BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LTD.

CERTIFICATE CUM POLICY SCHEDULE

Policy issuing office and corres- N-A/7,Irrigation
A/7,Irrigation Dept., Employees Co
Co-operative Society,Chitragupt Nagar, KankarBagh, ,, Patna-
pondence address for communic- 800020 PH:0612-3923036
3923036
ation by Policy holder of Certific-ate
of Insurance for claim, service
request, notice, summons, etc;
Policy Number OG-19-2416-1806-0001
00011272 Product Two Wheeler -Liability
Liability Only Policy
Period Of Insurance From: 03-OCT-2018
2018 00:01 (Hrs) Policy issued on 03-OCT-2018
To: 02-OCT-2019
2019 Midnight Cover Note No. /
Insured Name DIVAKAR UPADHYAY Zone B
Insured Address VILL PO SIKATIYA,, SIWAN SIWAN, , BIHAR,
BIHAR-841244
Customer Id 127559120 Premium Payer Id 72985989
Application No 0 Scrutiny No 95708951
Reference No : null
Policy Status ISSUED
GSTIN / UIN NA STATE CODE / NAME 10 - Bihar
Coinsurance Details : .
Registration No Make Model SubType CC Year Of Mfg Seat Cap Chassis number. Engine No.
BR01BB8483 HERO PASSION CAST DRUM 100 2012 2 MBLHA10A6DHM14414
6DHM14414 HA10ENDHM8893
PRO KICK 3
Elec. Accessories Non-Elec.
Elec. Acc. Side Car CNG/LPG Unit
0 0 0 0
SCHEDULE OF PREMIUM
Own Damage Liability
Total Own Damage Premium 0 Basic Third Party Liability 720
Total Act Premium: 720
Total Premium 720
Special Discount
Net Premium 720
State GST (9%) 65
Central GST (9%) 65
Final Premium Rs. 850

Geographical Area : India Voluntary Excess : Nil

Compulsory Deductible : Rs. 0 Additional Compulsory Deductible : Rs. 0
Previous Insurer - NA Previous Policy No - 0 Expiry On -
LIMITS OF LIABILITY: Under section II-I(i) of the policy -> > Death of or bodily injury : Such amount is necessary to meet there requirements of the Motor Vehicles Act,1988. Under
section II-I(ii) of the policy ->
> Damage to Third Party Property : Rs. 100000
LIMITATION AS TO USE : The Policy covers use of the vehicle le for any purpose other than : Hire or reward, Carriage of goods(other than samples or personal luggage), Organised ra-
ra
cing, Pace making, Speed testing, Reliability trials, Any purpose in connection with Motor Trade.
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 disqualified from holding or obtaining
such a licence. Provided also that the person holding an effective Learner's licence may also drive the vehicle and that such a person satisfies the requirements of Rule 3 of the Central
Motor Vehicles Rules, 1989.
Past Claim Reference : -
IMPORTANT NOTICE : The Insured is not indemnified if the vehicle is used or driven otherwise than in accordance with thisthis 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.
Insured. See the clause headed AVOIDANCE OF CERTAIN
TERMS AND RIGHT OF RECOVERY.

Broker Code 527100150010 Channel Name : AC

Broker Name : Anurag KUMAR
Contact No : 9386118244
Email - ANURAG4445@GMAIL.COM
Plan Description:
Premium Collection Details :- [Receipt No/Collection No/Amount] Rs. 850, By Float No : 10042624
*** If premium paid through cheque, the policy is void ab-initio
initio in case of dishonor of cheque.
This certificate of insurance is issued in accordance with the provision of Chapter X and Chapter XI of M.V.Act, 1988.
In case of any claim, please contact ourr 24 Hour Call centre at 1800
1800-22-5858, 1800-102-5858 ,1800-102-5858,1800
5858,1800-209-5959(Toll Free) / 91-
020-30305858
30305858 (chargeable, add area code before this number in case of mobile call) or email us at 'customercare@bajajallianz.co.in'
'customercare@bajajallianz.co.i
95708951/-/527100150010/527100150010/-
PIN NO : NA Damage Details: NA
Remarks : null
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.
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