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Og 20 1101 1802 00023839 PDF
Og 20 1101 1802 00023839 PDF
Registered and Head Office: Bajaj Allianz House, Airport Road, Yerwada, Pune
A. Proposer details
1. Proposer Name : DEEPAK GUPTA
2. Proposer Address : H NO-E-29/A D-BLOCK SHAKAR PUR BARAMAD, SHAKARPUR
, , EASTDELHI, DELHI-110092
3. Proposer Mobile Number : 9899325234
4. Proposer Residential Number : NA
5. Proposer e-mail id : kashyapinsure83@gmail.com
6. Proposer Profession : NA
B.Vehicle Details
Registration Month / Year Vehicle Vehicle Vehicle Sub Cubic Capa- Fuel Type Year of Man- Seating Ca-
Number of Regn Make Model Type city/Kilowatt ufacture pacity
DL3SCX902 APR/2016 ROYAL EN- BULLET 350 350 Petrol 2016 2
9 FIELD
Engine Number Chassis Number Vehicle IDV (in Electrical Non-Electrical CNG/LPG Unit Total IDV (in
Rs.) Accessories Accessories (Extra fitted) Rs.)
IDV (in Rs.) IDV (in Rs.) IDV (in Rs.)
990306 990306 67790 0 0 0 67790
C. Coverage opted
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 li-
cense at the time of the accident and is not disqualified from holding or obtaining such a license.
Provided also that the person holding an effective Learner's license may also drive the vehicle
when not used for the transport of goods/passengers at the time of the accident and that such a
person satisfies the requirements of Rule 3 of the Central Motor Vehicle Rules, 1989.
Limits of Liability Under section II-I(i) of the policy -> Death of or bodily injury : Such amount is necessary to meet
there requirements of the Motor Vehicles Act,1988. Under section II-I(ii) of the policy -> Dam-
age to Third Party Property : Rs. 100000
No Claim Bonus The insured is entitled for a No Claim Bonus (NCB) on the Own Damage section of the policy, if
no claim is made or pending during the preceding year (s), as per the following: 1. The preceding
year: 20% , 2. Preceding Two consecutive years: 25% , 3. Preceding Three consecutive years:
35%, 4. Preceding Four consecutive years: 45% , 5. Preceding Five consecutive years: 50% No
Claim Bonus will only be allowed provided the policy is renewed within 90 days of the expiry
date of the previous policy.
Existing Damage Details NA
Nominee Details Name :DIVYAGUPTA - Relationship :Spouse
Subject to Warranties/ 22,7
IMT-Endorsements/
Add on Package
Additional Details Coinsurance Details: - . Transaction Id: -
Premium Details Receipt No. 1101-01077283, Date 21-NOV-19 ** If Premium paid through Cheque, the Policy is
void ab-initio in case of dishonour of Cheque.
Excess Details Compulsory Excess: Rs.100 Additional Excess: Rs.0 Voluntary Excess: Rs.0
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.
For & On Behalf of
Bajaj Allianz General Insurance Company Ltd.
Stamp
Duty Rs.
0.5
Authorized Signatory
This document is digitally signed, hence counter signature / stamp is not required.
Consolidated Stamp Duty of Rs.0.5/- paid towards Insurance Stamps vide Challan No. MH006357478201920M Defaced No. 0003534430201920 ORDER NO.CSD/169/2019/4519 OR-
DER DATED 03.10.2019DEFACED DATE dated 03-OCT-19 timing 11:07:41 of General Stamp Office,Mumbai,India.
Principal Location : Block No-4, 7th Floor, DLF Towers, 15, Shivaji Marg, -, New Delhi - 110015 PH:011-66278000 | Services Accounting
Code : 997134 - Motor vehicle insurance services. No reverse charge is payable on these services.
Bajaj Allianz General Insurance Company Ltd.
12th Floor, Dr. Gopaldass Bhawan, 28, Barakhamba Road, Connaught Place, New Delhi - 110001
Contact No:Contact No: 41490500/41490573/41490588/509/560; Fax No: 91-11-41490511
RECEIPT
Authorised Signatory