Bajaj Allianz General Insurance Company Ltd.
GE Plaza, Airport Road, Yerwada, Pune - 411006(India)
CERTIFICATE CUM POLICY SCHEDULE

Policy Servicing Off: Bajaj Allianz General Insurance Co Ltd., The Silver Line, 11/9,, Civil Lines,, Opp Elgin Retail Shop,, Kanpur-208001
Phone No :05122530780
Policy Number OG-18-1321-1806-00004312 Product Motor Liability Only Policy-TW through CSC
(UIN : BAL-MT-P16-01-V01-16-17)
Period Of Insurance From: 10-Oct-2017 00:01 Policy issued on 09-Oct-2017 -
To: 09-Oct-2018 Midnight Cover Note No /
Application No Scrutiny No 75604292
Insured Name MR GHANSHYAM Zone B
Insured Address PARAMANANDPUR, KERAKAT, JAUNPUR,,
UTTAR PRADESH - 222129
Customer ID 105668638 Premium Payer ID 72985989
Transaction Id
Policy Status ISSUED
GSTIN / UIN NA STATE CODE / NAME 09 - Uttar Pradesh
Registration Make SubType Model CC Mfg year Seat Cap Vehicle/Trailer Engine Number
No. Chassis No
UP62AM8281 HERO HONDA CAST - DRUM PASSION PRO 100 2014 2 MBLHA10A6EHE5 HA10ENEHE76425
BRAKE ELEC- 3868
TRIC START

Vehicle IDV Elec Acc Non Elec Acc Side Car Trailer Reg No CNG/LPG Unit Total Sum Insured
0 0 0 0 0
SCHEDULE OF PREMIUM
OWN DAMAGE LIABILITY
Total Own Damage Premium: Basic Third Party Liability 720
PA Cover For Owner-Driver Of Rs. 100000 50
Total Liability Premium: 770
Additional loading @ % 0

Total premium 770

Special Discount
Net Premium 770
State GST (9%) 69
Central GST (9%) 69
Final Premium Rs. 908 ***All premium Figures are in Rupees
Geographical Area : INDIA No Claim Bonus : 0%
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.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 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 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 : & Policy wordings attached herewith
Broker Code UP02669 Channel Name : AC
Broker Name : ROHIT CHAURASIYA
Contact No : 0/0
Email -
Damage Details as per Annexure I
Premium Collection Details :- [Receipt No/Collection No/Amount] / Rs. 908 By Float No : NF
*** 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 -

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 'customercare@bajajallianz.co.in'.
75604292/-/UP02669/UP02669/-
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.

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

Stamp
Duty Rs.
0.5

Authorized Signatory
null null Consolidated stamp Duty paid vide Receipt No: .47 dated 26-SEP-17

Regd. Office : GE Plaza, Airport Road, Yerawada,Pune - 411006 (India),A Company incorporated under Indian Companies Act, 1956 and licensed by Insur-
ance Regulatory and Development Authority of India [IRDA] vide Reg No.113, Corporate Identification Number U66010PN2000PLC015329.BAGIC GST No :
09AABCB5730G1ZV | Principal Location : Bajaj Allianz General Insurance Co.Ltd, 15/54 B 2nd Floor, Virendra Smriti Complex, Civil Lines, KANPUR
NAGAR - 208001 PH:0512-2338277 | Services Accounting Code : 997134 - Motor vehicle insurance services. No reverse charge is payable on these ser-
 



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