Policy_schedule_doc
Policy_schedule_doc
Policy_schedule_doc
Policy issuing office and correspondence address for communication by RAMPUR (VSO)-Narian Automobiles, 3rd Floor, ,4 Shahnazaf Road, Hazratganj,
policyholder for claim, service request, notice, summons, etc.: Lucknow ,,,Lucknow,Uttar Pradesh,INDIA,226001
It is our privilege to welcome you to the Bajaj Allianz General Insurance family.
We thank you for choosing Bajaj Allianz for your Insurance needs. We are one of India's leading general insurance companies with iAAA rating
from ICRA for the last ten consecutive years indicating the company's high claims paying ability and fundamentally strong position in the industry.
Please be assured that you have made the right choice by choosing us and we will stand by you in your hour of need.
Please find enclosed the policy schedule. We wish to inform you that the policy issued is based on the information submitted in the proposal form
as well as the acceptance of the terms and conditions, and this will be verified at the time of filing of claim. Request you to kindly go through the
same once again and in case of any disagreement, discrepancy or clarifications – write to us at bagichelp@bajajallianz.co.in within 15 days of the
letter date. For policy wordings containing detailed terms, conditions and exclusions of your insurance coverage, you will receive a hard copy on
your correspondence address.
Once again, we welcome you to the Bajaj Allianz family and look forward to a long association with you.
We assure you the best of our services and look forward to a continual patronage and association with you.
Bajaj Allianz General Insurance Co.Ltd. Bajaj Allianz House, Airport Road, Yerawada, Pune -411 006.IRDA Reg. No.:113 CIN:U66010PN2000PLC015329
www.bajajallianz.com www.bit.do/bjazgi
We wish to inform you that your contract under policy number '12-1805-0006179830-00' will be based on the information and declaration given
by you through telephonic conversation / email / web-inputs / TAB/CSC Centres or other means which would be considered as the final proposal,
the transcript of which is as follows:
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 back 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.
A. Proposer details:
Name Ankur Kumar
Mailing Address Mohalla Chak Swar , Suar Rampur 244924 Uttar Pradesh
Email ID sainibjp405@gmail.com
Profession NA
B. Vehicle Details:
C. Coverage opted:
1. Period of Insurance
For Third Party Liability Section From 01-12-2024 00:00:01 hrs to 30-11-2025 Midnight
For Compulsory Personal Accident Cover for Owner Driver From Not Applicable to Not Applicable
2. Is your vehicle fitted with external LPG/CNG kit. NO
3. Whether PA cover is opted for owner-driver No, Exemption Reason:Already having Personal Accident
Cover for Owner- Driver
4. i. Whether geographical area extension is opted No
ii. Details of Countries to which geographical area extension is covered NA
5. Is LL to person for Paid driver/Operation/Maintenance opted No
i. No of persons NA
6. Whether PA cover is opted for paid driver other than owner driver No
i. No of paid Drivers 0
ii.Sum Insured for Paid Driver 0
7.Whether PA cover is opted for passengers No
i. Number of Passengers 0
ii.Sum Insured per Passenger 0
8. Is TPPD restricted to statutory limit of Rs.6000? Yes
9. Premium for Liability coverage, quoted and agreed upon Rs. 1994
10. Do you have valid PUC certificate of the vehicle NA
11. Do you have valid Fitness certificate of the vehicle NA
12. About the last insurance company
i. Insurance Provider
ii. Previous Policy No
iii. Previous Policy Expiry Date
13. Customer Level Underwriting Declaration
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 hereby give voluntary consent to BAGIC/Company to share my/our personal information and data provided in this proposal form with its
group companies or any other person in connection with the Insurance Policy or otherwise, including for providing products and services of group
companies that may be of interest to me/us, to be used in accordance with their respective privacy policies and subject to appropriate measures
being in place to safeguard my/our personal information.
I/We hereby unconditionally allow the Company to share all my / our information being collected in this proposal form or through telephonic /
email / web-inputs means or other means, as updated from time to time within group entities.
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 prospectuses or tables of the Insurer. Any person making default in complying with
the provisions of this section shall be punishable with a penalty, which may extend to Ten Lakh Rupees.
Bajaj Allianz General Insurance Co.Ltd. Bajaj Allianz House, Airport Road, Yerawada, Pune -411 006.IRDA Reg. No.:113 CIN:U66010PN2000PLC015329
www.bajajallianz.com www.bit.do/bjazgi
Motor Liability Only Policy - PC through CSC - POLICY SCHEDULE CUM CERTIFICATE OF
INSURANCE
UIN : BAL-MT-P16-02-V01-16-17
Policy issuing office and correspondence address for communication by RAMPUR (VSO)-Narian Automobiles, 3rd Floor, ,4 Shahnazaf Road,
policyholder for claim, service request, notice, summons, etc.: Hazratganj, Lucknow ,,,Lucknow,Uttar Pradesh,INDIA,226001
Insured Mohalla Chak Swar, , , Suar,, Rampur,, Uttar Pradesh- From: 01-12-2024 00:00:01 hrs
Period of Insurance
Address 244924 To: 30-11-2025 Midnight
Third Liability Cover 01-12-2024 00:00:01 hrs 30-11-2025 Midnight
Application No 11-1805-0012042647-00 Owner Driver CPA Not Applicable Not Applicable
Customer ID PI32288964 Cover Note Details NA
Hypothecated With NA Invoice Number 092411I000624110
GSTIN / UIN Company GST No 09AABCB5730G1ZV
Place of Supply/
09 - UTTAR PRADESH Company PAN AABCB5730G
State Code/Name
Premium Payer ID 72985989 Zone B
Scrutiny No NA Policy Status ACTIVE POLICY
Geographical Area INDIA Bank Reference No 1
Vehicle Details:
Registration Number Vehicle Make Vehicle Model Vehicle Subtype CC KW
Year of Manufacture Place of Reg Seating Capacity Chassis Number Engine Number Vehicle IDV(Rs)
UK06-UDHAM SINGH
2013 5 MALAA51HLDM800024D B4HADM659661 0
NAGAR
0 0 0
SCHEDULE OF PREMIUM
Agency Details
The Policy covers use of the vehicle for any purpose other than : Hire or reward, Carriage of goods( other
Limitation as to Use 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 license at the time
of the accident and is not disqualified from holding or obtaining such a license. Provided also that the person
Driver 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 there
Limits of Liability requirements of the Motor Vehicles Act,1988. Under section II-I(ii) of the policy ->Damage to Third Party
Property : Rs. 6000
No Claim Bonus NA
Subject to Warranties/
20
IMT-Endorsements
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"
*Warranted that insured named herein or owner of the vehicle insured holds a valid Pollution Under Control (PUC) and / or Fitness
Certificate on the date of commencement of the Policy. If the PUC and/or Fitness Certificate is not found to be valid on the date of
commencement of the Policy, the Company reserves its right to consider the policy void ab initio.
It is mandatory to keep your policy with updated contact (Mobile No., Email ID and PAN Card) and bank account details, to process
any of your service requests faster and hassle-free in future.
You can update the same through Caringly yours App, WhatsApp Service { Say ‘Hi’ on WhatsApp - +91 75072 45858}, Contact our
24-Hour Call Center at 1800-209-5858, 1800-102-5858, Give a Missed Call on – 8080945060, SMS “WORRY” to 575758, Email -
bagichelp@bajajallianz.co.in , Website - www.bajajallianz.com, contact your agent or nearest branch.
Stamp Duty
Authorized Signatory Rs .5
Printed, Signed and Executed at Pune
This document is digitally signed, hence counter signature / stamp is not required.
Consolidated Stamp Duty of Rs. .5/- paid towards insurance policy stamps vide Challan No. MH003479644202425M Defaced No.
0002709637202425 Order No. LOA/ENF-1/CSD/36/2024-25 Order Dated 15/07/2024 Defaced Dated 10/07/2024 timing 15:00:00 of General
Stamp Office, Mumbai, India.
Principal Location: 1302 |Service Accounting Code: 997134 Motor vehicle insurance services. No reverse charge is payable on these services.
Policy Details Caringly Yours App Claim Registration Online Grievance Whatsapp Service
Bajaj Allianz General Insurance Co.Ltd. Bajaj Allianz House, Airport Road, Yerawada, Pune -411 006.IRDA Reg. No.:113 CIN:U66010PN2000PLC015329
www.bajajallianz.com www.bit.do/bjazgi
Name (Proposer) ANKUR KUMAR Name Bajaj Allianz General Insurance Company Ltd.
Address-3 Address-3 ,
Premium
IGST(12%) 0
IGST(18%) 0
Amount of Tax Subject to Reverse Charge: No reverse charge is payable on these services.
Services Accounting Code: 997134 Motor vehicle insurance services.
Principal Location: Bajaj Allianz House, Airport Road, Yerwada, Pune- 411006 PH-66026666
Authorized Signatory
Important Notes:
* The invoice is issued as per Section 31 of the CGST Act
* Signature
In case no Not Verified
GSTIN or incorrect GSTIN is provided by the Proposer at Proposal stage, Bajaj Allianz General Insurance Company Ltd shall not be responsible for any Input
Tax Credit
Digitally losses
signed by and no subsequent
DS BAJAJ ALLIANZ revision of invoice will be undertaken
* GENERAL
As per theINSURANCE
GST regulations, the amount
COMPANY of GST will not be refunded if the policy / endorsement is cancelled after 30th September of the next financial year
LIMITED
Date: 2024.11.29 10:38:58 IST
This is a digitally signed document and hence no physical signature is required
Bajaj Allianz General Insurance Co.Ltd. Bajaj Allianz House,Airport Road,Yerwada,Pune -411006.IRDA Reg.No:113 CIN:U66010PN2000PLC015329
www.bajajallianz.com www.bit.do/bjazgi