Professional Documents
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Registered and Head Office: Bajaj Allianz House, Airport Road, Yerwada, Pune
A. Proposer details
B.Vehicle Details
RegistrationMonth / Vehicle Vehicle Vehicle Fuel Type Cubic Ca- Year of Man- Seating Capa-
Number Year of Make Model Sub Type pacity/ ufacture city
Regn Kilowatt
GJ09AG5315 OCT-2010 MARUTI ALTO LXI PETROL 796 2010 5
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.)
443904 685325 0 0 0 0 0
C. Coverage opted
Policy issuing office and Correspondence address for communication by policyholder for claim, service request, notice, summons,
etc; 25-28,Upper Ground Flr,, Megh Mayur Plaza,, Athwalines,Parlepoint, , Surt Dumas Rd,, Surat-395007 Phone No :0261-2256682
Policy Number OG-23-2203-1805-00000072 Product Liability Only Policy For Private Car
Period Of Insurance From: 09-May-2022 00:01 Policy issued on 07-May-2022 -
To: 08-May-2023 Midnight Cover Note No /
Application No Scrutiny No 310752079
Insured Name AJAY SOLANKI Zone B
Insured Address TEST ONLINE1, TEST ONLINE1, TEST ON-
LINE1,TEST ONLINE1, TEST ONLINE1 -
411001
Customer ID 270150536 Premium Payer ID 270150536
Transaction Id
Policy Status ISSUED
GSTIN / UIN NA Place of Supply/State 27 - Maharashtra
Code/Name
Invoice No. 349989938/1
Company GST No 24AABCB5730G1Z3
Company PAN No AABCB5730G
Registration Make SubType Model CC/KW Mfg year Seat Cap Vehicle/ Engine Number
No. Trailer
Chassis
No
GJ09AG5315 MARUTI LXI ALTO 796 2010 5 685325 443904
Fuel Type Vehicle IDV Elec Acc Non Elec Acc Trailer Trailer Reg No CNG/LPG Unit Total Sum Insured
PETROL 0 0 0 0 0
SCHEDULE OF PREMIUM
OWN DAMAGE LIABILITY
Total Own Damage Premium: Basic Third Party Liability 2,072.00
PA Cover For Owner-Driver - SI - Rs. 331.00
15,00,000.00
Total Liability Premium: 2,403.00
Additional loading @ % 0
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 : 4th Floor, Tur-
quoise, Nr. Panchvati Circle, C.G Road, Ellisbridge, Ahmedabad - 380006 PH:079-26432000 | Services Accounting Code : 997134 - Motor vehicle insurance services. No
reverse charge is payable on these services. - Latest Schedule - 07-May-2022 14:24:48 PM (Web)
code before this number in case of mobile call) or email us at 'Bagichelp@bajajallianz.co.in'.
310752079/-/10031837/31837RFD/-
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. MH002405964202122M Defaced No. 0001482221202122 dated 05-JUL-21
timing 12:58:03 of General Stamp Office,Mumbai,India.
Generated by bhaumik desai
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 : 4th Floor, Tur-
quoise, Nr. Panchvati Circle, C.G Road, Ellisbridge, Ahmedabad - 380006 PH:079-26432000 | Services Accounting Code : 997134 - Motor vehicle insurance services. No
reverse charge is payable on these services. - Latest Schedule - 07-May-2022 14:24:48 PM (Web)