0BAJAJ I Allianz i 1111 111 1 11 111 1 111 rn1

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BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LTD.

Policy Servlcllng Bajaj Finserv Building, 1st Floor, Behind Weikf ield IT-Park, Viman Nagar, Pune-411014 PH:1800-
Office Polley Number 209-0144 OG-18-9906-1806-00000150 Product Two Wheeler -Liability Only
Period Of Insurance Policy From: 11-0CT-2018 (Hrs) Policy Issued on 09-0CT-2018
To: 10-0CT-2021 Midnight Cover Note No. I
Insured Name MOHAMMED FAIZAL SHA IKH Zone A
Insured Address A- SECTOR, G-LINE, ROOM N0.13.
CHEETA CAMP, TROMBAY MUMBAI MAHA-
RASHTRA, , , , -400088
CustomerId 93325562 Premium Payer Id 93325562
Key Field MUMBAI
Application No 0 Scrutiny No 67567872
Reference No : null
Polley Status ISSU ED
Coinsurance Details :NA.
Registration No Make Model SubType cc Year Of Mfg Seat Cap Chassis number. Engine No.
MH01BP5795 BAJAJ AV ENGER 220 STD 220 2013 2 MD2A22EZ4DCJ67395 PDZCDJ65673

Elec. Accessories Non-Elec. Acc. Side Car CNG/LPG Unit

0 0 0 0
SCHEDULE OF PREMIUM
Own Damage Liability
Total Own Damage Premium 0 Basic Third Party Liability 970
PA Cover for Owner-Driver of Rs. 100000 50
Total Act Premium: 1020
Total Premium 1020
Special Discount 0
Net Premium 1020
Service Tax 143
Swachh Bharat Gess 5
Krishi Kalyan Gess 5
Final Premium Rs. 1173 *** All Premium Figures are in Rupees
Geoj:lraphical Area :India Voluntary Excess :Nil
Compulsory Deductible : Additional Compulsory Deductible :Rs. 0
Rs. 0
Previous Insurer - Cholamandalam MS General Insurance Company Limited. Previous Policy No - NA Expiry On -09-0CT-18
LIMITS OF LIABILITY: Under section 11-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 11-I(ii) of the policy -> Damage to Third Party Property : Rs. 100000
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 raci ng, Pace maki ng, Speed testing, Reliabili ty trials, Any purpose in connection wi th Motor Trade.
DRIVER : Any person including the insured Provided that a person drivi ng holds an effective driving licence at the time of the accident and is not disqualified from holdi ng or obtaining
such a licence. Provided also that the person holding an effective Learner's licence may also drive the vehicle and that such a person satisfies the requirements of Rule 3 of the
Central Motor Vehicles Rules.. 1989.
Past Claim Ref erence : -
IMPORTANT NOTICE :The Insured is not indemnified if the vehicle is used or driven otherwise than in accordance with this schedule.Any paymen t 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 AN D RIGHT OF RECOVERY. Contact No :1800-103-3999/1800-103-3999
Email - enquiry @policybazaar.com

Plan Description:
Premium Collection Details :- [Receipt No/Collection No/Amount] 9906-01202617,/67567872,/ Rs.1173,
*** If premium paid through cheque, the policy is void ab-initio in case of dishonor of cheque.
This certificate of insurance is issued in accordance with the provision of Chapter X and Chapter XI of M.V.Act, 1988.
In case of a_n_y claim, please contact our 24 Hour Call centre at 1800-22-5858 1800-102-5858 ,1800-102-5858,1800-209-5959(Toll
Free) I
91-020-30305858 (chargeable,add area code before this number in case of mobe call) or email us at
'customercare@bajajallianz.co.in'
67567872/-/10043080/99060001/-
PIN NO :NA Damage Details: NA
Remarks : PDA MODULE
Kindly contact our nearest I local office(s) for No Claim Bonus Confinnations.
.....
For & On Behalf of Bajaj Allianz GeneralInsurance Company Ltd.
· Stamp
. Duty
Rs. ·
0.5

Authorized Signatory
Printed Signed and Executed at Puna null Consolidated stamp Duty paid vide Receipt No :.41dated 10.FEB-17
I

Regd. Office :GE Plaza Airport Road,Yerawada,Pune - 411006 (lndia),A Company incorporated underIndian Companies Ac!1 1956 and
licensed byIn surance1Reg_ulato!Y ana Development Authori ty ofIndia [ RDA] vide Reg No.113,CorporateIdentification Number
U66010PN2000PLC015329.
Service Tax Reg. No. AABCB5730G-ST-001
-Latest Schedule- 09-0ct-2018 20:57:08 PM (Web)
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