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*W-OG-11-1902-1801-00003564*

INVITATION OF RENEWAL
August 18,2011 Customer ID: 31513496

MR SANJAY KUMAR
76 - GF , G BLOCK, SOUTH CITY - 2 GURGAON,HARYANA-122018 HARYANA Tel:0-0,0-0,9711156405

Dear Sir/Madam, Ref: Renewal of Motor Insurance Policy No OG-11-1902-1801-00003564 expiring on 14-oct-2011, Ref No 8526147 We thank you very much for making us one of the leading General Insurance Companies in India, by choosing us as your insurer. We are now writing to remind you that your policy cited above expires on 14-oct-2011 Your Vehicle details are as under:Registration No:MH06W9672 Reg.Date:01-sep-2005 Yearof Mfg:2005 Engine No:507741 Chassis No:113673 Make:MARUTI Model:BALENO Sub Type:LXI In line to continue with our relationship, we are hereby providing the renewal information in the Renewal Instruction Form Overleaf, with a request to go though the same ,simply sign the note as token of your acceptance and return it to us along with your payment instructions, enabling us to renew the policy for the next year. Alternat- ively, you may log on to our website www.bajajallianz.co.in or call our 24 hour Toll Free Help Line and effect ONLINE RENEWAL of your policy by making payment through your credit card prior to expiry of the policy
We also request you to get in touch with us for any changes to be effected on the policy to recalculate the premi- um.
In case of any claim, please contact our 24 Hour Call centre at 1600-22-5858,1800-22-5858, 1800-102-5858,1800-209-5959 (Toll Free) / 91-020-30305858 (chargeable, add area code before this number in case of mobile call) or email us at 'info@bajajallianz.co.in'.

Service Officers will be glad to assist you in renewing your policy.


We look forward to continue our happy and mutually beneficial partnership and appreciate your continued sup- port. Thanking you and assuring you of our best services at all times, we remain, Yours sincerely,

Chief Executive Officer Notes: 1. If the Policy is renewed after 14-oct-2011 acceptance shall be subject to satisfactory inspection of the vehicle. 2. As per provisions of the Insurance Act 1938 and its amendments to date from time to time, renewal can not be effected unless the premium has been paid. P.T.O for Renewal Instruction Form ____________________________________________________________________________________________ Registered & Corporate Office- G E Plaza, Airport Road, Yerwada,Pune 411 006

Please fill the below Renewal Instruction Form and send along with payment instructions

RENEWAL INSTRUCTION FORM


To, Bajaj Allianz General Insurance Company Ltd, 101/102, 1st Flr, Devavrata BuildingPlot No. 83,Sector 17, Vashi, Navi Mumbai-400703 PH 022-66809511,022-66809511,022 66809500 Dear Sir/Madam, Ref: Renewal of Motor Policy No OG-11-1902-1801-00003564 expiring on 14-oct-2011 of Mr/Ms MR SANJAY KUMAR Intermediary Code:10004434 Sub Imd:0 Cust Id:31513496 I acknowledge receiving invitation of Renewal in respect of my above mentioned policy and agree to renew the said policy for one calendar year as per details provided below:

Vehicle Own Damage


Vehicle IDV NCB( -35 %) as on processed date 18-AUG-11

Sum insured 268667

Total Own damage Premium

Claim History : No of Claims 0 Claim Type Imd Channel : ML Expiring Policy Add-on Cover : Hypothecation details : Not Applicable Deductibles -Compulsory :1000 Additional : 0 Voluntary : 0 We understand the above OD premium is inclusive of all applicable Loading/ NCB other Discounts viz (Automobile Association Membership, Voluntary Excess, Anti theft device, Personal driver, Fiber Glass, CNG/LPG unit, Geographical extn., Imported Vehicle etc wherever applicable) The payment details are as follows: Cash / Cheque / DD no._______________________ Amount Rs ___________ Date __________ Name of the Bank _________________________________ Branch_____________________(Please write your cheque in favour of Bajaj Allianz General Insurance Company Ltd ) I hereby declare that the information provided above is true and I am interested to buy following product ( Please put mark in the box below) Hospital Cash [] Personal Guard [] Health Guard [] Motor 2 Wheeler []

Premium ( Rs) Public Liability 5640 Basic Third Party Liability Compulsory PA for owner driver PA for 5 Persons SI LL To Person For Operation/Maintenance 5640 Total Act Premium Service Tax and Cess Final Premium(in Rs) Claim No. Reg Date Status

Sum insured As per Act 200000 200000 As per Act

Premium ( Rs) 2750 100 100 25 2975 887 9502

Householder Package Critical Illness

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(Please refer attached product brochure or visit our website www.bajajallianz.co.in for more information on these products or call our 24 hour Toll Free Help line 1800-22-5858 (MTNL/ BSNL) 1800-102-5858 (Bharati) Please contact me on _____________________ or on my email ____________________________ (Please fill up this , to enable us to serve you better) Notes: 1. The terms in this Invitation are based on claims on expiring policy, Motor Tariff and Government Regulations as on 14oct-2011. This may change on actual Renewal date. 2. Insured Declared Value (IDV) mentioned above should be the sum insured for renewal and has been arrived as per provisions of the New Motor Tariff. Notice generated by : swati.thadani@bajajallianz.co.in Renewal Reference Number : 8526147