Bajaj Allianz General Insurance Company Limited.

Servicing Office : 25-28,Upper Ground Flr,, Megh Mayur Plaza,, Athwalines,Parlepoint, Surt Dumas Rd,, SURAT,
GUJARAT (State Code:24) -395007
Private Car Policy - Bundled UIN --IRDAN113RP0007V01201819
Certificate Cum Policy Schedule (FORM 51 OF THE CENTRAL MOTOR VEHICLE RULES, 1989)
PAN :AABCB5730G GSTIN: 24AABCB5730G1Z3 CIN :U66010PN2000PLC015329 IRDAI Reg:113

Policy No: OG-24-9910-1825-00097444 Proposal No. & Date: HIIB4715847, 22-SEP-2023

Policy Issued On: 22-SEP-2023 14:06 HRS Previous Policy No.: NA
Insured Name: MR. KRUPAL SANJAYKUMAR PANDYA Previous Insurer: NA
Period of Own Damage : 22-SEP-2023 (14:06) To 21-SEP-2024 (1 YEAR)
04 MADHURAM PARK NANDELAV BHARUCH , BHARUCH , Period of Liability Cover: 22-SEP-2023 (14:06) To 21-SEP-2026 (3 YEARS)
Insured Address:
GUJARAT (State Code:24) -393001
Period of Compulsory 22-SEP-2023 (14:06) To 21-SEP-2026 (3 YEARS)
Personal Accident Cover:
Customer Type PAN GSTIN Name Age (Yr.) Relation
Customer Details Nominee Details
INDIVIDUAL XXXXX8481E NA DEVANSHIBEN PANDYA 24 SPOUSE

Vehicle Details
Make Model Variant Cubic Capacity Manufacturing Year Seating capacity
HYUNDAI Exter 1.2MT KAPPA S CNG 1197 2023 5
Body Type Registration No. RTO Hypothecation/Lease* Fuel Type VIN/Chassis No.
SUV NEW BHARUCH YES PETROL MALB281CLPM028871
Vehicle IDV Electrical Accessories Non-Electrical Accessories BI Fuel Kit Total IDV Engine No
773,575 0 0 0 773,575 G4LAPM689301

Own Damage Premium (A) Amount(INR) Liability Premium (B) Amount(INR)

Basic Own Damage Premium Basic Third Party Liability Premium 10,640
Vehicle 22,217 Bi-Fuel Kit 180
Non-Elec. Accessories (IMT-24) 0 Geographical Area Extension (IMT-1) 0
Elec. Accessories (IMT-24) 0 Sub Total (Third Party Liability) 10,820
Bi-Fuel Kit (IMT-25) 1,110 Personal Accident (PA) Cover
Geographical Area Extension (IMT-1) 0 Compulsory PA Cover for Owner Driver Rs 1500000 (IMT-15) 909
IMT 23 Premium 0 PA Cover for 5 Unnamed Passengers Rs 100000 Each (IMT-16) 750
Sub Total (Basic Premium) 23,327 PA cover for Paid Driver of Rs 2 Lac (IMT-17) 0
Discount/Deductibles Sub Total PA Cover 1,659
Voluntary Deductibles (0) (IMT-22A) 0 Legal Liability
Anti Theft Device (IMT-10) 0 Paid Driver (IMT-28) 150
AA Membership (IMT-8) 0 Employees (for 0 persons) (IMT-29) 0

No Claim Bonus (0%) 0 Sub Total (Legal Liability) 150

Handicapped Discount (IMT-12) 0 Net Liability Premium (B) 12,629

Sub Total (Deductibles) 0 Total Premium (A+B) 42,058
Total Own Damage Premium 23,327 SGST(9%) 3,786
Add On Coverages ( ZD, CM, EP, KP, PB ) 6102 CGST(9%) 3786
Net Own Damage Premium (A) 29,429 Gross Premium Paid 49,630
Add-on Cover Opted in the Policy: Depreciation Shield-Bundled(IRDAN113RP0007V01201819/A0009V01201819), Consumable Expenses-Bundled
(IRDAN113RP0007V01201819/A0020V01201819), Engine Protector-Bundled(IRDAN113RP0007V01201819/A0015V01201819), Keys and Lock Replacement Cover-Bundled
(IRDAN113RP0007V01201819/A0016V01201819), Personal Baggage Cover-Bundled(IRDAN113RP0007V01201819/A0017V01201819)
Notes: 1. Consolidated Stamp Duty of Rs.0.5/- paid towards Insurance Stamps vide Challan No. MH002405964202122M Defaced No. 0001482221202122 dated 05-JUL-21 timing 12:58:03 of General Stamp
Office,Mumbai,India.
2.This policy has been issued upon declaration by the Insured that a valid Pollution Under Control (PUC) Certificate is held on the date of
commencement of the Policy. The insured undertakes to renew and maintain a valid and effective PUC and/or fitness Certificate, as applicable, 3.Geographical Area: India
during the subsistence of the Policy.
5.The policy is subject to compulsory deductible of INR 1000
4. Policy issuance is subject to realization of cheque if premium is paid by cheque
(IMT-22) & Voluntary Deductible of INR 0
6. This policy is to be read in conjunction with the Policy /Add-on wordings T&C available on the insurer website http://www.bajajallianz.com
*Hypothecation Details: STATE BANK OF INDIA - BHARUCH - BHARUCH Payment Mode: Online
Limitations as to use:The policy covers use of the vehicle for any purpose other than (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 (7) Any purpose in connection with motor trade.
Driver's Clause: Any person including the insured: Provided that the person driving holds an effective driving license at the time of the accident and is not disqualified from holding or obtaining such
license. Provided also that the person holding an effective learners license may also drive the vehicle & that such a person satisfies the requirements of Rule 3 of the Central Motor Vehicle 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 the requirements of the Motor Vehicle Act 1988.Under Section II-1 (ii) of
the policy-Damage to third party property is INR 7.5 Lakhs, PA Cover Under Section III for Owner-Driver is INR 15 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) - 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.
NCB is allowed provided the policy is renewed within 90 days of the expiry date of the previous policy.
Declaration on Tax Invoice We hereby declare that though our aggregate turnover in any preceding financial year from 2017-18 onwards is more than the aggregate turnover notified under sub-rule (4)
of rule 48, we are not required to prepare an invoice in terms of the provisions of the said sub-rule.
Important Notice: The insured is not indemnified if the vehicle is used or driven otherwise than in accordance with the schedule. Any payment made by the company by 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 & RIGHT
OF RECOVERY" For legal interruption, English version will hold good.
Grievance Clause: For resolution of any query or grievance, Insured may check Grievance redressal policy at https://www.bajajallianz.com/about-us/customer-service.html or connect with the respective
servicing office of insurance company. In the event of unsatisfactory response,he/she may approach the insurance ombudsman for the redressal of grievance at www.irdai.gov.in or on website of General
Insurance Council: www.gicouncil.in
HSN/SAC : 997134, Description of Service : Motor Vehicle Insurance Services, Place of Supply : GUJARAT(State Code : 24), Insurer Invoice Number : HAP/HBZ/HIIB4715847
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 XI of Motor Vehicle Act, 1988.
Insurance Broker Name : Hyundai India Insurance Broking Pvt. Ltd. Scan for Renewal For & On Behalf of
Corporate Office:16th Floor, Building No. 9A, DLF Cybercity, Phase III, Gurugram, (Valid from 90 Days Prior to Expiry) Bajaj Allianz General Insurance Company Limited.
Haryana 122001
Broker Code: 822 (Valid UPTO:30/05/2025) MISP NAME-EMINENT AUTOCAR
CIN No.: U67200HR2021PTC098982 PRIVATE LIMITED
GST: 06AAGCH0310P1ZP MISP CODE-HIIB-MHY-0153
Email ID: connect@hiib.in DP NAME-SANJAYKUMAR ISHWARLAL
Contact No: 0124-6833000 PATEL
Authorized Signatory
For Claims, Policy Servicing & Renewal, Kindly contact (EMINENT AUTOCARS PRIVATE LIMITED) at +91-6357573621