Bajaj Allianz General Insurance Company Ltd.
GE Plaza, Airport Road, Yerwada, Pune - 411006(India)
CERTIFICATE CUM POLICY SCHEDULE

Policy Servicing Off: Bajaj Allianz General Insurance Co Ltd., Golden Heights,, 4th Floor, No.1/2, 59th "C" Cross, 4th "M" Block,, Bangalore-
560010 Phone No :080-67195000
Policy Number OG-18-1731-1831-00000261 Product Commercial Vehicle - Liability Only
Vehicle Type Passenger Carrying - 3 Wheel & Carrying Capacity <= 6
Period Of Insurance From: 12-Mar-2018 23:45 Policy issued on 12-Mar-2018 -
To: 11-Mar-2019 Midnight Cover Note No 0/
Application No 83452546 Scrutiny No
Insured Name MRS SHOBHA C Zone
Insured Address W/O B M MANJUNATHA, PATALAMMA LAY-
OUT, MALUR, KOLAR, MALUR, ,, KOLAR -
563130
Customer ID 114614970 Premium Payer ID 114614970
Transaction Id
Policy Status ISSUED
GSTIN / UIN NA STATE CODE / NAME 29 - Karnataka
Registration Make SubType Model CC Mfg year Seat Cap Vehicle/Trailer Engine Number
No. Chassis No
KA02C7907 BAJAJ 4 STROKE REAR ENGINE 145 2005 3 BMC14882 BMC15689
CNG - 145 CNG
AUTORICK-
SHAW

Vehicle IDV Elec Acc Non Elec Acc Trailer Trailer Reg No CNG/LPG Unit Total Sum Insured
0 0 0 0 0
SCHEDULE OF PREMIUM
OWN DAMAGE LIABILITY
Total Own Damage Premium: Basic Third Party Liability 5401
CNG / LPG Unit (IMT.25) 60
PA Cover For Owner-Driver Of Rs. 200000 100
LL For Operation/Maintenance For 1 Person 50
Total Liability Premium: 5611
Additional loading @ 0% 0

Total premium 5611

Special Discount 0
Net Premium 5611
State GST (9%) 505
Central GST (9%) 505
Final Premium Rs. 6621 ***All premium Figures are in Rupees
Geographical Area : INDIA No Claim Bonus : 0% Voluntary Excess :
LIMITS OF LIABILITY: Under Section II-1(i) of the policy -> Death of or bodily injury : Such amount as is necessary to meet there requirements of the Motor
Vehicles Act,1988. Under Section II-1(ii) of the policy -> Damage to Third Party Property : Rs.750000/-
LIMITATION AS TO USE: The Policy covers use only under a permit within the meaning of the Motor Vehicle Act, 1988 or such a carriage falling under Sub-
section 3 of Section 66 of the Motor Vehicle's Act 1988. The Policy does not cover use for : Organised racing, Pace Making, Reliability Trials, Speed Test-
ing,Use whilst drawing a trailer except the towing (other than for reward) of any one disabled Mechanically propelled vehicle.
DRIVER : : Any person including the insured : Provided that a person driving holds an effective driving licence at the time of the accident and is not disquali-
fied from holding or obtaining such a licence. Provided also that the person holding an effective Learner's licence may also drive the vehicle when not used for
the transport of passengers at the time of the accident and that such a person satisfies the requirements of Rule 3 of the Central Motor Vehicles Rules, 1989.
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".
Subject To IMT Endorsement Nos : 28 & Policy wordings attached herewith
Agency Code BAG100000257 Channel Name : ML
Agency Name : Sandhya Rani K Papaiah
Contact No : 0/9980946588
Email -
Damage Details as per Annexure I
Premium Collection Details :- [Receipt No/Collection No/Amount] 1731-00003285 / 83452546 / Rs. 6621 ,
*** 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 '[email protected]'.
83452546/-/10041892/-/0
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.

For & On Behalf of Bajaj Allianz General Insurance Company Ltd.

Stamp
Duty Rs.
0.5

Regd. Office : GE Plaza, 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.BAGIC GST No : 29AABCB5730G1ZT | Princip-
al Location : Golden Heights, 4th Floor, No.1 / 2, 59th C Cross, 4th M Block, Rajajinagar, BANGALORE - 560010 PH:080-67195000 | Services Accounting Code : 997134 -
Motor vehicle insurance services. No reverse charge is payable on these services. | Invoice No. : 94615471/1 - Latest Schedule - 12-Mar-2018 13:08:36 PM (Web)
  

Authorized Signatory
Printed , Signed and Executed at Pune

Consolidated Stamp Duty of Rs.0.5/- paid towards Insurance Stamps vide Challan No.
MH010176711201718M Defaced No. 0005747963201718 dated 09-FEB-18 timing 13:12:55 of General
Stamp Office,Mumbai,India.
Generated by Silent_Printing

Regd. Office : GE Plaza, 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.BAGIC GST No : 29AABCB5730G1ZT | Princip-
al Location : Golden Heights, 4th Floor, No.1 / 2, 59th C Cross, 4th M Block, Rajajinagar, BANGALORE - 560010 PH:080-67195000 | Services Accounting Code : 997134 -
Motor vehicle insurance services. No reverse charge is payable on these services. | Invoice No. : 94615471/1 - Latest Schedule - 12-Mar-2018 13:08:36 PM (Web)