDV (in
Rs.) (in Rs.) Rs.)
1,30,677 0 0 0 1,30,677
C. Coverage opted
Policy issuing office and Correspondence address for communication by policyholder for claim, service request, notice, summons,
etc; 12th Floor, Dr. Gopaldass Bhawan,, 28, Barakhamba Road,, Connaught Place,, , New Delhi-110001 Phone No
:41490500/41490573/41490588/509/560
Policy Number OG-21-1101-1803-00001424 Product Commercial Vehicle Package Policy
Vehicle Type Passenger Carrying - 3 Wheel & Carrying Capacity <= 6
Period Of Insurance From: 01-Sep-2020 11:17 Policy issued on 31-Aug-2020 -
To: 31-Aug-2021 Midnight Cover Note No /
Application No Scrutiny No 205434926
Insured Name INDER JIT Zone A
Insured Address C P M , SHAKTI PEETH, ,CHATTARPUR,
SOUTH WEST DELHI - 110074
Customer ID 190471799 Premium Payer ID 190471799
Transaction Id
Policy Status ISSUED
GSTIN / UIN NA Place of Supply/State 07 - Delhi
Code/Name
Invoice No. 208284305/1
Company GST No 07AABCB5730G1ZZ
Company PAN No AABCB5730G
Registration Make SubType Model CC/KW Mfg year Seat Cap Vehicle/Trailer Engine Number
No. Chassis No
DL1RV7779 BAJAJ CNG 4 RE COMPACT 199 2018 3 D45256 D78902
STROKE 4S
AUTO
RIKSHAW
Fuel Type Vehicle IDV Elec Acc Non Elec Acc Trailer Trailer Reg No CNG/LPG Unit Total Sum Insured
1,30,677 0 0 0 1,30,677
SCHEDULE OF PREMIUM
OWN DAMAGE LIABILITY
Total Own Damage Premium: 88.00 Basic Third Party Liability 6,318.00
CNG / LPG Unit (IMT.25) 60.00
PA Cover For Owner-Driver - SI - Rs. 331.00
15,00,000.00
LL For Operation/Maintenance For 1 Person 50.00
Total Liability Premium: 6,759.00
Total premium 6,847.00
Special Discount
Net Premium 6,847.00
State GST (9%) 616
Central GST (9%) 616
Final Premium Rs. 8,079.00 ***All Premium Figures are in Rupees
Geographical Area : No Claim Bonus : 0% Voluntary Excess : Nil
Nominee Details Name : NA Relationship : NA
Compulsory Deductible : Rs.500 Additional Compulsory Deductible : Rs.0
The above Total OD Premium is inclusive of all applicable Loading/Discounts viz (Automoble Association Membership,Voluntary Excess,Anti-Theft,Handicap Per-
son,Driver Tution,Fibre Glass,Cng/Lpg Unit,Geographical Extn,Imported Vehicle etc wherever applicable)
As per the GST regulations, the amount of GST will not be refunded if the policy / endorsement is cancelled after 30th
September of the next financial year
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.7,50,000.00/-
LIMITATION AS TO USE: The Policy covers use only under a permit within the meaning of the Motor Vehicle Act, 1988 or such a carriage falling under Sub-
section 3 of Section 66 of the Motor Vehicle's Act 1988. The Policy does not cover use for : Organised racing, Pace Making, Reliability Trials, Speed Test-
ing,Use whilst drawing a trailer except the towing (other than for reward) of any one disabled Mechanically propelled vehicle.
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 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".
Subject To IMT Endorsement Nos : 25, 28, & Policy wordings attached herewith
Warranted that insured named herein or owner of the vehicle insured holds a valid Pollution Under Control (PUC) and
/ or Fitness Certificate on the date of commencement of the Policy. If the PUC and/or Fitness Certificate is not found to
be valid on the date of commencement of the Policy, the Company reserves its right to consider the policy void ab ini-
tio.
Agency Code BAG100006748 Channel Name : ML
Agency Name : JITENDER KUMAR
Contact No : 9871576526/9871576526
Email - 143JITENDRAK@GMAIL.COM
Damage Details as per Annexure I
Premium Collection Details :- [Receipt No/Collection No/Amount] 1101-01132738 / 205434926 / Rs. 8,079.00 ,
*** If premium paid through cheque, the policy is void ab-initio in case of dishonour of cheque.
Regd. Office : Bajaj Allianz House, 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.Principal Location : Block No-4, 7th
Floor, DLF Towers, 15, Shivaji Marg, -, New Delhi - 110015 PH:011-66278000 | Services Accounting Code : 997134 - Motor vehicle insurance services. No reverse charge
is payable on these services. - Latest Schedule - 31-Aug-2020 11:21:48 AM (Web)
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 : - Cost of Repair / Replacement towards the damaged parts noticed during the inspection of your vehicle
prior to enrolment under this policy as per Inspection report reference number 2020-06327515 duly signed by you or your
representative as well as the photographs shall be excluded in the event of any future claims.
Remarks -
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 'Bagichelp@bajajallianz.co.in'.
205434926/-/10049023/NA/-
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.
This is the 'Digital Print' and original Policy would follow and the Original policy, duly countersigned, to be relied on for all legal purposes.
Authorized Signatory This document is digitally signed, hence counter signature / stamp is not required
null
Regd Office : Bajaj Allianz House,Airport Road, Yerwada Pune-411006 (India), A Company incorporated under Indian Companies Act, 1956 and licensed by In-
surance Regulatory and Development Authority of India [IRDA] vide Reg No.113, Corporate Identification Number U66010PN2000PLC015329.
Consolidated Stamp Duty of Rs.0.5/- paid towards Insurance Stamps vide Challan No. MH013770432201920M Defaced No. 0000433117202021 Order
No.CSD/22/2020/1432/2020 Order Dated 09.06.2020Defaced date dated 09-JUN-20 timing 12:23:03 of General Stamp Office,Mumbai,India.
Generated by 10049023@general bajajallianz co in
Regd. Office : Bajaj Allianz House, 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.Principal Location : Block No-4, 7th
Floor, DLF Towers, 15, Shivaji Marg, -, New Delhi - 110015 PH:011-66278000 | Services Accounting Code : 997134 - Motor vehicle insurance services. No reverse charge
is payable on these services. - Latest Schedule - 31-Aug-2020 11:21:48 AM (Web)
Bajaj Allianz General Insurance Company Ltd.
12th Floor, Dr. Gopaldass Bhawan, 28, Barakhamba Road, Connaught Place, New Delhi - 110001
Contact No:Contact No: 41490500/41490573/41490588/509/560; Fax No: 91-11-41490511
RECEIPT
Authorised Signatory