Bajaj Allianz General Insurance Company Ltd.
GE Plaza, Airport Road, Yerwada, Pune - 411006(India)
CERTIFICATE CUM POLICY SCHEDULE
Policy Servicing Off: Bajaj Finserv Building, 1st Floor, Behind Weikfield IT-Park, Viman Nagar, Pune-411014 Phone No :1800-209-0144
Policy Number OG-18-9906-1805-00011848 Product Private Car - Liability Only Policy
Period Of Insurance From: 16-Dec-2017 Policy issued on 15-Dec-2017 -
To: 15-Dec-2018 Midnight Cover Note No /
Application No 78871692 Scrutiny No
Insured Name PADMENDRA SINGH B Zone
Insured Address H.NO. 201 MITHEY PUR PO. LAWAR MEER-
UT, MEERUT, UTTAR PRADESH, ,, - 250110
Customer ID 110527531 Premium Payer ID 110527531
Transaction Id
Policy Status ISSUED
GSTIN / UIN NA STATE CODE / NAME 09 - Uttar Pradesh
Registration Make SubType Model CC Mfg year Seat Cap Vehicle/Trailer Engine Number
No. Chassis No
UP15AJ2389 MARUTI LXI ALTO 796 2008 5 MA3EYD81S01266 F8DN1262330
667
Vehicle IDV Elec Acc Non Elec Acc Trailer Trailer Reg No CNG/LPG Unit Total Sum Insured
0 0 0 0 0
SCHEDULE OF PREMIUM
OWN DAMAGE LIABILITY
Total Own Damage Premium: Basic Third Party Liability 2055
PA Cover For Owner-Driver Of Rs. 200000 100
Total Liability Premium: 2155
Additional loading @ 0% 0
Contact No : 0/1800-103-3999
Email -
Damage Details as per Annexure I
Premium Collection Details :- [Receipt No/Collection No/Amount] 9906-01566625 / 78871692 / Rs. 2543 ,
*** If premium paid through cheque, the policy is void ab-initio in case of dishonour of cheque.
This certificate of insurance is issued in accordance with the provision of Chapter X and Chapter XI of M.V. Act, 1988.
Damage Details Annexure : - NA
Remarks PDA MODULE
In case of any claim, please contact our 24 Hour Call centre at 1800-22-5858, 1800-102-5858 (Toll Free) / 91-020-30305858
(chargeable, add area code before this number in case of mobile call) or email us at 'customercare@bajajallianz.co.in'.
78871692/-/10043080/99060001/-
This is a one page Policy Document [without enclosing the Terms and Conditions (T&C) of the Policy] issued by the Company, pursuant to the authorization of Insured to display the T&C of the Policy on its website (www.bajajallianz.com) that enables access by the In-
sured. The T&C of the Policy are available on the Company's website and can be accessed by the Insured.
Kindly contact our nearest / local office(s) for No Claim Bonus Confirmations.
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Authorized Signatory
Printed , Signed and Executed at Pune null Consolidated stamp Duty paid vide Receipt No: .49 dated 27-NOV-17
Generated by Silent_Printing
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.BAGIC GST No : 27AABCB5730G1ZX | Princip-
al Location : GE Plaza, Airport Road, Yerwada, Pune - 411006 PH:66026666 | Services Accounting Code : 997134 - Motor vehicle insurance services. No reverse charge
is payable on these services. | Invoice No. : 91401689/1 - Latest Schedule - 15-Dec-2017 19:15:35 PM (Web)
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