BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LTD.

Regd. Office & Head Office: Bajaj Allianz House, Airport Road, Yerawada, Pune-411006.
IRDAI Registration No.113
Corporate Identity Number: U66010PN2000PLC015329
Policy Issuing,correspondence address for communic-
Bajaj Finserv Building, 1st Floor, Behind Weikfield IT-Park, Viman Nagar, Pune-
ation by policy [or certificate of insurance] hold- 411014 PH:1800-209-0144
er,policy/claim servicing, notices and or summons
Insured Name SHIVANI SAINI Policy Number OG-25-9906-1871-00058987

Welcome to Bajaj Allianz Family

SHIVANI SAINI
GUNYAZUDDI,GUNYAZUDDI,, , , MUZAFFARNAGAR, UTTAR PRADESH-
247772

Customer ID : 455559589
Dear Customer,
Thank you for choosing Bajaj Allianz General Insurer as your preferred insurer. Bajaj Allianz General Insurance Company Limited, a con-
sistently profitable insurer enjoys a reputation of expertise, stability and strength. We are a customer focused market leader present in over
200 locations across India. As an organization we strive to understand the risk management needs of our consumers and translate it into af-
fordable products and services of global quality that deliver value for money. Bajaj Allianz has an ISO Certified claims,Operations and Ser-
vices processes and has received iAAA rating for the last three consecutive years from ICRA Limited, an associate of Moody's Investors Ser-
vice, for claims paying ability. The rating indicates highest claims paying ability and a fundamentally strong position in the industry.

We request you to kindly go through the contents of the policy schedule and the terms and conditions. In case of any clarification or dis-
agreement, please write to us at bagichelp@bajajallianz.co.in within fifteen days of receipt of this policy.
We assure you the best of our services and look forward to a continual patronage and association with you.

For & on the behalf

Bajaj Allianz General Insurance Company Ltd.

Authorized Signatory

For help and more information:

Contact our 24 Hour Call Centre at 1800-102-5858, 1800-209-5858, Toll Free: 30305858( chargeable, add area code before this number in case of mobile call) Email us at Bagichelp@bajajallianz.co.in or
Visit our Website www.bajajallianz.com
Corporate Identification Number U66010PN2000PLC015329
 Bajaj Allianz General Insurance Company Ltd.
Regd. Office & Head Office: Bajaj Allianz House, Airport Road, Yerawada, Pune-411006
IRDAI Registration No. 113
Corporate Identity Number: U66010PN2000PLC015329
Transcript of Proposal for Standalone Own Damage Cover for Two Wheeler

Dear SHIVANI SAINI,

We wish to inform you that the contract under policy number 'OG-25-9906-1871-00058987' has been finalized based on the
proposal / information and declaration given by you, the transcript whereof 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 back within a period of 15 days from date of your receipt of this transcript along with Policy
failing which it will be deemed that you have positively confirmed/ 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 : SHIVANI SAINI
2. Proposer Address : GUNYAZUDDI,GUNYAZUDDI,,
, , MUZAFFARNAGAR, UTTAR PRADESH-247772
3. Proposer Mobile Number : 8218006513
4. Proposer Residential Number : NA
5. Proposer e-mail id : reetuchoudhary1288@GMAIL.COM
6. Proposer Profession : NA

B.Vehicle Details
Registration Month / Year Vehicle Vehicle Vehicle Sub Cubic Capa- Fuel Type Year of Man- Seating Ca-
Number of Regn Make Model Type city ufacture pacity
UP12BR879 AUG/2023 HERO MO- SPLENDOR i3S SELF 100 Petrol 2023 2
3 TOCORP PLUS START
DISC
BRAKE AL-
LOY
WHEEL

Engine Number Chassis Number Vehicle IDV (in Electrical Non-Electrical CNG/LPG Unit Total IDV (in
Rs.) Accessories Accessories (Extra fitted) Rs.)
IDV (in Rs.) IDV (in Rs.) IDV (in Rs.)
HA11E8PHG203 MBLHAW233P 55148 0 0 0 55,148.00
54 HG50207
 C. Coverage opted

From : 21-DEC-2024 00:00 (Hrs)

1. Own Damage Standalone Cover Period of Insurance
To : 20-DEC-2025 Midnight
From : 18-sep-2023 To :
Period of Insurance
17-sep-2028
Details of Active Third Party
2. Go Digit General Insurance
Liability Policy Name of Insurance Company
Limited
Policy Number D111868024

3. Is your vehicle fitted with external LPG/CNG kit : No.

4. Electrical Accessories cover Opted (If Applicable) : No.
5. Non - Electrical Accessories cover Opted (If Applicable): : No.
6. Is Voluntary Excess opted : No.
Amount of voluntary excess opted : Rs.NA.
7. compulsory deductible : Rs.100.00
8. Is any additional compulsory deductible imposed and agreed upon : No.
Amount of additional compulsory deductible imposed : NA.
9. Whether geographical area extension is opted : No.
Details of Countries to which geographical area extension cover is given : NA.
10. Pre Existing damages in the vehicle : NA.
11. Total Premium (excluding GST) for OD coverages, quoted and agreed upon is: Rs.195
12. Do you have valid PUC certificate of the vehicle : NA
13. NCB (No Claim Bonus) claimed by you and granted by us based on your : 0%.
declaration of no claim during your previous policy
14. Previous Own Damage Policy Detail
(i) Insurer Name .
(ii) Previous Policy No : NA , Previous Policy Expiry Date : NA
15. Whether your vehicle is Hypothecated and if so the details of Pledgee whose name is registered by us: No.
Name of Pledgee : NA.
16. Add on Cover(s) opted : No.Plan name:NA

17. To support our Go Green initiative, send policy copy link on registered mobile number / email id:

Please note Cover Note No. / issued to you basing on the above information.
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 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.
Toll free Number : 1800-102-5858,1800-209-5858
Email address : Bagichelp@bajajallianz.co.in
Website : www.bajajallianz.com
Contact our policy servicing branch at: Bajaj Finserv Building, 1st Floor, Behind Weikfield IT-Park, Viman
Nagar, Pune-411014 PH:1800-209-0144.
INSURANCE ACT, 1938 SECTION 41 - PROHIBITION OF REBATES
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 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 IN BREACH OF COMPLYING WITH THE PROVISIONS OF THIS SECTION SHALL BE
PUNISHABLE WITH FINE WHICH MAY EXTEND TO RUPEES TEN LAKH.Bajaj Allianz General Insurance Co Ltd
 BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LIMITED
Regd. Office & Head Office: GE Plaza, Airport Road, Yerwada,Pune-411006(India)
IRDAI Registration No. 113
Corporate Identity Number: U66010PN2000PLC015329
STANDALONE OWN DAMAGE COVER FOR TWO WHEELER
Certificate of Insurance
UIN : IRDAN113RP0002V01201920
Policy issuing office and correspondence address for communication by holder of Bajaj Finserv Building, 1st Floor, Behind
Certificate of Insurance for claim, service request, notice, summons, etc: Weikfield IT-Park, Viman Nagar,
Pune-411014 PH:1800-209-0144
Insured Name SHIVANI SAINI Policy Number OG-25-9906-1871-00058987
Certificate No. NA

INSURED DETAILS POLICY DETAILS

Insured Address GUNYAZUDDI,GUNYAZUDDI,,Policy Issued on 18-DEC-2024
, , MUZAFFARNAGAR, UTTAR Period of Insurance For Own Damage Section For Third Party Liability
PRADESH-247772 Section
From : 21-DEC-2024 From : 18-sep-2023To
00:00 (Hrs) : 17-sep-2028
To : 20-DEC-2025
Midnight
Third Party Liability Name of Insurance Co Policy Number
Section Go Digit General D111868024
Insurance Limited
Customer ID 455559589 Policy Status ISSUED
GSTIN / UIN NA Cover Note Details /
Place of Supply/State 09 - Uttar Pradesh Previous Policy No /
Code/Name
Particulars of Vehicle Insured:

Registration Number Place of Registration Engine Number Chassis Number Make & Model
UP12BR8793 UP12-MUZAFFARNA HA11E8PHG20354 MBLHAW233PHG50 HERO MOTOCORP -
GAR 207 SPLENDOR PLUS

Sub Type Year of Mfg NCB % CC Seating Capacity

i3S SELF START DISC BRAKE ALLOY 2023 0 100 2
WHEEL
Name of Registration Authority : UP12-MUZAFFARNAGAR
Name and Address of Insured : SHIVANI SAINI
: GUNYAZUDDI,GUNYAZUDDI,, , ,
MUZAFFARNAGAR, UTTAR PRADESH-247772
Geographical Area : .00
Business or Profession : NA
Persons or Class of Persons entitled to drive:
Any person including the insured:
a) 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.
b) Provided also that the person holding an effective learner's license may also drive the vehicle and that such a person
satisfies the requirements of Rule 3 of the Central Motor Vehicles Rules, 1989.
IMT-Endorsements/Add on Package
22

For help and more information:

Contact our 24 Hour Call Centre at 1800-102-5858, 1800-209-5858, Toll Free: 30305858( chargeable, add area code before this number in case of mobile call) Email us at
Bagichelp@bajajallianz.co.in or Visit our Website www.bajajallianz.com
Corporate Identification Number U66010PN2000PLC015329
Latest Schedule - 18-Dec-2024 14:48:53 PM- Silent_Printing (Web) (99060001)
Beneficier Details:
Beneficier1 Beneficier2 Beneficier3 Beneficier4 Beneficier5
Limitations as to Use:
The Policy covers use 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
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 provi-
sions of Chapter X and Chapter XI of M.V. Act, 1988.
For & On Behalf of
Bajaj Allianz General Insurance Company Ltd.

Authorized Signatory
 BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LIMITED
Regd. Office & Head Office: GE Plaza, Airport Road, Yerwada,Pune-411006(India)
IRDAI Registration No. 113
Corporate Identity Number: U66010PN2000PLC015329

STANDALONE OWN DAMAGE COVER FOR TWO WHEELER

POLICY SCHEDULE
IRDAN113RP0002V01201920
Policy issuing office and Correspondence address for communication by policyholder for claim, service request, notice, summons, etc:
Bajaj Finserv Building, 1st Floor, Behind Weikfield IT-Park, Viman Nagar, Pune-411014 PH:1800-209-0144
Note:-
The coverage under this policy is only for Own Damage and no other liability in connect with the vehicle.
Policy will be void ab initio in case of misrepresentation/ fraud or non-existence of valid Third party liability policy for the full
Policy period of this Standalone own damage cover-Two Wheeler policy

INSURED DETAILS POLICY DETAILS

Insured Name SHIVANI SAINI Policy Number OG-25-9906-1871-00058987
GUNYAZUDDI,GUNYAZUDDI,, , , Policy Issued on 18-DEC-2024 14:49 PM
MUZAFFARNAGAR, UTTAR PRA-
Insured
From :21-DEC-2024
DESH-247772
Address Details of Own 00:00 (Hrs)
Geographical Policy Period
.00 Damage Stan- To :20-DEC-2025
Area dalone Cover Midnight
Customer ID
455559589 From : 18-sep-2023 To
Policy Period
Bank Reference Details of Active : 17-sep-2028
No 1
Third Party Liab- Name of Insur- Go Digit General Insur-
GSTIN / UIN NA ility Policy ance Co. ance Limited
Place of Supply/ Policy Number D111868024
09 - Uttar Pradesh
State Code/Name Cover Note
Company /
Details
27AABCB5730G1ZX
GSTIN
Previous Policy No /
Company PAN AABCB5730G
Invoice No 442483838/1
Make & Mod-
Registration Number Place of Registration Engine Number Chassis Number SubType
el
HERO MOTO- i3S SELF
UP12-MUZAFFARNA MBLHAW233PH CORP - START DISC
UP12BR8793 HA11E8PHG20354
GAR G50207 SPLENDOR BRAKE AL-
PLUS LOY WHEEL
Year Of Manufactur- Trailer Registra-
NCB % CC/KW Seating Capacity Hypothecation Details
ing tion Number
HDFC BANK
0 100 2 2023 -,- LTD
Vehicle IDV Value For Trailers Non electrical Electrical/Elec- Value of CNG/ Total Value
accessories tronic accessories LPG kit
55148 0 0 0 0 55,148.00

Own Damage Premium(Rs.) Final Premium(In Words): Rupees Two Hundred

Own Damage Premium 195 Thirty Only

For help and more information:

Contact our 24 Hour Call Centre at 1800-102-5858, 1800-209-5858, Toll Free: 30305858( chargeable, add area code before this number in case of mobile call) Email us at Ba-
gichelp@bajajallianz.co.in or Visit our Website www.bajajallianz.com
Corporate Identification Number U66010PN2000PLC015329
Latest Schedule - 18-Dec-2024 14:48:53 PM- Silent_Printing (Web) (99060001)
Integrated GST (18%) 35
Final Premium Rs. 230

**Note: The above Total OD Premium is inclusive of all applicable Loading /Discounts viz (Automobile association membership, Voluntary Excess, Anti
Theft, Handicap Person, Driver Tuition, Fiber Glass, CNG/LPG Unit, Geographical Extension, Imported Vehicle Etc. wherever Applicable)

As per the GST regulations, the amount of GST will not be refunded if the policy / endorsement is cancelled after 30th September of the next financial year
I/We hereby declare that though our aggregate turnover in any preceding financial year from 2017-18 onwards is more than the aggregate turnover
noti-fied 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.

Broker Code 10043080 Contact No. 0/1800-103-3999

Broker Name POLICYBAZAAR INSURANCE BROKERS PRIVATE LIMTED
E-Mail ID.

Limitation as to Use The Policy covers use of the vehicle for any purpose other than : Hire or reward, Carriage of
goods( other than samples or personal luggage),Organised racing,Pace making, Speed testing,
Reliability trials. Any purpose in connection with Motor Trade.
Driver Any person including the insured provided that a person driving holds an effective driving li-
cense at the time of the accident and is not disqualified from holding or obtaining such a license.
Provided also that the person 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.
No Claim Bonus
Existing Damage Details NA
Nominee Details Name :NA - Relationship :NA
Subject to Warranties/ 22
IMT-Endorsements/
Add on Package
Additional Details Coinsurance Details: - . Transaction Id: -
Premium Details Receipt No. 9906-10788853, Date 18-DEC-24 ** If Premium paid through Cheque, the Policy is
void ab-initio in case of dishonour of Cheque.
Excess Details Compulsory Excess: Rs.100.00 Additional Excess: Rs.0 Voluntary Excess: Rs..00
Theft Excess: Rs.0
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 {Link}, 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 ba-
gichelp@bajajallianz.co.in, website {http://www.bajajallianz.com}, contact your agent or nearest branch.
For & On Behalf of
Bajaj Allianz General Insurance Company Ltd.

Stamp
Duty Rs.
0.50
Authorized Signatory
This document is digitally signed, hence counter signature / stamp is not required.
Consolidated Stamp Duty of Rs. 0.50/- paid for insurance policy stamps vide Order No. CSD/36/2024-25/2886 dated 01-AUG-24 of General Stamp Office, Mumbai, India.

Principal Location : Bajaj Allianz House, Airport Road, Yerwada, Pune - 411006 PH:66026666 | Services Accounting Code : 997134
- Motor vehicle insurance services. No reverse charge is payable on these services.

For help and more information:

Contact our 24 Hour Call Centre at 1800-102-5858, 1800-209-5858, Toll Free: 30305858( chargeable, add area code before this number in case of mobile call) Email us at Ba-
gichelp@bajajallianz.co.in or Visit our Website www.bajajallianz.com
Corporate Identification Number U66010PN2000PLC015329
Latest Schedule - 18-Dec-2024 14:48:53 PM- Silent_Printing (Web) (99060001)
 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

Receipt Number 9906-10788853

Receipt Date 18/12/2024
Business Channel WS

Received with thanks from SHIVANI SAINI

(Customer ID : 455559589 ) a total sum of Rupees Two Hundred Thirty One Only by,

Instrument Instrument No. Instrument Bank Name Branch Name Amount

Type Date
Online Pay- PBPB1127236 18/12/2024 NA NA 231
ment 73

Total Amount Rs. 231.00

Issuance of this receipt does not amount to acceptance of the risk by Bajaj Allianz General In-
surance Company Limited. The insurance cover for the risk shall be as per the terms and
con-ditions of the Insurance Policy if and when issued.
* Cheque/DD/PO receipt is valid subject to realisation of the instrument.

For & on behalf of

Bajaj Allianz General Insurance Company Ltd.

Authorised Signatory

Regd.Office: Bajaj Allianz House,Airport Road, Yerwada, Pune - 411006