The Certificate of Insurance

Page 1 of 1
BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LTD
U66010PN2000PLC015329
GE PLAZA, AIRPORT ROAD, YERAWADA, PUNE 411006,
Tel.: 1800-22-5858 1800-102-5858 Fax:
Email: info@bajajallianz.co.in
IRDA Reg No.: 113
Service Tax Registration No : AABCB5730G-ST-001
Certificate Cum Policy Schedule

THE INSURED:

Policy No:
Policy Type :
Issue Date :
Occupation :

Mr. Ranjit Babulal Bhavsar

OG-15-2202-1801-00063779
Package Policy( Private Vehicle )
08:02:41:PM on 24-Jan-2015
NA

D-201,SUN RESIDENCY,NR:WATER TANK, BH:SAHAJANAND BUNGLOWS,

KOTESHWAR ROAD, MOTERA, AHMEDABAD-380005, Gujarat
Period Of Insurance From 00:00:00 AM 01-Mar-2015 to midnight on 29-Feb-2016
D' Zire New LXI/MARUTI SWIFT DZIRE
LXI

The Vehicle
Geographical Area

Engine-Chassis No.

INDIA

1146823 - 109116

Vehicle Identification Number(VIN)

Date and Proposal No.:

MA3EJKD1S00109116

24-Jan-2015 / 52969337

Type of Body

CC

Mfg.Year

Seating Capacity

Registration Mark & Place of

Registration

Saloon

1197

2012

GJ1RA3550 / AHMEDABAD

INSURED'S DECLARED VALUE

Vehicle

Non-Elec accessories

Elec accessories

CNG/LPG KIT

Total Value (IDV)

359708

359708

Schedule Of Premium
A. OWN DAMAGE

B. LIABILITY

Vehicle & Accessories

5906 Vehicle

1332

Total

5906 Total

1332

Add
b)

5906
Geographical Area Extn.

NA
0

5% Extra premium towards inbuilt LPG

b) Additional PA Cover Premium (100000 per person) For 5 Person (IMT- 16) 250
d) Legal Liability (WC) to Driver (IMT-28)

g) For Anti-theft Devices (IMT-10)

Deduct 25% for NCB

100

NA

Less
i)

1332

a) Compulsory PA Cover Premium

Sub-Total Additions
c)

Add

148

e) Legal Liability to Employees (IMT-29)

50
0

1440

Sub-Total (deductions)

1588

Depreciation Shield

3058

Total(A)

7376

Sub-Total Additions

400

Total(B)

1732

Grand Total

9108

1. If the premium is paid by Cheque, the issue of Policy is subject to the

realization of Cheque.

Service Tax @ 12.36%

1126

2. Consolidated Stamp duty paid to state exchequer.

Total Premium

Note :-

Compulsory Deductible

10234

1000

Limitations as to use: Use only for social domestic and pleasure purposes and for the Insured's business. The Policy does not cover the use for : (1) Hire or reward (2) Carriage of
goods(other than samples or personal luggage) (3) Organized racing (4) Pace making (5) Speed testing (6) Reliability trials g) Any purpose in connection with motor trade.
Driver's Clause:Any person including the insured: Provided that a person driving holds an effective driving license at the time of the accident and is not disqualified from holding or
obtaining such a license. Provided also that the person holding an effective learner's license may also drive the vehicle & that such a person satisfies the requirements of Rule 3 of
the Central Motor Vehicles Rules,1989.
Limits of Liability Clause : 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 vehicle act 1988.
Under section II-1 (ii) of the policy-Damage to third party property is Rs. 7.5 lakhs P.A. Cover under section III for Owner-Driver is Rs. 2.0 Lakhs
No claim bonus : The insured is entitled for a No Claim Bonus (NCB) on the own damage section of the policy, if no claim is made or pending during the preceding year(s), as per
the : The preceding year/20%, Preceding two consecutive years/25%, Preceding three consecutive years/35%, Preceding four consecutive years/45%, Preceding five consecutive
years/50% of NCB on OD Premium. No claim bonus only be allowed provided the policy is renewed with in 90 days of the expiry date of the previous policy.
Lease/HP/Hypothecation : STATE BANK OF INDIA , .
Nominee Detail For Compulsary PA: PINANG R BHAVSAR
Subject to I.M.T. Endt. Nos. & memorandum : 7 10 15 16 22 28

printed herein.

The insured is not indemnified if the vehicle is used

I / We hereby certify that the policy to which this certificate relates as well as this certificate of insurance are issued in
or driven otherwise than in accordance with this
accordance with the provisions of chapter X and chapter XI of M.V. act, 1988.
schedule. Any payment made by the company by
For BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LTD
reasons 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". For legal interpretation, English version
will hold good.
Authorized Signatory
This policy is sourced and serviced through :

MARUTI INSURANCE BROKING PRIVATE LIMITED

DIRECT BROKER LICENSE No. : IRDA/DB475/10, Intermediary Code : 55555551, Mail Id: support@mibpl.co.in, Contact No: (011/022/033/044)-33774477,
For terms & conditions please visit

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