*Q361060382*

BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LIMITED

(A Company incorporated under Indian Companies Act, 1956 and licensed by Insurance Regulatory and Development Authority of India [IRDAI] vide Regt. No.113)
Regd Office: GE Plaza, Airport Road, Yerwada, Pune - 411006(India)

Quotation for Private Car - Package Policy

Proposal Issuing Office RIAAN House 2nd Floor,, LIC Chowk,, Kingway Sadar,, Near NIT Building, Nagpur-440001 PH:0712-2815300
IMD Code :66666674 IMD Name :ONE-2-ONE- CORE Sub IMD Code:BG37263 Sub IMD Name:NIKHIL KUMAR NIWARE
CUSTOMER DETAILS QUOTATION DETAILS
Customer Name SUNITA Quotation Issued on 30-August-2023
Customer Address ,, Quotation Number. Q361060382
Contact Details 0-8888888888
e-mail: NIKHILNEWARE435@GMAIL.COM
Registration Year of
Registration Number Date of Registration Vehicle Make Vehicle Model Vehicle Sub Type Vehicle Fuel Type
Authority Manufacturing
MH36Z3742 MH36-BHANDARA 14-September-2018 2018 MARUTI BALENO NEW ALPHA PETROL AT Petrol
Cubic Licensed Carrying Licensed Carrying Lease / Hire Purchase
Carrying Capacity Zone Engine Number Chassis Number
Capacity/Kilowatt Capacity Passengers Capacity GVW / Hypothecation
MA3EWB22SJE49055
1197 0 5 B K12MN4416525 9
Electrical Accessories Non Electrical
Vehicle IDV CNG/LPG Kit IDV Trailer Voluntary Deductible Additional Deductible NCB
IDV Accessories IDV
5,34,056 - - - - - - 0
Geographical Extension Plan Name**
Consumable Expenses_S ,Drive Assure Welcome_S
Own Damage Premium (Rs.) Liability Premium (Rs.)
Own Damage Premium 14867.628 Basic Third Party Liability 6832
PA Cover for Unnamed Passengers(IMT.16) 250
PA Cover For Owner-Driver 662
Personal Accident To Paid Drivers (IMT.17) 100
Total OD Premium A 14867.628 Total Act. Premium B 7844
Net Premium (Net Premium) (A+B) 22712
State Gst 2044
Central Gst 2044
Final Premium 26800
Final Premium (in Words): Rupees Twenty Six Thousand Eight Hundred Only
Excess Details Compulsory Excess : 2000 Rs.

Add on Packages /Top up Cover, if opted, will be subject to below mentioned Guidelines
● Applicable to all the channels, except National Tie Ups (NTUs) for brands including MARUTI , HONDA, NISSAN, FORD, BMW, HYUNDIA, VW, Audi Skoda ,GM ,Toyota and KIA , Mercedes ,
JLR or as may be communicated from time to time.
● Applicable to Our Renewals, Rollover as well as new vehicle business.
● The benefit for each Add on package and Top up covers is applicable to the vehicles based on vehicle age.
● The benefit for each Add on package and Top up covers is applicable to vehicles registered as Private Cars Only.
● Add On Packages Drive Assure Welcome (DAW) & Drive Assure Welcome Plus (DAW+), cannot be sold without a deductible of Rs 1000/- in addition to Compulsory deductible as per
tariff , applicable in the event of claim , irrespective of age and model , unless the vehicle is repaired at an approved garage specifically advised by us .
● Midterm endorsements of Add on packages & / or Top up covers are not allowed.
● A top up cover is a standalone individual add on cover, which can be opted only if the Add on Package is also opted.
● Proposal form is mandatory, with all details of the covers opted mentioned therein.

Add On Packages Details

Drive Assure Welcome (DAW): 24x7 Spot Assistance + Depreciation Shield.
(For Vehicle Age up to 5 years and subject to compulsory Pre-insurance inspection)
Drive Assure Economy (DAE): 24x7 Spot Assistance + Depreciation Shield + Engine Protector (For Vehicle Age up to 5 years)
Drive Assure Prime plus: 24x7 Spot Assistance + Keys & Locks Replacement + Personal Baggage (For Vehicle Age up to 10 years)
Drive Assure Welcome Plus (DAW+) = DAW + Keys & Locks Replacement + Personal Baggage (For Vehicle Age up to 5 years and subject to compulsory Pre-insurance inspection)
Drive Assure Economy Plus (DAE+) = DAE + Keys & Locks Replacement + Personal Baggage (For Vehicle Age up to 5 years)
Drive Assure Drivesmart Prestige : 24x7 Spot Assistance+ Depreciation Shield+ Engine Protector+ Conveyance Benefit+ Accident Sheild+ Keys And Locks Replacement Cover+ Personal
Baggage Cover+ Consumable Expenses(For vehicle age up to 5 years)
Drive Assure DriveSmart Classic : 24x7 Spot Assistance+ Accident Shield+ Keys And Locks Replacement Cover+ Personal Baggage Cover(For vehicle age up to 5 years)
Drive Assure Drivesmart Premium : 24x7 Spot Assistance+ Depreciation Shield+ Engine Protector+ Accident Sheild+ Keys And Locks Replacement Cover+ Personal Baggage Cover(For
vehicle age up to 5 years)

Top up Covers Details:

Top up covers are stand-alone individual Add on covers which can be added to the Add on Package opted by the user
Top up Cover 1: Consumables Expenses (For Vehicle Age up to 5 years)
Top up Cover 2: Conveyance Benefit (For Vehicle Age up to 10 years)
Top up Cover 3: Accident Shield (For Vehicle Age up to 10 years)
Top up Cover 4: Vehicle Replacement Advantage (For Vehicle Age up to 3 years)

For help and more information:

Contact our 24 Hour Call Centre at 18002095858
Email: bagichelp@bajajallianz.co.in or Website www.bajajallianz.com
Corporate Identification Number: U66010PN2000PLC015329
Important Notes:

1. This quotation is based on information provided to us and is subject to relevant proofs being submitted and inspection of vehicle at the time of issuance of policy.

2. Quote is subject to change based on documentation and in case actual information at the time of issuance differs from the above.

3. This submission is only a quotation and not an insurance policy or cover note. The insurance coverage would start only after issuance of policy and receipt of payment of premium subject
to terms of policy.

4. This quote is valid for 15 days from issue of quotation date noted above.

5. You are requested to return duly signed copy of this quote as a confirmation of acceptance of the terms and reconfirmation of information provided above.

6. Alternately you may send your objection, what so ever with regard to the above quote or the terms and condition of policy issued, within 7 days from the date of this quote, failing which it
will be concluded that you are fully satisfied and have accepted the quote including the terms and condition of the policy and the correctness of the information provided above.

7. Policy would be issued after tendering full premium quoted above and subject to inspection of vehicle where required.

8. Please furnish us the following information for issuance of policy. a) Previous insurance policy copy / Renewal Notice b) NCB confirmation letter c) Copy of Registration Certificate d) Copy
of driving license Insurance.
PROHIBITION OF REBATES. The Insurance Act, 1938.

Section 41 prohibition of Rebates:

1) No person shall allow or offer to allow, directly or indirectly as an inducement to any person to take, renew or continue an Insurance in respect of any kind of risk relating to live or
property in India any rebate of the whole or part of the commission payable or any rebate of the premium shown in the policy nor shall any person taking out or renewing or continuing a
policy accept any rebate, except such rebates which may be in accordance with the published prospectus or tables of the Insurer.
2) Any person making default in complying with the provision of the Section shall be punishable with fine which may extend to Ten Lakh rupees.

Proposer Signature

For help and more information:

Contact our 24 Hour Call Centre at 18002095858
Email: bagichelp@bajajallianz.co.in or Website www.bajajallianz.com
Corporate Identification Number: U66010PN2000PLC015329