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Bajaj Allianz General Insurance Company LTD
Bajaj Allianz General Insurance Company LTD
Registered and Head Office: Bajaj Allianz House, Airport Road, Yerwada, Pune
A. Proposer details
B.Vehicle Details
Registration
Month / Vehicle VehicleVehicle Fuel Type Cubic Ca- Year of Man- Seating Capa-
Number Year of Make Model Sub Type pacity/ ufacture city
Regn Kilowatt
UK14E5681 SEP-2018 BAJAJ AVENGER STREET PETROL 180 2018 2
180
Engine Num- Chassis Num- Vehicle IDV Electrical Non-Electrical Ac- CNG/LPG Unit Total IDV (in Rs.)
ber ber (in Rs.) IDV (in Rs.) cessories IDV (in (Extra fitted)
Rs.) IDV (in Rs.)
PDYCJD59143MD2B43CY7J 0 0 0 0 0
CD22731
C. Coverage opted
Policy issuing office and Correspondence address for communication by policyholder for claim, service request, notice, summons,
etc; Bajaj Finserv Building, 1st Floor, Behind Weikfield IT-Park, Viman Nagar, Pune-411014 Phone No :1800-209-0144
Policy Number OG-21-9906-1806-00271451 Product Liability Only Policy For Two Wheeler
Period Of Insurance From: 09-Jan-2021 Policy issued on 08-Jan-2021 -
To: 08-Jan-2022 Midnight Cover Note No /
Application No 235750204 Scrutiny No
Insured Name AMIT ASWAL B Zone
Insured Address 102, NEHRU MARG, ASHUTOSH NAGA, R, ,,
RISHIKESH - 249201
Customer ID 202121039 Premium Payer ID 202121039
Transaction Id
Policy Status ISSUED
GSTIN / UIN NA Place of Supply/State 05 - Uttarakhand
Code/Name
Invoice No. 238009342/1
Company GST No 27AABCB5730G1ZX
Company PAN No AABCB5730G
Registration Make SubType Model CC/KW Mfg year Seat Cap Vehicle/ Engine Number
No. Trailer
Chassis
No
UK14E5681 BAJAJ STREET AVENGER 180 180 2018 2 MD2B43C PDYCJD59143
Y7JCD227
31
SCHEDULE OF PREMIUM
OWN DAMAGE LIABILITY
Total Own Damage Premium: Basic Third Party Liability 1,193.00
Total premium 1,193.00 Total Liability Premium: 1,193.00
Special Discount 0
Net Premium 1,193.00
Integrated GST (18%) 215.00
Final Premium Rs. 1,408.00 ***All Premium Figures are in Rupees
Geographical Area : No Claim Bonus : 0%
Nominee Details Name : NA Relationship : NA
Previous Insurer - Cholamandalam MS General Insurance Company Limited.Previous Policy No -NA Expiry
On - 08-JAN-21
As per the GST regulations, the amount of GST will not be refunded if the policy / endorsement is cancelled after 30th
September of the next financial year
Contact No : 0/1800-103-3999
Email -
Damage Details as per Annexure I
Premium Collection Details :- [Receipt No/Collection No/Amount] 9906-04447122 / 235750204 / Rs. 1,407.00 ,
*** If premium paid through cheque, the policy is void ab-initio in case of dishonour of cheque.
This certificate of insurance is issued in accordance with the provision of Chapter X and Chapter XI of M.V. Act, 1988.
Damage Details Annexure : - NA
Remarks PDA MODULE
In case of any claim, please contact our 24 Hour Call centre at 1800-22-5858, 1800-102-5858 (Toll Free) / 91-020-30305858
(chargeable, add area code before this number in case of mobile call) or email us at 'Bagichelp@bajajallianz.co.in'.
235750204/-/10043080/99060001/-
This is a one page Policy Document [without enclosing the Terms and Conditions (T&C) of the Policy] issued by the Company, pursuant to the authorization of Insured to display the T&C of the Policy on its website (www.bajajallianz.com) that enables access by the In-
sured. The T&C of the Policy are available on the Company's website and can be accessed by the Insured.
Kindly contact our nearest / local office(s) for No Claim Bonus Confirmations.
Regd. Office : Bajaj Allianz House, Airport Road, Yerawada,Pune - 411006 (India),A Company incorporated under Indian Companies Act, 1956 and licensed by Insurance
Regulatory and Development Authority of India [IRDA] vide Reg No.113, Corporate Identification Number U66010PN2000PLC015329.Principal Location : Bajaj Allianz
House, Airport Road, Yerwada, Pune - 411006 PH:66026666 | Services Accounting Code : 997134 - Motor vehicle insurance services. No reverse charge is payable on
these services. - Latest Schedule - 08-Jan-2021 11:40:24 AM (Web)
Authorized Signatory This document is digitally signed, hence counter signature / stamp is not required
Printed , Signed and Executed at Pune
Consolidated Stamp Duty of Rs.0.5/- paid towards Insurance Stamps vide Challan No. MH013770432201920M Defaced No. 0000433117202021 Order
No.CSD/22/2020/1432/2020 Order Dated 09.06.2020Defaced date dated 09-JUN-20 timing 12:23:03 of General Stamp Office,Mumbai,India.
Generated by Silent_Printing
Regd. Office : Bajaj Allianz House, Airport Road, Yerawada,Pune - 411006 (India),A Company incorporated under Indian Companies Act, 1956 and licensed by Insurance
Regulatory and Development Authority of India [IRDA] vide Reg No.113, Corporate Identification Number U66010PN2000PLC015329.Principal Location : Bajaj Allianz
House, Airport Road, Yerwada, Pune - 411006 PH:66026666 | Services Accounting Code : 997134 - Motor vehicle insurance services. No reverse charge is payable on
these services. - Latest Schedule - 08-Jan-2021 11:40:24 AM (Web)
Bajaj Allianz General Insurance Company Ltd.
Bajaj Finserv Building, 1st Floor, Behind Weikfield IT-Park, Viman Nagar, Pune - 411014
Contact No:Contact No: 1800-209-0144
RECEIPT
Authorised Signatory