Bajaj Two-Wheeler Policy – Bundled

Policy No. Issued at HERO INSURANCE BROKING INDIA PVT LTD.

Bajaj Allianz General Insurance Co. Ltd. IRDA Registration No.: 649
HMB/BAGIC1810202400086591
BAJAJ ALLIANZ GENERAL INSURANCE CO LTD 3RD Toll-Free No.: 1800 102 4376
FLOOR NARAIN BUILDING SHAHNAZAF ROAD, 226001 264, Okhla Ind. Estate, Phase-III, Delhi-110020
Tel:18002585956
bagichelp@bajajallianz.co.in

Insured Business/Profession Address of The Insured TP Valid From TP Valid To

S/O SHALIK RAM BAKTA BUJURG CHITRAKOOT
Mr UMA SHANKAR 18-10-2024
Private Company-Middle Le CHITRAKOOT Chitrakoot UTTAR PRADESH 21020 Midnight of 17-10-2029
VISHWAKARMA 16:45:57
6
Cubic GSTIN No.
Vehicle Regn No. Engine No. Chassis No. Make & Model Year of Mfg
Capacity (Customer)
Hero MotoCorp DESTINI
New JF17ERRGF09362 MBLJFN358RGF09350 2024 125
PRIME DRS CAST
Declared Value (IDV) of Side Car IDV Non-Electrical Electrical Accessories CNG/LPG/Bi- Total IDV
Vehicle Accessories IDV IDV Fuel IDV
71303.00 NA 0.00 0.00 0.00 71303
Place of Regn. Body Type HP/Lease/Hire-Purchase Branch Office of Seating Premium
Agreement With HP/Lease/Hire- Capacity
Purchase
CHITRAKOOT Solo , --- 2 5192.00
Section A B. Liability Premium Computation (Section II) in Rs.
Basic OD Premium : 478.00 Basic Third Party Liability : 3851.00
Non-Electrical-Fitting Premium : 0.00 TPPD Discount : 250.00
Electronic & Electrical Accessories : 0.00 Total : 3601.00
Geographical Extension : 0.00 CNG/LPG/Bi-Fuel Kit : 0.00
ND Cover : 321.00 Geographical Extension : 0.00
Less : Add
Handicapped Discount : 0.00 Compulsory PA Cover (Owner Driver) : 0.00
For Anti-Theft Discount : 0.00 Optional PA Cover(Un Named Passenger) : 0.00
NCB : 0.00 Optional PA Cover(Un Named Driver) : 0.00
Total Own Damage Premium(A) : 799.00 Legal Liability Cover (Paid Drivers, Cleaners) : 0.00
Legal Liability Cover (Per Licensed Passenger) : 0.00
Total Liablity Premium (B) : 3601.00
Total Premium (A + B) : 4400.00
For any other extra : 0.00
CGST @ 9.00% : 396.00
SGST @ 9.00% : 396.00
Gross Premium : 5192.00
IRDAI'sRegnNo.:113||LicenceNo.:113||CINNo.:U66010PN2000PLC015329||PANNo.:AABCB5730G||HSN/SAC:997134|| GSTIN No.:09AABCB5730G1ZV ||UIN No.-IRDAN113
RP0008V01201819||IRDAN113RP0008V01201819/A0024V01201819
18-10-2024 To 17-10- 18-10-2025 To 17-10- 18-10-2026 To 17-10- 18-10-2027 To 17-10- 18-10-2028 To 17-10-
OD Policy Period
2025 2026 2027 2028 2029
IDV 71303 NIL NIL NIL NIL
CPA Sum Insured(NODL) NIL NIL NIL NIL NIL
Sum Insured of Optional PA Cover:-Sum Insured of Optional PA Cover "Unnamed Passenger"-NA and "Unnamed Driver"-NA
LIMITATIONS AS TO USE:--The Policy covers use of the vehicle 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.
DRIVER: Any person including insured: Provided that a person driving holds an effective driving licence at the time of the accident and is not disqualified from
Holding or obtaining such a licence.Provided also that the person holding an effective Learner's Licence may also drive the vehicle and that such a person
satisfies the requirements of Rule 3 of the Central Motor Vehicle Rules, 1989.
LIMIT OF LIABILITY: Limit of the amount of the Company's liability under the Section II-I(i) in respect of any one accident as per M.V. Act 1988. Limit of the
amount of the Company's liability under Secion II-I(ii) in respect of any one claim or series of claims arising out of one event : Upto Rs - 6000/
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 RIGHTS OF RECOVERY'
I/We certify that the policy to which the certificate relates as well the certificate of insurance are issued in accordance with this provisions of Chapter X & XI of M.V. Act 1988
Broker : Hero Insurance Broking India Pvt. Ltd.
Premium of Rs. 5192.00 Received Vide CASH
Cash/Cheque No.
SAVITAA The policy is subject to a compulsory excess of Rs. 100/- &
Dated Nominee Name DEVI Depreciation is applicable as per policy terms & conditions*(Please
turn overleaf for details)
Drawn on Nominee Age 30 Consolidated Stamp Duty Paid Endorsements : IMT - 22,20
Scan to Renew / Acknowledgement 18-10- Nominee Relation Wife
View Policy Dt 2024
FOR RENEWALS CONTACT: KRITI SRIVASTAVA Ph.No- 08960-631091 On behalf of Bajaj Allianz General Insurance Co. Ltd.

18-Oct-2024
Date & Signature of
proposer

Dealer's Stamp & Signature Duly Constituted Attorney

# : Received with Thanks Rs 5192.00 from Mr UMA SHANKAR VISHWAKARMA as premium against the money receipt no
02HMB/BAGIC1810202400086591
Regd. & Head Office : Bajaj Allianz House, 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 Consolidated Stamp Duty of Rs. XX/- (As per the
Product Code) paid for insurance policy stamps vide Order No. CSD/17/2023/4571 dated 10-NOV-23 of General Stamp Office, Mumbai, India
For further information about motor insurance policy please also visit www.irdai.gov.in >> Grievances >> Policyholder Handbooks