Professional Documents
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Registered and Head Office: Bajaj Allianz House, Airport Road, Yerwada, Pune
A. Proposer details
B.Vehicle Details
Registration
Month / Vehicle Vehicle
Vehicle Fuel Type Cubic Ca- Year of Man- Seating Capa-
Number Year of Make Model
Sub Type pacity/ ufacture city
Regn Kilowatt
MH06AN191 OCT-2007 MARUTI WAGON R LXI LPG CNG/LPG 1061 2007 5
4
Engine Num- Chassis Num- Vehicle IDV Electrical Non-Electrical Ac- CNG/LPG Unit Total IDV (in Rs.)
ber ber (in Rs.) IDV (in Rs.) cessories IDV (in (Extra fitted)
Rs.) IDV (in Rs.)
F10DN440118 MA3EED81S0 0 0 0 0 0
4 0577074
C. Coverage opted
Policy issuing office and Correspondence address for communication by policyholder for claim, service request, notice, summons,
etc; Bajaj Finserv Building, 1st Floor, Behind Weikfield IT-Park, Viman Nagar, Pune-411014 Phone No :1800-209-0144
Policy Number OG-21-9906-1805-00078430 Product Liability Only Policy For Private Car
Period Of Insurance From: 22-Mar-2021 Policy issued on 20-Mar-2021 -
To: 21-Mar-2022 Midnight Cover Note No /
Application No 256515814 Scrutiny No
Insured Name SUNITA M JOSHI B Zone
Insured Address FLAT NO. 103 SUSHIL PRIDE SWAM I
NITYANAND MARG PLOT NO. 67/2 NEAR
GARDEN HOTEL THANA NAKA, NAVI MUM-
BAI, MAHARASHTRA, ,, - 410206
Customer ID 142071879 Premium Payer ID 142071879
Transaction Id
Policy Status ISSUED
GSTIN / UIN NA Place of Supply/State 27 - Maharashtra
Code/Name
Invoice No. 257576295/1
Company GST No 27AABCB5730G1ZX
Company PAN No AABCB5730G
Registration Make SubType Model CC/KW Mfg year Seat Cap Vehicle/ Engine Number
No. Trailer
Chassis
No
MH06AN1914 MARUTI LXI LPG WAGON R 1061 2007 5 MA3EED81 F10DN4401184
S00577074
Fuel Type Vehicle IDV Elec Acc Non Elec Acc Trailer Trailer Reg No CNG/LPG Unit Total Sum Insured
CNG/LPG 0 0 0 0 0
SCHEDULE OF PREMIUM
OWN DAMAGE LIABILITY
Total Own Damage Premium: Basic Third Party Liability 3,221.00
CNG / LPG Unit (IMT.25) 60.00
Total Liability Premium: 3,281.00
Additional loading @ 0% 0
Contact No : 0/1800-103-3999
Email -
Damage Details as per Annexure I
Premium Collection Details :- [Receipt No/Collection No/Amount] 9906-04702137 / 256515814 / Rs. 3,871.00 ,
*** 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 1800-102-5858 (Toll Free) / 91-020-30305858 (chargeable, add area
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 : Bajaj Allianz
House, Airport Road, Yerwada, Pune - 411006 PH:66026666 | Services Accounting Code : 997134 - Motor vehicle insurance services. No reverse charge is payable on
these services. - Latest Schedule - 20-Mar-2021 12:26:55 PM (Web)
code before this number in case of mobile call) or email us at 'Bagichelp@bajajallianz.co.in'.
256515814/-/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.
Authorized Signatory This document is digitally signed, hence counter signature / stamp is not required
Printed , Signed and Executed at Pune
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. MH010174751202021M Defaced No. 0004860541202021 dated 25-JAN-21
timing 17:39:54 of General Stamp Office,Mumbai,India.
Generated by Silent_Printing
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 : Bajaj Allianz
House, Airport Road, Yerwada, Pune - 411006 PH:66026666 | Services Accounting Code : 997134 - Motor vehicle insurance services. No reverse charge is payable on
these services. - Latest Schedule - 20-Mar-2021 12:26:55 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
Authorised Signatory