Bharti Axa General Insurance Company Limited

1800-103-2292 (Toll Free)

customer.service@bhartiaxa.com
SMS <Service> to 5667700
www.bharti-axagi.co.in

Date:12/02/2021
Policy Number: SE795399

Smart Drive Standalone Motor Compulsory Personal Accident Policy Schedule

Your Smart Drive Standalone Motor Compulsory Personal Accident Policy Number(SE795399) is enclosed. The terms,
conditions, guidelines and other relevant details of your Insurance coverage is given below.

Policy Information

Policy Number SE795399

Source
Proposer Subhash Singh
Village - Bhaiyapur, Post - Darra ( Sangipur) ,
Address Tehsil - Lalganj, District - Pratapgarh
Pratapgarh,Uttar Pradesh-230139
Period of Insurance 13/02/2021-00:00:00.000 TO 12/02/2022-Midnight

Premium

Premium 325
GST 59
Total Payable 384

Risk Details

Name of member insured Subhash Singh

Mobile number ******5529
Sum Insured 1500000
Beneficiary Akansha singh
Relationship Daughter

Coverage Details

Plan Name CPA750

Source 1. 100% of CSI for Death, Loss of Two Limbs or sight of both eyes or
one limb and sight of one eye.
2. 50% of CSI for Loss of one Limb or sight of one eye.
3. 100% for Permanent Total Disablement from injuries other than
named above

UIN NO IRDAN139RP0072V01201819
Issued by:bagiagent on:12/02/2021

BHARTI AXA GENERAL INSURANCE COMPANY LIMITED

Corporate Office: Unit 102, Ist Floor, Raheja Titanium, Off Western Express Highway, Goregaon, Mumbai - 400063
Registered office: First Floor, Hosto Centre, No. 43, Millers Road, Vasant Nagar, Bangalore - 560062. IRDA Reg. No. 139. Tel: 1800-103-2292 (Toll Free), Email: customer.service@bhartiaxa.com