Jun 7 Aarti Mogare Extra Care

Welcome to Bajaj Allianz Family
NASIK-Bajaj Allianz General Insurance Co Ltd,3rd Floor,

Sumangal Business Court,Plot No.39, Yeolekar Mala,Near
Policy issuing office and Correspondence address
Shraddha Petrol Pump,Beside 3m Car Mall,Nashik,Maharashtra,
INDIA,422005
Insured Name Aarti Subhash Mogare Policy number 12-8432-0000004188-00
Name: Aarti Subhash Mogare

Address:
Line1: B-4 Kamal Matoshree Row House Nr Hotel Seven Heaven
Line2: Hotel Sai Palace Chetana Nagar Cidco Nashik
City: NASHIK State: 27 - MAHARASHTRA
Post Code: 422009
Customer ID: PI20306345
Dear Aarti Subhash Mogare,
It is our privilege to welcome you to the Bajaj Allianz General Insurance family.
We thank you for choosing Bajaj Allianz for your Insurance needs. We are one of India's leading general insurance companies with iAAA
rating from ICRA for the last ten consecutive years indicating the company's high claims paying ability and fundamentally strong
position in the industry. Please be assured that you have made right choice by choosing us and we will stand by you in your hour of
need.
Please find enclosed the policy schedule. We wish to inform you that the policy issued is based on the information submitted in the
proposal form as well as the acceptance of the terms and conditions, and this will be verified at the time of filing of claim. Request you
to kindly go through the same once again and in case of any disagreement, discrepancy or clarifications – write to us at
[email protected] within 15 days of the letter date. For policy wordings containing detailed terms, conditions and exclusions
of your insurance coverage, you will receive a hard copy on your correspondence address.
Once again, we welcome you to the Bajaj Allianz family and look forward to a long association with you.
We assure you the best of our services and look forward to a continual patronage and association with you.
For & on the behalf

Bajaj Allianz General Insurance Company Ltd.
Authorized Signatory
Signature Not Verified

Digitally signed by DS BAJAJ ALLIANZ GENERAL
INSURANCE COMPANY LIMITED 01
Date: 2021.06.09 12:14:59 IST
Bajaj Allianz General Insurance Co. Bajaj Allianz House,Airport Road,Yerwada,Pune - 411 006. Reg. No.: 113 CIN: U66010PN2000PLC015329
Give a Missed Call on 808094506 SMS 'WORRY' to 575758 http://www.facebook.com/BajajAllianz
Contact our 24-Hour Call Center at 1800-209-5858 http://twitter.com/BajajAllianz
www.bajajallianz.com www.bit.do/bjazgi
[email protected] Demystify Insurance http://support.bajajallianz.com

Transcript of Proposal for ([11-8432-0000025477-00] EXTRA CARE PLUS)
[(UIN):BAJHLIP20147V021920]
Dear Aarti Subhash Mogare,
We wish to inform you that your contract will be based on the information and declaration given by you through telephonic conversation / email / web-
inputs / TAB /CSC Centers or other means which would be considered as the final proposal, the transcript of which is as follows:
You are requested to yourself reconfirm the same at your end. In case of any disagreement or objection or any changes with respect to information
mentioned below, we request you to please revert within a period of 15 days from the date of your receipt of this document. In case of our non-receipt
of your disagreement or objection or any changes [as mentioned hereinabove] with respect to information mentioned below, it shall be deemed that
you have positively confirmed to us the correctness of the below mentioned transcript and declaration. Where you disagree to any of
information/contents of this transcript, standard Terms or conditions, you have the option to return the original Policy stating the reasons for your
objection, and upon our receipt of original Policy together with your request to cancel the Policy, you shall be entitled to a refund of the premium paid,
subject only to there being no claim made under the Policy and also subject to a deduction of the expenses incurred by us and the stamp duty
charges.
Proposer Details
Proposer Name Aarti Subhash Mogare
Are you an Existing Bajaj Allianz Customer: Yes/No If Yes, please mention the policy No
Gender Female Date of Birth 19/07/1970
PAN No NA UID/Unique ID NA
Bajaj Allianz Employee Code, if Proposer is BAGIC/BALIC Employee
Marital Status NA No of children 1
Occupation Other Class 1
Address
Correspondence Address
Permanent/ Residential Address
(All the communications will be sent to the below address)
B-4 Kamal Matoshree Row House Nr Hotel Seven B-4 Kamal Matoshree Row House Nr Hotel Seven
Address Line 1 Heaven
Address Line 1 Heaven
Address Line 2 Hotel Sai Palace Chetana Nagar Cidco Nashik Address Line 2 Hotel Sai Palace Chetana Nagar Cidco Nashik
Address Line 3 Address Line 3
City/District NASHIK City/District NASHIK
State 27 - MAHARASHTRA State 27 - MAHARASHTRA
Pin Code 422009 Pin Code 422009
Telephone 8600441663 Telephone 8600441663
Mobile 8600441663 Mobile 8600441663
Email [email protected] Email [email protected]
Educational Qualification NA
Family Monthly Income 50000
In case of any offer, you would prefer to be contacted by 8600441663,[email protected]
Nationality Indian
Plans Floater
Sum Insured Option, Deductible and Air Ambulance Table

Sum Insured Deductible Options Air Ambulance Cover Sum Insured
1000000 300000 NA
Details of the Persons to be Insured

Sr DOB Gender Relationship
Name Age Ht Wt Occupation Relation Premium Nominee
No (DD/MM/YY) (M/F) of Nominee
Aarti
Aniket
1 Subhash 19/07/1970 50 Female 157 60 Other Class 1 Self 5603 Son
Mogare
Mogare
Aniket Aarti
2 Subhash 14/02/2000 21 Male 163 75 Son 2983 Subhash Mother
Mogare Mogare
Add on Cover
Non-Medical Expenses Cover
Member Name
UIN: BAJHLAP21586V012021
AARTI SUBHASH MOGARE No
ANIKET SUBHASH MOGARE No
Member Name Health Questionnaire Yes/No Details
Aarti Subhash Mogare Has any of the persons to be insured suffer from/or No NA
investigated for any of the following?Disorder of the heart,
or circulatory system, chest pain, high blood pressure,
stroke, asthma any respiratory conditions, cancer tumor
lump of any kind, diabetes, hepatitis, disorder of urinary
tract or kidneys, blood disorder, any mental or psychiatric
conditions, any disease of brain or nervous system, fits
(epilepsy) slipped disc, backache, any congenital/ birth
defects/ urinary diseases, AIDS or positive HIV, If yes,
indicate in the table given below.If yes please provide
details
Aarti Subhash Mogare Do you or any of the family members to be covered No NA
have/had any health complaints/met with any accident in
the past 4 years and prior to 4 years and have been taking
treatment, regular medication (self/ prescribed)or planned
for any treatment / surgery / hospitalization?
Aarti Subhash Mogare Do you smoke cigarettes or consume tobacco (chewing No NA
paste) / alcohol, nicotine or marijuana in any form? Please
give duration and daily consumption
Aarti Subhash Mogare Have you or any of your immediate family members (father, No NA
mother, brother, or sister) have/had cancer, heart attack, or
stroke and at what age? Prior to age 60?
Aarti Subhash Mogare Has any proposal for life, critical illness or health related No NA
insurance on your life or lives ever been postponed,
declined or accepted on special terms? If yes, give details
Aniket Subhash Has any of the persons to be insured suffer from/or No NA
Mogare investigated for any of the following?Disorder of the heart,
or circulatory system, chest pain, high blood pressure,
stroke, asthma any respiratory conditions, cancer tumor
lump of any kind, diabetes, hepatitis, disorder of urinary
tract or kidneys, blood disorder, any mental or psychiatric
conditions, any disease of brain or nervous system, fits
(epilepsy) slipped disc, backache, any congenital/ birth
defects/ urinary diseases, AIDS or positive HIV, If yes,
indicate in the table given below.If yes please provide
details
Aniket Subhash Do you or any of the family members to be covered No NA
Mogare have/had any health complaints/met with any accident in
the past 4 years and prior to 4 years and have been taking
treatment, regular medication (self/ prescribed)or planned
for any treatment / surgery / hospitalization?
Aniket Subhash Do you smoke cigarettes or consume tobacco (chewing No NA
Mogare paste) / alcohol, nicotine or marijuana in any form? Please
give duration and daily consumption
Aniket Subhash Have you or any of your immediate family members (father, No NA
Mogare mother, brother, or sister) have/had cancer, heart attack, or
stroke and at what age? Prior to age 60?
Aniket Subhash Has any proposal for life, critical illness or health related No NA
Mogare insurance on your life or lives ever been postponed,
declined or accepted on special terms? If yes, give details
Kindly note that as the information/contents and declarations/confirmations provided by you as contained in this transcript is the basis on which we are
issuing / have issued the Policy to you, we advise you to please ensure that you have provided/disclosed and or not withheld any material
facts/information and declarations, as Policy becomes Void ab-initio if material facts are not provided/disclosed and or withheld and in such case no
claim, if any, will be considered by us apart from forfeiture of the premium.
Disclaimer
A. EXCLUSIONS AND TERMS AND CONDITIONS:
The detailed list of exclusions, standard terms and conditions, including the exclusion of pre-existing ailments/diseases, were fully explained to you and
for full details thereof please refer to the Policy wordings:
Answer given by You: Yes, I/we have been explained in full the details of exclusions, standard terms and conditions including the exclusion of pre-
existing ailments/diseases and knowing the same I/we have opted and proposed for this Policy.
B. The contents of the proposal [transcript of proposal of you is this document] and connected documents have been fully explained to him and you
have fully understood the significance of the proposed contract basis which you have confirmed for policy issuance.
C. In case of Disagreement or objection or any changes with respect to information, declarations, Terms and Conditions, exclusions 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.
Declaration
1. I hereby declare, on my behalf and on behalf of all persons proposed to be insured, that the above statements, answers and/or particulars given by
me are true and complete in all respects to the best of my knowledge and that I am authorised to propose on behalf of these other persons.
2. I understand that the information provided by me will form the basis of the insurance policy, is subject to the Board approved underwriting policy of
the insurer and that the policy will come into force only after full payment of the premium chargeable.
3. I further declare that I will notify in writing any change occurring in the occupation or general health of the life to be insured/proposer after the
proposal has been submitted but before communication of the risk acceptance by the company.
4. I declare that I consent to the company seeking medical information from any doctor or hospital who/which at any time has attended on the person
to be insured/proposer or from any past or present employer concerning anything which affects the physical or mental health of the person to be
insured/proposer and seeking information from any insurer to whom an application for insurance on the person to be insured /proposer has been made
for the purpose of underwriting the proposal and/or claim settlement.
5. I authorize the company to share information pertaining to my proposal including the medical records of the insured/proposer for the sole purpose of
underwriting the proposal and/or claims settlement and with any Governmental and/or Regulatory authority.
Prohibition of Rebates
SECTION 41 OF INSURANCE ACT, 1938
No person shall allow or offer to allow, either directly or indirectly, as an inducement to any person to take out or renew or continue an insurance in
respect of any kind of risk relating to lives or property in India, any rebate of the whole or part of the commission payable or any rebate of the premium
shown on the policy, nor shall any person taking out or renewing or continuing a policy accept any rebate except such rebate as may be allowed in
accordance with the published prospectuses or tables of the Insurer. Any person making default in complying with the provisions of this section shall
be punishable with a penalty, which may extend to Ten Lakh Rupees.
This transcript is authorized by you through OTP from your registered mobile no 8600441663 on
Contact our Policy servicing branch at: NASIK-Bajaj Allianz General Insurance Co Ltd,3rd Floor, Sumangal Business Court,Plot No.39,
** This is print of electronic records maintained by us in accordance with law and hence does not require signature.
Bajaj Allianz General Insurance Co.Ltd. Bajaj Allianz House,Airport Road,Yerwada,Pune - 411006. Reg.No.:113 CIN:U66010PN2000PLC015329
Give a Missed Call on 8080945060, SMS 'WORRY' to 575758 http://www.facebook.com/BajajAllianz

EXTRA CARE PLUS POLICY SCHEDULE
UIN: BAJHLIP20147V021920
NASIK-Bajaj Allianz General Insurance Co Ltd,3rd Floor, Sumangal

Policy issuing office and Correspondence address Business Court,Plot No.39, Yeolekar Mala,Near Shraddha Petrol Pump,
Beside 3m Car Mall,Nashik,Maharashtra,INDIA,422005
Proposer Details
Proposer Name Aarti Subhash Mogare
B-4 KAMAL MATOSHREE ROW HOUSE NR HOTEL SEVEN HEAVEN,HOTEL SAI PALACE CHETANA NAGAR
Proposer Address
CIDCO NASHIK,NASHIK,MAHARASHTRA,422009
Phone No 8600441663 Email ID [email protected]
Customer ID PI20306345 Previous Policy No NA
Policy Details
Policy Number 12-8432-0000004188-00 Endorsement No
Policy Issued on 09/06/2021 Policy Status ACTIVE
From 08/06/2021 00:00 Hrs To

Period of Insurance Expiry Date 07/06/2022
07/06/2022 Midnight
GSTIN / UIN Unregistered

Place of Supply/State
27 - MAHARASHTRA
Code/Name
Company GST No: 27AABCB5730G1ZX
Company PAN AABCB5730G Invoice No: 272106I000351922
Insured Member Details

Nominee Name & First Policy
Member Name Customer ID Gender Date of Birth Age Relation
Relation Inception Date
Aarti Subhash
PI20306345 Female 19/07/1970 50 Self Aniket Mogare,Son 08/06/2021
Mogare
Aniket Subhash Aarti Subhash
PI00737659 Male 14/02/2000 21 Son 08/06/2021
Mogare Mogare,Mother
B-4 KAMAL MATOSHREE ROW HOUSE NR HOTEL SEVEN HEAVEN,HOTEL SAI PALACE CHETANA NAGAR CIDCO
Insured Address
NASHIK,NASHIK,MAHARASHTRA,422009
Cover Details
Inpatient Hospitalization Treatment (SI)
Aggregate Deductible (SI) Air Ambulance (SI)
1000000 300000 NA
Add On Cover
Non-Medical Expenses Cover
Member Name
UIN: BAJHLAP21586V012021
AARTI SUBHASH MOGARE No
ANIKET SUBHASH MOGARE No

Premium Details
Description Amount (INR) Description Amount (INR)
Base Premium 7276 Long Term Policy Discount 0
Premium on Add-on Cover 0 Employee Discount 0
Gross Premium: Eight Thousand Five Hundred Eighty-Six Net Premium 7276
Rupees
State GST(9%) 655
Central GST(9%) 655
IGST 0
UTGST 0
CESS
Gross Premium 8586
"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 E. & O.E"
"In case no GSTIN or incorrect GSTIN is provided by the Proposer at Proposal stage, Bajaj Allianz General Insurance Company Ltd shall not be
responsible for any Input Tax Credit losses and no subsequent revision of invoice will be undertaken."
Exclusions
Member Name Exclusion
Aarti Subhash Mogare NA

Aniket Subhash
NA
Mogare
Special Exclusion at Policy

NA
Level
Additional Remarks NA
This is to certify that Aarti Subhash Mogare has paid Rs.8586 towards Health Insurance premium for
Period and Policy Number as mentioned on the Policy Schedule and is eligible for Deduction under
Section 80-D of Income Tax (Amendment) Act, 1986
Notes:
80 D Certificate 1. This is subject to the provisions of Section 80D of income tax (Amendment) Act, 1986 as amended
from time to time.
2. This certificate must be surrendered to the company in case of cancellation of this policy.
3. In event of incorrect representation of this declaration the liability shall be upon the policy holder.
4. This certificate will not be valid if premium payment has been made in cash.
Receipt Number: 54-21-000000027437 Date: 08/06/2021 Premium Payer ID: PI20306345 Float: NA;
Premium Payment Details Payment Frequency: Single Premium ** If Premium paid through Cheque, the Policy is void ab-initio in
case of dishonour of Cheque
Financial Institution Ref. NA
AGENCY CODE 10077627 CONTACT NO 9766339960

AGENCY NAME Pratik Ramkrushna Patil EMAIL ID [email protected]
For & on the behalf
Bajaj Allianz General Insurance Company Ltd. Consolidated Stamp Duty of Rs. .5/- paid towards paid towards Insurance Premium
Stamps Vide Challan No. MH001915407201819M defaced number 0001369763201819/order
no.CSD/45/2018/2156/18 dated 08-JUN-18 timing 17:49:13 of General Stamp of India.
Stamp Duty
Rs..5/- This document is digitally signed,hence counter signature / stamp is not required
Principal Location : Bajaj Allianz House, Airport Road, Yerwada, Pune- 411006 PH-
66026666 | Services Accounting Code : 997133 Accident and health insurance services.
SUB 10077627 / NA

Digitally signed by DS BAJAJ ALLIANZ
GENERAL INSURANCE COMPANY LIMITED 01
Date: 2021.06.09 12:14:56 IST
Policy Verification Claim Registration
Bajaj Allianz General Insurance Co. Ltd. Bajaj Allianz House,Airport Road,Yerwada,Pune - 411 006. Reg.No.:113 CIN:U66010PN2000PLC015329
Give a Missed Call on 8080945060, SMS "WORRY"to 575758 http://www.facebook.com/BajajAllianz

RECEIPT
NASIK-Bajaj Allianz General Insurance Co Ltd,3rd Floor,

Sumangal Business Court,Plot No.39, Yeolekar Mala,Near
Policy issuing office and Correspondence address
Shraddha Petrol Pump,Beside 3m Car Mall,Nashik,
Maharashtra,INDIA,422005
Proposer Name Aarti Subhash Mogare Policy Number 12-8432-0000004188-00
Receipt Number 54-21-000000027437 Receipt Date 08/06/2021
Business Channel BACKOFFICE
Received with thanks from: Aarti Subhash Mogare
Customer ID: PI20306345 a total sum of Rupees Eight Thousand Five Hundred Eighty-Six Rupees Only by,
Instrument Type Instrument No Instrument Date Bank Name Branch Name Amount (Rs.)
Online Payment 17519205 08-Jun-2021 BN00000158 BN00000158 8,586.00
Total Amount: 8586
Note: Issuance of this receipt does not amount of acceptance of the risk by Bajaj Allianz General Insurance Company Limited. The insurance cover for
the risk shall be as per the terms and conditions of the Insurance Policy if and when issued.
*Cheque/DD/PO receipt is valid subject to realisation of the instrument
For & on the behalf

Date: 2021.06.09 12:15:00 IST

HEALTH & WELLNESS CARD

Scan QR to view your policy details

Health Card Number: 31-8432-0011398017-0001
Policy No: 12-8432-0000004188-00
Inception Date: 08/06/2021
Valid Up to: 07/06/2022
Member Name: ANIKET SUBHASH MOGARE
Age: 21
Bajaj Allianz General Insurance Company

(A Company incorporated under Indian Companies Act, 1956 and licensed by Insurance
Regulatory and Development Authority of India [IRDAI] vide Reg No. 113)
Regd.Office: Bajaj Allianz House, Airport Road, Yerwada, Pune-411006 (India)
Cashless hospitalization in network hospitals can be obtained only if this card is produced along
with a letter of authorization from Bajaj Allianz except for emergency cases. This is subject to
terms and conditions of the policy. Please quote your ID number for assistance. Intimation to
Bajaj Allianz Helpline is mandatory in case of any hospitalization.
HOSPITAL ALERT: In emergency, Patient may approach with id card; please call Bajaj Allianz
helpline to verify coverage and cashless authorization.
For help and more information:

Say Hi on WhatsApp on 7507245858, Give a Missed Call on 8080945060, SMS ‘WORRY’ to
575758, Contact our 24-Hour Call Center at 1800-209-5858
Email: [email protected], Website www.bajajallianz.com
Corporate Identification Number: U66010PN2000PLC015329
Bajaj Allianz General Insurance Co.Ltd. Bajaj Allianz House,Airport Road,Yerwada,Pune - 411006. Reg.No.: 113 CIN: U66010PN2000PLC015329


Scan QR to view your policy details

Health Card Number: 31-8432-0011398016-0001
Policy No: 12-8432-0000004188-00
Inception Date: 08/06/2021
Valid Up to: 07/06/2022
Member Name: AARTI SUBHASH MOGARE
Age: 50
Bajaj Allianz General Insurance Company

(A Company incorporated under Indian Companies Act, 1956 and licensed by Insurance
Regulatory and Development Authority of India [IRDAI] vide Reg No. 113)
Regd.Office: Bajaj Allianz House, Airport Road, Yerwada, Pune-411006 (India)
Cashless hospitalization in network hospitals can be obtained only if this card is produced along
with a letter of authorization from Bajaj Allianz except for emergency cases. This is subject to
terms and conditions of the policy. Please quote your ID number for assistance. Intimation to
Bajaj Allianz Helpline is mandatory in case of any hospitalization.
HOSPITAL ALERT: In emergency, Patient may approach with id card; please call Bajaj Allianz
helpline to verify coverage and cashless authorization.
For help and more information:

Say Hi on WhatsApp on 7507245858, Give a Missed Call on 8080945060, SMS ‘WORRY’ to
575758, Contact our 24-Hour Call Center at 1800-209-5858
Email: [email protected], Website www.bajajallianz.com
Corporate Identification Number: U66010PN2000PLC015329
Bajaj Allianz General Insurance Co.Ltd. Bajaj Allianz House,Airport Road,Yerwada,Pune - 411006. Reg.No.: 113 CIN: U66010PN2000PLC015329

Certificate for the purpose of deduction under Section 80-D of Income Tax
Amendment Act, 1986
This is to certify that Aarti Subhash Mogare has paid Rs. 8586 towards Health Insurance premium for EXTRA CARE
PLUS for the period from 08/06/2021 to midnight of 07/06/2022 under Policy no 12-8432-0000004188-00
Issue Date: 09/06/2021

Place: NASIK-Bajaj Allianz General Insurance Co Ltd,3rd Floor,
For & on the behalf of

This certificate must be surrendered to the company for issuance of fresh certificate in case of cancellation of the Policy or any alteration
in the insurance affecting premium.
Notes:
1. This is subject to the provisions of Section 80D of income tax (Amendment) Act, 1986 as amended from time to time.
2. This certificate must be surrendered to the company in case of cancellation of this policy.
3. In event of incorrect representation of this declaration the liability shall be upon the policy holder.
4. This certificate will not be valid if premium payment has been made in cash.

Date: 2021.06.09 12:14:56 IST
Policy Verification
Claim Registration

TAX INVOICE
(Customer Copy)
Invoice Number 272106I000351922 Customer ID PI20306345
Invoice Date 0 Policy No. 12-8432-0000004188-00
Recipient/ Details of Insured Supplier/ Details of Insurer
GSTIN Unregistered GSTIN 27AABCB5730G1ZX
PAN NA PAN AABCB5730G
Name (Proposer) Aarti Subhash Mogare Name Bajaj Allianz General Insurance Company Ltd.
Address-1 B-4 Kamal Matoshree Row House Nr Hotel Seven Address-1 Bajaj Allianz General Insurance Co Ltd
Address-2 Hotel Sai Palace Chetana Nagar Cidco Nashik Address-2 3rd Floor, Sumangal Business Court
Address-3 Address-3 Plot No.39, Yeolekar Mala,Near Shraddha Petrol
Pin Code 422009 Pin Code 422005
City NASHIK City NASHIK
State MAHARASHTRA State MAHARASHTRA
Client Category NON HNI Place of Supply 27 - MAHARASHTRA
Premium
Description Amount(INR) Description Amount(INR)
Net Premium 7276 State GST(9%) 655

Receipt Number: 54-21-000000027437 Date: 08/06/2021
Central GST(9%) 655
Premium Payer ID: PI20306345 Float: NA; ** If Premium paid
through Cheque, the Policy is void ab-initio in case of dishonour of 0
IGST(18%)
Cheque
Gross Premium 8586
Total Invoice Value (In figures) : 8586

Total Invoice Value (In Words) : Eight Thousand Five Hundred Eighty-Six Rupees
Amount of Tax Subject to Reverse Charge: No reverse charge is payable on these services.
Services Accounting 997133 Accident and health insurance services.

Principal Location: Bajaj Allianz House, Airport Road, Yerwada, Pune- 411006 PH-66026666
For & on the behalf


Date: 2021.06.09 12:15:00 IST
Important Notes:
* The invoice is issued as per Section 31 of the CGST Act
* In case no GSTIN or incorrect GSTIN is provided by the Proposer at Proposal stage, Bajaj Allianz General Insurance Company Ltd shall not be
responsible for any Input Tax Credit losses and no subsequent revision of invoice will be undertaken
* 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 E. & O.E
This is a digitally signed document and hence no physical signature is required
Bajaj Allianz General Insurance Co. Bajaj Allianz House,Airport Road,Yerwada,Pune - 411006. Reg.No.:113 CIN:U66010PN2000PLC015329

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Welcome to Bajaj Allianz Family

NASIK-Bajaj Allianz General Insurance Co Ltd,3rd Floor,

Insured Name Aarti Subhash Mogare Policy number 12-8432-0000004188-00

Name: Aarti Subhash Mogare

Dear Aarti Subhash Mogare,

For & on the behalf

Signature Not Verified

Give a Missed Call on 808094506 SMS 'WORRY' to 575758 http://www.facebook.com/BajajAllianz

Contact our 24-Hour Call Center at 1800-209-5858 http://twitter.com/BajajAllianz

[email protected] Demystify Insurance http://support.bajajallianz.com

Dear Aarti Subhash Mogare,

Gender Female Date of Birth 19/07/1970

Bajaj Allianz Employee Code, if Proposer is BAGIC/BALIC Employee

Marital Status NA No of children 1

Occupation Other Class 1

Address Line 3 Address Line 3

City/District NASHIK City/District NASHIK

State 27 - MAHARASHTRA State 27 - MAHARASHTRA

Pin Code 422009 Pin Code 422009

Telephone 8600441663 Telephone 8600441663

Mobile 8600441663 Mobile 8600441663

Email [email protected] Email [email protected]

Family Monthly Income 50000

In case of any offer, you would prefer to be contacted by 8600441663,[email protected]

Sum Insured Option, Deductible and Air Ambulance Table

Details of the Persons to be Insured

AARTI SUBHASH MOGARE No

ANIKET SUBHASH MOGARE No

Member Name Health Questionnaire Yes/No Details

A. EXCLUSIONS AND TERMS AND CONDITIONS:

Give a Missed Call on 8080945060, SMS 'WORRY' to 575758 http://www.facebook.com/BajajAllianz

Contact our 24-Hour Call Center at 1800-209-5858 http://twitter.com/BajajAllianz

[email protected] Demystify Insurance http://support.bajajallianz.com

NASIK-Bajaj Allianz General Insurance Co Ltd,3rd Floor, Sumangal

Phone No 8600441663 Email ID [email protected]

Customer ID PI20306345 Previous Policy No NA

Policy Issued on 09/06/2021 Policy Status ACTIVE

From 08/06/2021 00:00 Hrs To

GSTIN / UIN Unregistered

Company PAN AABCB5730G Invoice No: 272106I000351922

Insured Member Details

AARTI SUBHASH MOGARE No

ANIKET SUBHASH MOGARE No

Base Premium 7276 Long Term Policy Discount 0

Premium on Add-on Cover 0 Employee Discount 0

Central GST(9%) 655

Gross Premium 8586

Aarti Subhash Mogare NA

Special Exclusion at Policy

AGENCY CODE 10077627 CONTACT NO 9766339960

Signature Not Verified

Policy Verification Claim Registration

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Proposer Name Aarti Subhash Mogare Policy Number 12-8432-0000004188-00

Receipt Number 54-21-000000027437 Receipt Date 08/06/2021

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