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:17/10/2020
Policy Number: SE679463

Smart Drive Standalone Motor Compulsory Personal Accident Policy Schedule

Your Smart Drive Standalone Motor Compulsory Personal Accident Policy Number(SE679463) is enclosed. The terms,
conditions, guidelines and other relevant details of your Insurance coverage is given below.

Policy Information

Policy Number SE679463

Source
Proposer Purushothaman Jayaraman M
CHNo 8, Kothandapani street, 1 st Lane, Rajiv
Address Nagar, Nerkundr am, Mettukuppam
Chennai,Tamil Nadu-600107
Period of Insurance 27/10/2020-00:00:00.000 TO 26/10/2021-Midnight

Premium

Premium 325
GST 59
Total Payable 384

Risk Details

Name of member insured Purushothaman Jayaraman M

Mobile number ******9089
Sum Insured 1500000
Beneficiary Sapna T D
Relationship Spouse

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:17/10/2020

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