Excellent customer service, add-on products benefits like never before & much more..

For details please refer to Chevrolet Assured program brochure.

Dear Mr. RAVI KANT KALRA,

We thank you for choosing your Motor Insurance from Bajaj Allianz General Insurance Company Ltd (the “Insurer”). Your Motor Insurance Policy from the Insurer will be

generated through Marsh India Insurance Brokers Pvt. Ltd (“MIIBPL”). We are committed in bringing to you a satisfying experience for all your Motor Insurance

requirements. Keeping your convenience in mind, we have arranged to fulfill all your motor insurance needs at your nearest Chevrolet Sales India Pvt

Ltd's("Chevrolet")Authorized dealerships.

In case of an unfortunate event of an accident, you may contact the Insurer directly on the Toll free mentioned below. You may also contact us (MIIBPL) on 1800 2666 111

For your convenience, all the Authorized workshops of Chevrolet will assist you should the need arise.

We would like to add that your Motor Insurance Policy is recognized and welcomed by a wide network of Chevrolet's authorized dealers / workshops across the country.

The salient features of your motor Policy are:

• Online printout of policy certificate generated by the MIIBPL system
•Near cashless accident claims services per policy terms.
•Chevrolet authorized repairs and genuine spare parts in repairs
•Hassle Free, Fast & Convenient claims settlement
•Dedicated call center for policy related queries
•Seamless claims service at all authorized Chevrolet showrooms across India

Thank you once again for choosing us as your broker. We assure you of our best services at all times.

Happy and Safe Driving!!!

Team - Chevrolet Assured
A Motor Vehicle Insurance Program
Managed By : Marsh India Insurance Brokers Private Ltd.
Corporate /Registered office at 1201-02, Tower 2, One Indiabulls Centre, Jupiter Mills
Compound,
Senapati Bapat Marg, Elphinstone Road (W), Mumbai 400 013
Composite Broker
IRDA license no.120
License validity :03/03/2015 to 02/03/2018.
www.mmc.com www.marsh.com www.marsh.co.in
Toll free:1800 2666 111. Email: help.chevroletassured@marsh.com
Insurance is the subject matter of solicitation.
The purchase of Chevrolet Assured motor insurance is not mandatory. Customers may
opt for any motor insurance coverage of their choice. For more details on risk factors ,
terms and conditions please read sales brochure of the Insurer carefully before
concluding sale.

Your Insurer:
Bajaj Allianz General Insurance Company Ltd. Toll Free: 1800-22-5858, 1800-102-5858. www.bajajalianz.com
Printed At : Aarav Chevrolet - NCR Delhi
11 - A, SHIVAJI MARG, MOTI NAGAR, OPP. L & T,,New Delhi,Delhi Central , DELHI ,Delhi - 110015 , Mob No :9999999999

Disclaimer:
Pursuant to sec 64VB of the Insurance Act, You policy will only be effective after the Insurer has received the premium for the policy in cleared funds
In case of dishonor of the premium cheque, your policy is automatically cancelled Ab initio (i.e. from the outset)
For legal interpretation, English version will prevail. The attached policy certificate cum schedule is to be read with the policy wordings terms and conditions governing the coverage, which can be
downloaded from the Insurer’s web site : www.bajajallianz.com
Insurance is the subject matter of solicitation.
89378D0CE5275-8

Bajaj Allianz General Insurance Co. Ltd.

1st Floor, GE Plaza, Airport Road, Yerawada, Pune
411006
IRDA Regn. No.113
Private Car Package Policy
CERTIFICATE CUM POLICY SCHEDULE
Certificate cum Policy No: CBA/189378

DETAILS OF THE POLICY HOLDER POLICY DETAILS

Insured Name Mr. RAVI KANT KALRA Policy Issuing Office Code 1000
Insured Address HNO-1575, SECTOR-16, FARIDABAAD Policy Issuing Office 1st Floor, GE Plaza, Airport Road, Yerawada,
Faridabad HARYANA-121001 Pune 411006
Contact No. (s) 9873661110 Policy Issued On 25/01/2016
Email Address kalra.ravikant@gmail.com Policy Term 28/01/2016 00:01:00 To 27/01/2017 00:00:00
Nominee Details VINITA KALRA-55-WIFE Hypothecated To ICICI BANK LTD. - NEW DLEHI
Appointee Details Previous Policy No. OG-15-1101-1801-00019935
Broker Code 10039755 Previous Insurance Company Name Bajaj Allianz General Insurance Co. Ltd.

Broker Name Marsh India Insurance Brokers Pvt Ltd. Previous Policy Expiry date 27/01/2016

Broker Telephone No. 02266512900

VEHICLE DETAILS

Registration no RTO Location Make Model Variant Engine No. Chassis No. MFG(Year) CC Seating Carrying
Capacity Capacity
HR-51-AU- FARIDABAD- CHEVROLET Spark CHEVROLET B10S1003107K MA6MFBA1DD 2013 995 5 5
7712 HR51 SPARK 1.0 LS D2 T000325
13M

INSURED DECLARED VALUE

Vehicle IDV (In Rs.) Elec. Accessories Non-Elec. Accessories BIFUEL Kit Total Value (in Rs.)
252033.00 0.00 0.00 0.00 252033.00

SCHEDULE OF PREMIUM(IN RS.)

Own Damage(A) Liability(B)
Total Own Damage(A) 3158.00 Basic TPL 1468.00
NCB (25.00) % Add
Add On
Nil Dep + Consumables 2294.00
Consumables ,Nil Depreciation
PA Cover Owner Driver 100.00
PA Cover Paid Driver 50.00
PA Unnamed Passenger 250.00
Legal Liability Paid Driver 0.00
Legal Liability Employee 0.00
Bi-Fuel Kit TP 0.00
Total Liability Premium(B) 1868.00
Gross Premium(A+B+ADD ON) 7320.00
Service Tax 1025.000
Swatcha Bharat Tax 37.000
Net Premium 8381.00

Geographical Area Extension: India, Compulsory Deductibles (IMT-22) : 1000.00

IMT Codes : 22,7,15,17,16
LIMITS OF LIABILITY :
(a)Under Section II - 1 (i) of the policy -> Death of or bodily injury : Such amount as is necessary to meet the requirements of the Motor Vehicles Act, 1988.
(b)Under Section II - 1 (ii) of the policy -> Damage to Third Party Property Rs 750,000.00 ; PA Cover for Owner-Driver under section III: CSI Rs 2,00,000.00 ;
Voluntary Deductable Rs. 0.00
LIMITATIONS 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), Organized racing, Pace making,
Speed testing, Reliability trials,Any purpose in connection with Motor Trade.
DRIVER'S CLAUSES:
Any person including the insured : Provided that a person driving holds an effective Driving License at the time of the accident and is not disqualified from holding or obtaining
such a license. Provided also that the person holding an effective Learner's License may also drive the vehicle and that such a person satisfies the requirements of Rule 3 of the
Central Motor Vehicles Rules, 1989. Subject to IMT Endorsement Nos. & Memorandum printed herein / attached hereto : 28,22
Under Hire Purchase/Hypothecation/Lease Agreement with : ICICI BANK LTD.
Premium Collection Details :-[Amount / ReceiptDate] Rs.8381.00 / 25/01/2016 15:25:31
Received with thanks from Mr. RAVI KANT KALRA an amount of Rs. 8381.00 towards Insurance Premium. Consolidated Stamp Duty Paid.
Note : Policy cover is subject to realisation of cheque.
WARNING THAT IN CASE OF DISHONOUR OF THE PREMIUM CHEQUE , THIS DOCUMENT STANDS AUTOMATICALLY CANCELLED 'AB-INITIO'
I/We hereby certify that the policy to which the certificate relates as well as the certificate of insurance are issued in accordance with the provision of chapter X,XI of M.V.Act
1988
Service Tax Registration No. : AABCB5730G-ST-001 For Bajaj General Insurance Company Ltd
Insurance Company PAN No. : AABCB5730G
Service Tax Code Number : PNEB02239G
Category : General Insurance Services
Stampduty Challan No. : ADJ/CS/42/07/7383/07
Challan Date : 18th April 2007

Duly Constituted Attorney

In Witness whereof this Policy has been signed at Delhi this 25/01/2016 15:25:31.
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". For legal interpretation,English version will hold good.This document is to be read with the policy wordings terms and conditions governing
the coverages which can be downloaded from our web site : www.bajajallianz.com
Please call Toll Free No. 1800-22-5858, 1800-102-5858 ,1800-102-5858,1800-209-5959(Toll Free) /
91-020-30305858 for all Insurance Related Assistance
 DEPRECIATION SHIELD
A. Endorsement Wordings
In consideration of payment of additional premium, it is hereby agreed and declared that this Policy extends to cover the depreciation amount,
partly or fully, on assessed damaged parts allowed for replacement during repairs in the event of a Partial Loss to the Insured Vehicle.
In the event You have opted for co-payment, Your contribution shall be to the extent agreed by You as shown in the Schedule for the
depreciation amount on the assessed parts for each and every Partial Loss claim.
The benefits under ‘Depreciation Shield’ would be available only if the Insured Vehicle is repaired at Our authorized workshops. In case
You have opted to repair the Insured Vehicle at a non-authorized workshop, Our liability will be restricted to 90% of the assessed total claim
amount under this cover.
B. Conditions
a. Claims made by You against Us under ‘Depreciation Shield’ are subject to the terms and conditions set forth under the Motor Insurance
Policy
b. In case of transfer of ownership of the Insured Vehicle, the cover under ‘Depreciation Shield’ shall expire
c. The benefits under ‘Depreciation Shield’ can be utilized for a maximum of two times during the Policy Period
C. Exclusions
In addition to the exclusions mentioned under Motor Insurance Policy, We will not be liable to indemnify You for the following events:
1. Where the Own Damage Claim made by You against Us under the Motor Insurance Policy is not payable
2. Depreciation pertaining to any part/ sub part/ accessories not approved for replacement by Us under Motor Insurance Policy
3. Loss or damage to tyres and/or battery of the Insured Vehicle
4. Consequential loss of any kind arising out of claims lodged under ‘Depreciation Shield’
5. Where a loss is covered under Motor Insurance Policy or any other type of insurance policy with any other insurer or manufacturer’s
warranty or recall campaign or under any other such packages at the same time
D. Definitions
The words and phrases listed have special meanings We have set below whenever they appear in bold type and initial capitals. Please note
that references to the singular or to the masculine also include references to the plural or to the female the context permits and if appropriate.
1. You, Your, Yourself: The person or persons We insure as set out in the Schedule
2. We, Our, Us: Bajaj Allianz General Insurance Company Limited
3. Accident, Accidental: A sudden, unintended and fortuitousexternal and visible event
4. Policy/ Motor Insurance Policy: Private Car Package Policy issued by Us to which this cover is extended
5. Insured Vehicle: The vehicle insured by Us under the Motor Insurance Policy and as shown on the Schedule
6. Policy Period: The period between and including the commencement date and expiry date as shown in the Motor Insurance Policy
Schedule
7. Schedule: The Schedule and any Annexure or Endorsement to it which sets out Your personal details and the insurance cover in force
8. Own Damage Claim: The claims raised by You against Us for loss or damage to the Insured Vehicle due to the perils mentioned under
Section 1 of Motor Insurance Policy
9. Total Loss/ Constructive Total Loss: A loss under the Motor Insurance Policy where the aggregate cost of retrieval and/ or repair of the
Insured Vehicle, subject to terms and conditions of the Policy, exceeds 75% of the IDV of the Insured Vehicle
10. Partial Loss: Any loss falling into a category other than (a) the loss mentioned under Sr. No. 9 above and (b) theft of the Insured Vehicle
CONSUMABLE EXPENSES
UIN: BAL-MO-A00-00-48-V01-13-14
A.Endorsement Wordings
In consideration of payment of additional premium, it is hereby agreed and declared that if the Insured Vehicle is damaged by a covered peril
mentioned under the own damage section of the Motor Insurance Policy and needs to be repaired, We will cover cost of consumables
required to be replaced/ replenished during the repair of the damaged vehicle.
Consumable for the purpose of this cover shall include engine oil, gear box oil, power steering oil , coolant , AC gas oil , brake oil , AC
refrigerant , battery electrolyte , windshield washer fluid, radiator coolant, nut & bolt, screw, oil filter, fuel filter, bearings, washers,
clip, wheel balancing weights , and items of similar nature excluding fuel.
B.Conditions
a. This cover is applicable if it is shown on Your schedule
b.Claims made by You against Us under ‘CONSUMABLE EXPENSES’ are subject to the terms and conditions set forth under the Motor
Insurance Policy
c. In case of transfer of ownership of the Insured Vehicle, the cover under ‘CONSUMABLE EXPENSES’’ shall expire
d.Full benefits under‘CONSUMABLE EXPENSES’ would be available only if the Insured Vehicle is repaired at Our authorized
workshops. In case You have opted to repair the Insured Vehicle at a non-authorized workshop, Our liability will be restricted to 90% of the
assessed total claim amount under this cover.
e. Where a loss is covered under Motor Insurance Policy or any other type of insurance policy with any other insurer at the same time, claim
payable shall be according to Contribution clause.
C.Exclusions:
In addition to the exclusions mentioned under Motor Insurance Policy, We will not be liable to indemnify You for the following events:
1. Where the Own Damage Claim made by You against Us under the Motor Insurance Policy is not payable
2. Consumables pertaining to any part/ sub part/ accessories not approved for replacement by Us under Motor Insurance Policy
D.Definitions
The words and phrases listed have special meanings We have set below whenever they appear in bold type and initial capitals. Please note
that references to the singular or to the masculine also include references to the plural or to the female the context permits and if appropriate.
1.Authorized workshop / garage / service station – A motor vehicle repair workshop / garage / service station authorized by us.
2. Contribution – Contribution is essentially the right of an insurer to call upon other insurers liable to the same insured to share the cost of
an indemnity claim on a rate able proportion of Sum Insured.
3.Insured Vehicle: The vehicle insured by Us under the Motor Insurance Policy and as shown on the Schedule
4.Policy/ Motor Insurance Policy: Motor Package Policy issued by Us to which this cover is extended.
5.Schedule: The Schedule and any Annexure or Endorsement to it which sets out Your personal details and the insurance cover in force
6.We, Our, Us: Bajaj Allianz General Insurance Company Limited
7.You, Your, Yourself: The person or persons We insure as set out in the Schedule
E.Contribution Clause
If at the time of any claim, there is, or but for the existence of this Policy, would be any other policy of indemnity or insurance in favour of or
effected by or on behalf of the Insured applicable to such claim, then the Company shall not be liable to pay or contribute more than its
rateable proportion of any loss or damage.

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