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Bajaj Allianz - OG-20-1904-1843-00001060
Bajaj Allianz - OG-20-1904-1843-00001060
Bajaj Allianz - OG-20-1904-1843-00001060
Registered and Head Office: Bajaj Allianz House, Airport Road, Yerwada, Pune
A. Proposer details
1. Proposer Name : ASHOK BAGAYYA MOGULLA
2. Proposer Address : R NO. 204 C 40, SECTOR 5,, SHANTI NAGAR, MIRA ROAD EAST
, , THANE, 401107-401107
3. Proposer Mobile Number : 9773561503
4. Proposer Residential Number : NA
5. Proposer e-mail id : frankyashok8@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
MH04JE419 OCT/2017 HONDA ACTIVA 4G 110 CC 110 Petrol 2017 2
8
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.)
JF50ET5607107 ME4JF507JHT60 38481 0 0 0 38481
6786
C. Coverage opted
Authorized Signatory
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. MH003753522201920M Defaced No. 0002277216201920 ORDER NO.CSD/93/2019/3587/19 OR-
DER DATED 24.07.2019DEFACED DATE dated 23-JUL-19 timing 15:54:05 of General Stamp Office,Mumbai,India.
Principal Location : Bajaj Allianz House, Airport Road, Yerwada, Pune - 411006 PH:66026666 | Services Accounting Code : 997134 -
RECEIPT
Authorised Signatory