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
BR21D8164 APR-2010 HERO CBZ X DISC KICK PETROL 150 2010 2
HONDA TREME START
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.)
KC12EBAGC0 MBLKC12EC 0 0 0 0 0
2619 AGC02783
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-22-9906-1806-00254628 Product Liability Only Policy For Two Wheeler
Period Of Insurance From: 03-Sep-2021 Policy issued on 01-Sep-2021 -
To: 02-Sep-2022 Midnight Cover Note No /
Application No Scrutiny No 285053515
Insured Name JITENDRA PRASAD Zone B
Insured Address VILL/PO RUSTAMPUR PS HULASHGAN, J
DIST JEHANABAD BIHAR, ,, NALANDA -
804407
Customer ID 226192375 Premium Payer ID 226192375
Transaction Id
Policy Status ISSUED
GSTIN / UIN NA Place of Supply/State 10 - Bihar
Code/Name
Invoice No. 302180339/1
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
BR21D8164 HERO DISC KICK CBZ X TREME 150 2010 2 MBLKC12E KC12EBAGC02619
HONDA START CAGC0278
3
SCHEDULE OF PREMIUM
OWN DAMAGE LIABILITY
Total Own Damage Premium: Basic Third Party Liability 702.00
Total premium 702.00 Total Liability Premium: 702.00
Special Discount 0
Net Premium 702.00
Integrated GST (18%) 126.00
Final Premium Rs. 828.00 ***All Premium Figures are in Rupees
Geographical Area : No Claim Bonus : 0%
Nominee Details Name : NA Relationship : NA
Previous Insurer - NA Previous Policy No -NA Expiry On -
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
In case of any claim, please contact our 24 Hour Call centre at 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'.
285053515/-/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.
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 - 01-Sep-2021 18:47:50 PM (Web)
Stamp
Duty Rs.
0.5
Authorized Signatory This document is digitally signed, hence counter signature / stamp is not required
Printed , Signed and Executed at Pune
Consolidated Stamp Duty of Rs.0.5/- paid towards Insurance Stamps vide Challan No. MH014271630202021M Defaced No. 0000144047202122 dated 12-APR-21
timing 13:29:05 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 - 01-Sep-2021 18:47:50 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