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Bajaj Insurance Bihar
Bajaj Insurance Bihar
Registered and Head Office: Bajaj Allianz House, Airport Road, Yerwada, Pune
A. Proposer details
1. Proposer Name : PUNAM DEVI
2. Proposer Address : BAIJUBARHOGA BAIJUBARHOGA BASA, NTPUR SIWAN
, , SIWAN, BIHAR-841406
3. Proposer Mobile Number : 9006598914
4. Proposer Residential Number : NA
5. Proposer e-mail id : [email protected]
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
BR29AE749 MAY/2018 HERO PASSION CAST - 100 Petrol 2018 2
4 HONDA PRO DISC
BRAKE-
ELECTRIC
START
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.)
HA10ACJHB497 MBLHAR188JH 30,224.00 0 0 0 30,224.00
84 B16562
C. Coverage opted
23. To support our Go Green initiative, send policy copy link on registered mobile number / email id:
Please note Cover Note No. / issued to you basing on the above information.
In case of Disagreement or objection or any changes with respect to information and contents mentioned hereinabove, please
contact our toll free number & register your objections/changes/disagreement to the contents of this transcript or you may also
send us email or written correspondence at the following details within a period of 15 days from date of your receipt of this
transcript along with Policy:
I/We hereby unconditionally allow the Company to share all my / our information being collected in this proposal form or
through telephonic / email / web-inputs means or other means, as updated from time to time within group entities.
Toll free Number : 1800-22-5858,1800-102-5858,1800-209-5858
Email address : [email protected]
Website : www.bajajallianz.com
Contact our policy servicing branch at: Bajaj Finserv Building, 1st Floor, Behind Weikfield IT-Park, Viman Nagar,
Pune-411014 PH:1800-209-0144.
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
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 racing,Pace making, Speed testing,
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. MH013770432201920M Defaced No. 0000433117202021 Order No.CSD/22/2020/1432/2020 Or-
der Dated 09.06.2020Defaced date dated 09-JUN-20 timing 12:23:03 of General Stamp Office,Mumbai,India.
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.
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