*91277347*

BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LIMITED

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

EXTENDED WARRANTY TRANSCRIPT OF PROPOSAL

Policy issuing office and Correspondence address for communication by policyholder for claim, service GE Plaza,Airport Road,Yerwada,Pune-411006,Phone No :66026666
request, notice, summons, etc. :
Insured Name MR GAUTAM PRIYADARSHI Child Certificate Number OG-19-1000-6609-00065600

Dear MR GAUTAM PRIYADARSHI,

We wish to inform you that the contract under policy number OG-19-1000-6609-00065600 has been finalized based on the information and declaration given by you, the transcript
where of is mentioned below. You are requested to reconfirm the same. 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 date of your receipt of this, failing which it will be deemed that you are satisfied with the correctness of the details
mentioned below. Kindly note that as the contents and declarations contained in this transcript is the basis on which we 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.

Details provided by you:

A. Proposer details:
1. Proposer Name : MR GAUTAM PRIYADARSHI
2. Proposer Address : S/O-CHAUTHI SADAI WN-02,S/O-CHAUTHI SADAI WN-02,/, DARBHANGA - 846004,BIHAR
3. Proposer Contact Number : 9801252227,9801252227,9801252227
4. Proposer e-mail id : NA

B. Asset details:
Asset Category Manufacturer Make Model
AIR CONDITIONER LG ELECTRONICS INDIA PVT.LTD LG-AC 89153

Manufacturer's Product Warranty Period Insured Asset Serial No Insured Asset Invoice No Invoice Date Sum Insured (in Rs.)
1 806NAHF019689 18/4292 29-JUN-2018 42000.0

C. Coverage opted:
1 Period of Extended Warranty 2 year(s)
2 Period of Insurance From 29-JUN-2019 00:00 Hours To 28-JUN-2021
3 Total Premium (including Service Tax /GST) Rs.4595
4 Deductibles NA

In case of Disagreement or objection or any changes with respect to information 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:
I/we have read and understood the Privacy Policy of your Company at www.bajajallianz.com and I hereby unconditionally agree and bind myself to all terms and conditions of your
Privacy Policy, as amended, from time to time.
For Extended Warranty policy related communication :
Toll Free Number : 1800-209-1021 (free calls from all mobiles and landlines) between 9 AM to 9 PM, 7 days a week
E-Mail Address : ew.cda@bajajallianz.co.in
Contact our policy servicing branch at : Bajaj Allianz General Insurance Company Ltd,GE Plaza, Airport Road, Yerawada, Pune-411006. PH: +91 (020) 66026666

(Details are system generated & hence no signature required).

Insurance Act, 1938 Section 41 - Prohibition of Rebates Insurance Act

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 prospectus or tables of the insurer. ANY PERSON MAKING FAULT IN
COMPLYING WITH THE PROVISIONS OF THIS SECTION SHALL BE PUNISHABLE WITH FINE WHICH MAY EXTEND TO FIVE HUNDRED RUPEES.

Schedule (1) | Printed on : 25-Jul-2018 07:11:30 pm |Silent Print|WEB|31837022

For help and more information: Page 1 of 2

Contact our 24 Hour Call Centre at 1800-209-5858, 1800-102-5858 (Toll Free)
Email: customercare@bajajallianz.co.in , Website www.bajajallianz.com Corporate Identification Number: U66010PN2000PLC015329

https://www.facebook.com/BajajAllianz https://twitter.com/BajajAllianz www.bit.do/bjazgi Demystify Insurance http://support.bajajallianz.com

 *91277347*

BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LIMITED

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

EXTENDED WARRANTY POLICY SCHEDULE UIN : BAL-OT-P15-04-V02-15-16

Policy issuing office and Correspondence address for communication by policyholder for claim, service GE Plaza,Airport Road,Yerwada,Pune-411006,Phone No :66026666
request, notice, summons, etc. :
Insured Name MR GAUTAM PRIYADARSHI Child Certificate Number OG-19-1000-6609-00065600

INSURED DETAILS POLICY DETAILS

Policy Issued on 21-JUL-2018
S/O-CHAUTHI SADAI WN-02,
S/O-CHAUTHI SADAI WN-02,/, From: 29-JUN-2019 00:00
Insured Address Period of Insurance
DARBHANGA - 846004, To : 28-JUN-2021 Midnight
BIHAR
Endorsement NA
Customer ID 123375881
GSTIN / UIN NA Policy Status ISSUED
STATE CODE / NAME 10 - Bihar
Master Policy Number OG-16-9999-9960-00000005
Cover Details
ASSET CATEGORY AIR CONDITIONER
SUM_INSURED 42000.0
NO OF YEARS 2
Premium Details
Net Premium. Rs.3894
Final Premium Rupees Four Thousand Five Hundred and Ninty Five only. Integrated GST (18%) Rs.701
Gross Premium. Rs.4595
Other Details
Manufacturer LG ELECTRONICS INDIA PVT.LTD
Make LG-AC
Model 89153
Manufacturer Product Warranty Period 1
Serial No. of Insured Asset 806NAHF019689
Invoice No. of Insured Asset 18/4292
Invoice Date of Insured Asset 29-Jun-2018
Supplier ID 234109
Dealer Name ADITYA VISION LTD # DARBHANGA # 1702977
Dealer Code 234109
Dealer Location DARBHANGA
Deductibles NA
Special Condition As per the Policy Wordings of Extended Warranty
Remarks N.A

For Extended Warranty policy related communication :

Toll Free Number : 1800-209-1021 (free calls from all mobiles and landlines) between 9 AM to 9 PM, 7 days a week
E-Mail Address : ew.cda@bajajallianz.co.in
Contact our policy servicing branch at : Bajaj Allianz General Insurance Company Ltd,GE Plaza, Airport Road, Yerawada, Pune-411006. PH: +91 (020) 66026666

Receipt Number:0 | Date:21-JUL-18 | Premium Payer ID:33875185 | Float: BG

Premium Details ** If Premium paid through Cheque, the Policy is void ab-initio in case of dishonour of Cheque.
Financial Institution Ref. No. IN2447804

Agency Code 10031837,BAJAJ FINANCE Contact No. 00

& Name LIMITED E-Mail ID. praveensharma@bflaf.co
.in
For & on the behalf
Bajaj Allianz General Insurance Company Ltd. QR Code

Authorized Signatory
(This is system generated document and need not be countersigned.)

Consolidated Stamp Duty of Rs.0.5/- paid towards Insurance Stamps vide Challan No. MH001488162201819M Defaced No. 0000969824201819 /Order no. CSD/33/2018/1747/18

BAGIC GST No : 27AABCB5730G1ZX | Principal Location : GE Plaza, Airport Road, Yerwada, Pune - 411006 PH:66026666 | Services Accounting Code : 997139 - Other non-life

Schedule (1) | Printed on : 25-Jul-2018 07:11:30 pm |Silent Print|WEB|31837022

For help and more information: Page 2 of 2
Contact our 24 Hour Call Centre at 1800-209-5858, 1800-102-5858 (Toll Free)
Email: customercare@bajajallianz.co.in , Website www.bajajallianz.com Corporate Identification Number: U66010PN2000PLC015329

https://www.facebook.com/BajajAllianz https://twitter.com/BajajAllianz www.bit.do/bjazgi Demystify Insurance http://support.bajajallianz.com