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OG-22-1901-1806-00109817 - Stake Secure
OG-22-1901-1806-00109817 - Stake Secure
Registered and Head Office: Bajaj Allianz House, Airport Road, Yerwada, Pune
A. Proposer details
B.Vehicle Details
Registration
Month / Vehicle Vehicle Vehicle Fuel Type Cubic Ca- Year of Man- Seating Capa-
Number Year of Make Model Sub Type pacity/ ufacture city
Regn Kilowatt
MH01CF709 FEB-2016 BAJAJ PULSAR ELECTRIC PETROL 150 2016 2
2 150 START
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.)
JEZCFH70203MD2A82DZ2F 0 0 0 0 0
CH59013
C. Coverage opted
Policy issuing office and Correspondence address for communication by policyholder for claim, service request, notice, summons,
etc; 952/954,, Appasaheb Marathe Marg,, Near Chaitnya Tower,, Next to Saraswat Bhavan,, Prabhadevi Mumbai - 400025-400022 Phone
No :022-66628666
Policy Number OG-22-1901-1806-00109817 Product Liability Only Policy For Two Wheeler
Period Of Insurance From: 06-Jan-2022 00:01 Policy issued on 05-Jan-2022 -
To: 05-Jan-2023 Midnight Cover Note No /
Application No 300251070 Scrutiny No
Insured Name MOHD SAMEER SHAIKH A Zone
Insured Address ROOM NO, 518 PREM NAGAR COLONY B G
KHER,ROAD NEAR COCA COLA COMPANY
WORLI, ,, MUMBAI - 400018
Customer ID 241038855 Premium Payer ID 241038855
Transaction Id
Policy Status ISSUED
GSTIN / UIN NA Place of Supply/State 27 - Maharashtra
Code/Name
Invoice No. 325143639/1
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
MH01CF7092 BAJAJ ELECTRIC PULSAR 150 150 2016 2 MD2A82DZ JEZCFH70203
START 2FCH5901
3
SCHEDULE OF PREMIUM
OWN DAMAGE LIABILITY
Total Own Damage Premium: Basic Third Party Liability 752.00
Total premium 752.00 Total Liability Premium: 752.00
Special Discount 0
Net Premium 752.00
State GST (9%) 68.00
Central GST (9%) 68.00
Final Premium Rs. 888.00 ***All Premium Figures are in Rupees
Geographical Area : No Claim Bonus : 0%
Nominee Details Name : Wife Relationship : Spouse
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
In case of any claim, please contact our 24 Hour Call centre at 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'.
300251070/-/10037456/-/-
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 - 05-Jan-2022 14:45:53 PM (Web)
Stamp
Duty Rs.
0.5
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. MH002405964202122M Defaced No. 0001482221202122 dated 05-JUL-21
timing 12:58:03 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 - 05-Jan-2022 14:45:53 PM (Web)
Bajaj Allianz General Insurance Company Ltd.
952/954, Appasaheb Marathe Marg, Near Chaitnya Tower, Next to Saraswat Bhavan, Prabhadevi Mum-
bai - 400025 - 400022
Contact No:Contact No: 022-66628666,67402424; Fax No: 022-66628621
RECEIPT
Authorised Signatory