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BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LIMITED


(A Company incorporated under Indian Companies Act, 1956 and licensed by Insurance Regulatory and Development Authority of India [IRDA]
vide Reg No.113)
Regd. Office: GE Plaza, Airport Road, Yerwada,Pune-411006(India)

Certificate of Insurance (Two Wheeler Package Policy)


Policy Number: OG-17-3067-1802-00000195

Customer ID: 82869174

Particulars of Vehicle Insured:


Registration Number Place of Registration
NEW
MUMBAI
Sub Type
SELF DISC ALLOY
Name of Registration Authority
Name and Address of Insured

Geographical Area
Business or Profession

Engine Number
05844
Year of Mfg
2016

NCB %
0

Chassis Number
58786
CC
150

Make & Model


HONDA - UNICORN

Seating Capacity Final Premium


2
Rs.1366.

: MUMBAI
: YASHWANT MADAGE
: B P T RAILWAY LINE GATE NO 4 KIDWAI ROAD,
NEAR JAI MANGAL SOCIETY WADALA MUM, B
P T COLONY, , MUMBAI, MAHARASHTRA-400037
: India
: NA

Effective date of commencement of Insurance for the purpose of act:


Policy Inception Date: From O' Clock on 11-AUG-2016
Policy Expiry Date: Midnight on 10-AUG-2017
Persons or Class of Persons entitled to drive:
Any person including the insured:
a) 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.
b) Provided also that the person holding an effective learner's license may also drive the vehicle and that such a person satisfies
the requirements of Rule 3 of the Central Motor Vehicles Rules, 1989.
Limitations as to Use:
The Policy covers use for any purpose other than
a) Hire or Reward, b) Carriage of goods (other than samples or personal luggage), c) Organized racing, d) Pace Making, e)
Speed testing,
f) Reliability Trials, g) Any purpose in connection with Motor Trade
I/We hereby certify that the Policy to which this certificate relates as well as this Certificate of Insurance are issued in
accordance with the provisions of Chapter X and Chapter XI of M.V. Act, 1988.
Full address of Issuing Office :
Bajaj Allianz General Insurance Co Ltd., 603,6th Floor, A Wing, BSEL Tech Park,, Plot no.39/5 &
39/5A, Sector- 30 A,Opp. Vashi Railway Station, Vashi, THANE-400703 PH:022-66809500
Date of issue :11-AUG-2016
For & On Behalf of
Bajaj Allianz General Insurance Company Ltd.
Now carry your m-policy on your mobile. Click here to download. http://goo.gl/Skh032

Authorized Signatory

For help and more information:


Contact our 24 Hour Call Centre at 1800-102-5858, 1800-209-5858, 1800-22-5858, Toll Free: 30305858( chargeable, add area code before this number in case of mobile call) Email us at
customercare@bajajallianz.co.in or Visit our Website www.bajajallianz.com
Corporate Identification Number U66010PN2000PLC015329
Latest Schedule - 11-Aug-2016 13:55:24 PM- ezetabprint (Web) ()




BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LIMITED


(A Company incorporated under Indian Companies Act, 1956 and licensed by Insurance Regulatory and Development Authority of
India [IRDA] vide Reg No.113)
Regd. Office: GE Plaza, Airport Road, Yerwada,Pune-411006(India)

TWO WHEELER PACKAGE POLICY SCHEDULE


Policy Issuing
Office

Bajaj Allianz General Insurance Co Ltd., 603,6th Floor, A Wing, BSEL Tech Park,, Plot no.39/5 &
39/5A, Sector- 30 A,Opp. Vashi Railway Station, Vashi, THANE-400703 PH:022-66809500
INSURED DETAILS

Insured Name
Insured
Address
Geographical
Area
Customer ID

POLICY DETAILS

YASHWANT MADAGE
B P T RAILWAY LINE GATE NO 4
KIDWAI ROAD, NEAR JAI MANGAL
SOCIETY WADALA MUM, B P T
COLONY , , MUMBAI, MAHARASHTRA-400037
India

82869174

Bank Reference
No 1

OG-17-3067-1802-00000195

Policy Issued
on

11-AUG-2016 13:51 PM
From : 11-AUG-2016 (Hrs)

Period of
Insurance

To : 10-AUG-2017 Midnight

Cover Note
Details

0/

Previous
Policy No

Engine Number

Chassis Number

Make & Model

SubType

MUMBAI

05844

58786

HONDA UNICORN

SELF DISC
ALLOY

Registration Number Place of Registration


NEW

Policy Number

NCB %

CC

Seating Capacity

Year Of Manufacturing

Hypothecation Details

150

2016

PIONEER FINANCE COMPANY PVT LTD

Value For Side Car

Non electrical
accessories

Electrical/Elec- Value of CNG/


Total Value
tronic accessories
LPG kit

Vehicle IDV
60846

0
Own Damage Premium(Rs.)
Own Damage Premium
Special Discount
Total OD Premium - A
Total Premium (Net Premium) (A+B)
Service Tax
Swachh Bharat Cess
Krishi Kalyan Cess
Final Premium ( Rupees One Thousand Three Hundred
Sixty Six Only )

0
0
Liability Premium(Rs.)
519 Basic Third Party Liability
0 PA Cover for Owner-Driver
519 Total Act Premium - B
1188
166
6
6
1366

60846
619
50
669

**Note: The above Total OD Premium is inclusive of all applicable Loading /Discounts viz (Automobile association membership, Voluntary Excess,
Anti Theft, Handicap Person, Driver Tuition, Fiber Glass, CNG/LPG Unit, Geographical Extension, Imported Vehicle Etc. wherever Applicable)

Agency Code

BAG100000697

Contact No.

09773665231/09773665231

Agency Name

Durgesh Dhananjay Naringrekar

E-Mail ID.

NARINGREKARDURGESH@GMAIL.COM

For help and more information:


Contact our 24 Hour Call Centre at 1800-102-5858, 1800-209-5858, 1800-22-5858, Toll Free: 30305858( chargeable, add area code before this number in case of mobile call) Email us at customercare@bajajallianz.co.in or Visit our Website www.bajajallianz.com
Corporate Identification Number U66010PN2000PLC015329
Latest Schedule - 11-Aug-2016 13:55:24 PM- ezetabprint (Web) ()




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,
Reliability trials. Any purpose in connection with Motor Trade.
Any person including the insured provided that a person driving holds an effective driving liDriver
cense 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
when not used for the transport of goods/passengers at the time of the accident and that such a
person satisfies the requirements of Rule 3 of the Central Motor Vehicle Rules, 1989.
Under section II-I(i) of the policy -> Death of or bodily injury : Such amount is necessary to meet
Limits of Liability
there requirements of the Motor Vehicles Act,1988. Under section II-I(ii) of the policy -> Damage to Third Party Property : Rs. 100000
The insured is entitled for a No Claim Bonus (NCB) on the Own Damage section of the policy, if
No Claim Bonus
no claim is made or pending during the preceding year (s), as per the following: 1. The preceding
year: 20% , 2. Preceding Two consecutive years: 25% , 3. Preceding Three consecutive years:
35%, 4. Preceding Four consecutive years: 45% , 5. Preceding Five consecutive years: 50% No
Claim Bonus will only be allowed provided the policy is renewed within 90 days of the expiry
date of the previous policy.
Existing Damage Details NA
Subject to Warranties/ 22,7
IMT-Endorsements/
Add on Package
Coinsurance Details: - NA. Transaction Id: Additional Details
Receipt No. 3067-00000956, Date 11-AUG-16 ** If Premium paid through Cheque, the Policy is
Premium Details
void ab-initio in case of dishonour of Cheque.
Compulsory Excess: Rs.100
Additional Excess: Rs.0
Voluntary Excess: Rs.0
Excess Details
Limitation as to Use

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.

For & On Behalf of


Bajaj Allianz General Insurance Company Ltd.

Authorized Signatory
This document is digitally signed, hence counter signature / stamp is not required.
Consolidated stamp Duty paid vide Receipt No: .35 dated 20-JUN-16
Service Tax Reg. No. AABCB5730G-ST-001

Bajaj Allianz General Insurance Company Ltd.


Bajaj Allianz General Insurance Co Ltd., 603, 6th Floor, A Wing, BSEL Tech Park, Plot no.39/5 & 39/5A, Sector30 A, Opp. Vashi Railway Station, Vashi, THANE - 400703 Contact No: 022-66809500; Fax No: 022-66628621

RECEIPT

Receipt Number

3067-00000956

Receipt Date

11/08/2016

Business Channel

ML

Received with thanks from

YASHWANT MADAGE

(Customer ID : 82869174 ) a total sum of Rupees One Thousand Three Hundred Sixty Six Only by,

Instrument
Type
Online Payment

Inst./Ref No
1119840

Instrument
Date
11/08/2016

Bank Name

Branch Name

Amount
1,366

Total Amount

Rs.

1,366.00

Issuance of this receipt does not amount to 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 behalf of


Bajaj Allianz General Insurance Company Ltd.

Authorised Signatory

Regd.Office: GE Plaza,Airport Road, Yerwada, Pune - 411006


CIN:U66010PN2000PLC015329; E-mail: customercare@bajajallianz.co.in; Website:www.bajajallianz.com

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