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  • Claim Form

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    Ashirwad Banerjee
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    The document is a claim summary sheet from Bajaj Allianz General Insurance Company for a vehicle insurance claim filed by Ravindra Kumar. It provides details of Ravindra Kumar's insurance policy, the vehicle involved in the claim, and describes the incident where Ravindra swerved to avoid an animal and lost control of the vehicle. The summary sheet also includes information on the inspection location and Ravindra's past claim history.

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    The document is a claim summary sheet from Bajaj Allianz General Insurance Company for a vehicle insurance claim filed by Ravindra Kumar. It provides details of Ravindra Kumar's insurance policy, the vehicle involved in the claim, and describes the incident where Ravindra swerved to avoid an animal and lost control of the vehicle. The summary sheet also includes information on the inspection location and Ravindra's past claim history.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    10 views1 page

    Claim Form

    Uploaded by

    Ashirwad Banerjee
    The document is a claim summary sheet from Bajaj Allianz General Insurance Company for a vehicle insurance claim filed by Ravindra Kumar. It provides details of Ravindra Kumar's insurance policy, the vehicle involved in the claim, and describes the incident where Ravindra swerved to avoid an animal and lost control of the vehicle. The summary sheet also includes information on the inspection location and Ravindra's past claim history.

    Copyright:

    © All Rights Reserved
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    of 1

    Bajaj Allianz General Insurance Company Ltd.

    Claim Summary Sheet


    Date of Intimation 28-Jan-2023 Intimation print Date 20-Feb-2023 04:52:55

    Policy Details Claim Intimation/Registration Details


    Policy Reference Number OG-23-2450-1803-00000240 Claim Reference Number OC-23-2401-1803-00002859

    Policy Holder\Insured Name Mr RAVINDRA KUMAR Name of Caller//Claimant RAVINDRA KUMAR

    Vehicle Registration Number BR24GB2657 Date of Loss 20-JAN-2023

    Policy Inception Date 23-SEP-2022 Time of Loss 05:30:00

    Policy Expiry Date 22-SEP-2023 Driver's Name sudhanshu kumar

    Policy Issuance Date 08-OCT-2022 Driving License Number BR2420190006164

    64VB 64VB is Cleared. Driver Relation with Insured Driver

    Policy Status Issued Claimant Relationship with --

    Vehicle Make TATA No Claim Bonus 0

    Vehicle Model SIGNA 3718 No Claim Bonus Amount 0

    Past Endorsement No. OG-23-2450-1803-00000240-EN02 NCB Status

    Engine Number ISBE591804081F63704039 Chassis (VIN) Number MAT541093J1F19928

    Previous Insurer Name NA Manufacturing Year 2018

    Previous Policy Number D044698101 IMD Name//Number 10048025,Sardar Charanjeet Singh

    Previous Policy Expiry Date 22-SEP-2022 Sub IMD Name//Number NA

    Pre-Inspection PIN Number NA Policy Cover Benefits IMT23,

    Voluntary Excess 0 IMT Endorsement 7, 17, 21, 23, 39(Loading


    and/or Unloading),
    Compulsary Deductible 1500 Policy Holder's Telephone No 9525215005

    Additional Compulsary 0 Policy Holder's Mobile No 9525215005/

    Email Id RAVINDRAK150@GMAIL.CO Callers Contact Number 9525215005

    Description of Loss I was driving my vehicle suddenly animal came in front of vehicle to save animal vehicle got misbalanced and
    fall down.
    vehicle body damage, cabin.

    Inspection Address Panaghar old GT road Pramod Yadav workshop .PIN-713148


    No need for delay letter claim registered on 20-01-2023 at ranchi location

    Past Claim History


    Number of claim Reported 2 Previous Claim Paid Amount 0

    Previous Claim Number OC-23-2406-1803-00000736 Previous Claim Date of Loss 20-JAN-23

    Previous Claim Surveyor Name MR PRATIK AJMERA Previous Claim Repairer Name TINKU GARAGE(2406)

    Number of Add-on Covers 0 Paid Amount- Add on covers

    ThankingYou,
    Yours FaithFully,
    From Bajaj Allianz General Insurance Company Ltd

    Claim Registering Centre Name - Call Center

    Regd. Office : GE Plaza, Airport Road, Yerawada, Pune - 411006 (India)

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