Bajaj Allianz General Insurance Company Ltd.
Bajaj Allianz House, Airport Road, Yerwada, Pune - 411006(India)
LIABILITY ONLY POLICY FOR TWO WHEELER CERTIFICATE CUM POLICY SCHEDULE
UIN : IRDAN113RP0041V01200102

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-21-9906-1806-00374969
OG-20395-22158-00-0021
OG-21-9906-1806-00526 Product Liability Only Policy For Two Wheeler
Period Of Insurance From
From
From
From:
From
From 28-11-2021
25-OCTOBER-2021
24-July-2021
15-April-202112:00:01
16-Mar-2021
19-Jan-2021
08-07-2021
27-11-2022
06-April 00:01 12:00:01
12:00:01
12:00:01
27-March-2021
2021 Policy issued on OCTOBER
JAN23
July 23 -
14-Mar-2021
07-june-2021
25-March-2021
182021
05-APRIL-2021
15-APRIL-2021
NOV
NOV-09
27
To
ToTo
To18-Jan-2022
07-07-2022
27-11-2022
To
To Midnight
Midnight
24-OCTOBER-2022
23-July-2022
14-April-2022
Midnight
26-March-2022
05-April
26-11-2023
2022 Midnight
Midnight
Midnight
Midnight
Midnight
midnight Cover Note No /
To: 15-Mar-2022 Midnight
Application No Scrutiny No 254922285
Insured Name MRMRS
S
MRS
MRSMR
V LALITHA
TAMMINENI
D SANTOSH
SREERAMULU
VARAHALU
RAMA G DPRABHAKARA
SANTHOSH KUMAR
RAOILAPANDA
PADMALATHA KUMAR RAO Zone B
MR
KMR
Mr VIK UMAMAHESWARI
MUSALAYYA
L HARIBABU
VENKATA
SONTHOSH
SURESH KOMATURU
SAI
KUMAR MANISH
MAVUDURI
Insured Address W/O
S/O
W/O
S/OS/O
S/O
A/O
W/O
S/O RAJESWARA
SRINIVASARAO
PARVATEESA
NEELAYYA
VENKATA
APPARAO
S/O THATA
UMAMAHESWARA
ASIRODU
KRISHNARAO,RAO RAO
SARMA
RAOLATE,BELAMARA-VIL,
RAO
S/OS/O S/O BHASKAR
LATCHAYYA
MALLESWARA
SRIKAKULAM
13-9-2/4/4 LATE RAO
DNO
MAIN 12-62
L,POLAKI-MDM,
STREET
DHARMAVARAM
2-14
H/17
DNOMAIN STREET
10-68/3
11-59,RAJAVEEDHI ,, SRIKAKULAM - 532430
85/102
VANAVANA
43C,PEDDA
ANDHRA
KAKIVEEDHI
TAMARA
8TH FLOOR
PETA
VEEDHI
PRADESH
PALLI
GEM
Customer ID SRIKURMAM
BONTHALA
MAIN ROAD
KALLEPALLI
211377102
KOTAPALEM
TEPPAREVU
SRIKAKULAM KODURU Premium Payer ID 211377102
GROVE
SRIKAKULAM APARTMENTS
LAVERU,ADAPAKA
SRIKAKULAM
NARASANNAPETA OMR
GARA
POLICY
ETCHERLAQUARTERS
MOPASUBANDARA
RANASTHALAM
PONNADA
PADUR
SRIKAKULAM
532001
SRIKAKULAM ,KANCHEEPURAM Transaction Id
ETCHERLA
SRIKAKULAM532408
532401
SRIKAKULAM Policy Status ISSUED
SRIKAKULAM
GSTIN / UIN NA Place of Supply/State 37 - Andhra Pradesh
Code/Name
Invoice No. 256029719/1
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
AP30AA4212 HERO BAJAJMO- KICK START DISCOVER
HF DELUX 100 2014
2010 2 MBLHA11E
YAHL152 HA11EFD9H26058
EFAHL71608
APAP
AP
AP
AP
AP
TN 30
3030
30
35AE
30
30
35
09
30
AH
LBX
K
M
K4272
N3464 MAHINDRA
M
N HERO
MAESTRO
YMAHA DURO BSIII SPLENDOR
PASSION
DELUX
YAMAHA FZ16BSIII+
DURO
PULSAR
PRO
DELUXE 125
97.00
150
10999.9 2011
2010
2015
2014 202
02
02
02 WH42025
1G37377
UJA89082
HH03897
FGK02284
2021001 MBUH54250
PFEAG313114
ZZUCA06353
HH04384
AAFG02933
CK020760
AP31
AP
AP 31BV
30 BN
AA TOCORP
SPLEND
HERO
HERO DRUM
HONDA
HEROBREAK
GLAMOUR DRUM
DRUMS
DUET 99.9 2010 2 WD9H2379
9M02190
55 GAM03055
AP1793
30
3480
90203
1470
7344
9782
0973 AA DUET
HONDA
DURO
MOTOR PASSION
DUET
SHINE 125
CB-SHINE
PRO
DTS I 125
150 2011
2014
2016
2014 02 06AGEGC
028086
GGF04044
HK17639
H06890 ET043985
6EJEGC
GGF05264
BHK19684
GH09142
9023
3601
7618
4828 FZ16
PRO
HONDA SPOKE
MOTOR
PASSIONCO KICK
PRO 5
0884 WHEEL

SCHEDULE OF PREMIUM
OWN DAMAGE LIABILITY
Total Own Damage Premium: Basic Third Party Liability 752.00
1080.00
Total premium 752.00
1080.00 Total Liability Premium: 752.00
1080.00
Special Discount 0
Net Premium 752.00
1080.00
Integrated GST (18%) 135.00
194.00
Final Premium Rs. 887.00
1274.00 ***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

Nominee Details Name : Relationship :

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.1,00,000.00/-
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
Warranted that insured named herein or owner of the vehicle insured holds a valid Pollution Under Control (PUC) and
/ or Fitness Certificate on the date of commencement of the Policy. If the PUC and/or Fitness Certificate is not found to
be valid on the date of commencement of the Policy, the Company reserves its right to consider the policy void ab ini-
tio.

Contact No : 0/1800-103-3999
Email -
Damage Details as per Annexure I
Premium Collection Details :- [Receipt No/Collection No/Amount] 9906-04681314 / 254922285 / Rs. 887.00 ,
*** 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 PDA MODULE

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'.
254922285/-/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.

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

Stamp
Duty Rs.
0.5

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 - 14-Mar-2021 15:32:33 PM (Web)