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 RACHNA YADAV Policy Number OG-25-9906-1871-00039094

Welcome to Bajaj Allianz Family

RACHNA YADAV
H NO 9 PART 1 VILLAGE BADSHAHP, UR HARYANA , , GURGAON, HARY-
ANA-122101

Customer ID : 449197796
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 RACHNA YADAV,

We wish to inform you that the contract under policy number 'OG-25-9906-1871-00039094' 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 : RACHNA YADAV
2. Proposer Address : H NO 9 PART 1 VILLAGE BADSHAHP, UR HARYANA
, , GURGAON, HARYANA-122101
3. Proposer Mobile Number : 9899960704
4. Proposer Residential Number : NA
5. Proposer e-mail id : gy39080@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
HR98F6731 JUL/2022 HONDA ACTIVA 6G H 110 Petrol 2022 2
SMART

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.)
JF91ED7076484 ME4JF91AFND0 62892 0 0 0 62,892.00
76429
 C. Coverage opted

From : 11-OCT-2024 00:00 (Hrs)

1. Own Damage Standalone Cover Period of Insurance
To : 10-OCT-2025 Midnight
From : 26-jun-2022 To :
Period of Insurance
25-jun-2027
Details of Active Third Party
2. Bharti AXA General Insurance
Liability Policy Name of Insurance Company
Company Limited
Policy Number ZXCVGF1234

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.1400
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 : Yes
Plan Name:Drive Assure-Basic Plan Description: depreciation shield ,
Please call us on 1800 103 5858 for any emergency.

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 RACHNA YADAV Policy Number OG-25-9906-1871-00039094
Certificate No. NA

INSURED DETAILS POLICY DETAILS

Insured Address H NO 9 PART 1 VILLAGE Policy Issued on 09-OCT-2024
BADSHAHP, UR HARYANA , , Period of Insurance For Own Damage Section For Third Party Liability
GURGAON, HARYANA-122101 Section
From : 11-OCT-2024 From : 26-jun-2022 To
00:00 (Hrs) : 25-jun-2027
To : 10-OCT-2025
Midnight
Third Party Liability Name of Insurance Co Policy Number
Section Bharti AXA General ZXCVGF1234
Insurance Company
Limited
Customer ID 449197796 Policy Status ISSUED
GSTIN / UIN NA Cover Note Details /
Place of Supply/State 06 - Haryana Previous Policy No /
Code/Name
Particulars of Vehicle Insured:
Registration Number Place of Registration Engine Number Chassis Number Make & Model
HR98F6731 HR98-BADSHAHPUR JF91ED7076484 ME4JF91AFND07642 HONDA - ACTIVA
9

Sub Type Year of Mfg NCB % CC Seating Capacity

6G H SMART 2022 0 110 2

Name of Registration Authority : HR98-BADSHAHPUR

Name and Address of Insured : RACHNA YADAV
: H NO 9 PART 1 VILLAGE BADSHAHP, UR
HARYANA, , GURGAON, HARYANA-122101
Geographical Area :
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 & Plan Name:Drive Assure-Basic & Plan Description: depreciation shield ,
Beneficier Details:
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 - 09-Oct-2024 00:02:25 AM- Silent_Printing (Web) (99060001)
 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 RACHNA YADAV Policy Number OG-25-9906-1871-00039094
H NO 9 PART 1 VILLAGE BADSHAHP, Policy Issued on 09-OCT-2024 00:02 AM
Insured UR HARYANA , , GURGAON, HARY-
ANA-122101 From :11-OCT-2024
Address
Details of Own 00:00 (Hrs)
Geographical Policy Period
Area Damage Stan- To :10-OCT-2025
Customer ID dalone Cover Midnight
449197796
From : 26-jun-2022 To
Policy Period
Bank Reference : 25-jun-2027
No 1 Details of Active
Bharti AXA General
Third Party Liab- Name of Insur-
GSTIN / UIN NA Insurance Company
ility Policy ance Co.
Place of Supply/ Limited
06 - Haryana
State Code/Name
Policy Number ZXCVGF1234
Company 27AABCB5730G1ZX
GSTIN Cover Note
AABCB5730G /
Company PAN Details
Invoice No 435944686/1
Previous Policy No /

Make & Mod-

Registration Number Place of Registration Engine Number Chassis Number SubType
el
ME4JF91AFND07 HONDA - AC-
HR98F6731 HR98-BADSHAHPUR JF91ED7076484 6G H SMART
6429 TIVA
Year Of Manufactur- Trailer Registra-
NCB % CC/KW Seating Capacity Hypothecation Details
ing tion Number
0 110 2 2022 -,-
Non electrical Electrical/Elec- Value of CNG/
Vehicle IDV Value For Trailers Total Value
accessories tronic accessories LPG kit
62892 0 0 0 0 62,892.00

Own Damage Premium(Rs.) Final Premium(In Words): Rupees One Thousand Six
Own Damage Premium 1400 Hundred Fifty Two Only
Integrated GST (18%) 252

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 - 09-Oct-2024 00:02:25 AM- Silent_Printing (Web) (99060001)
  

Final Premium Rs. 1652

**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 & Plan Name:Drive Assure-Basic & Plan Description: depreciation shield ,
IMT-Endorsements/
Add on Package
Additional Details Coinsurance Details: - . Transaction Id: -
Premium Details Receipt No. 9906-10450518, Date 09-OCT-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.
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 - 09-Oct-2024 00:02:25 AM- 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 9906-10450518

Receipt Date 09/10/2024
Business Channel WS

Received with thanks from RACHNA YADAV

(Customer ID : 449197796 ) a total sum of Rupees One Thousand Six Hundred Fifty Two Only
by,

Instrument Instrument No. Instrument Bank Name Branch Name Amount

Type Date
Online Pay- PBPB1062365 09/10/2024 NA NA 1,652
ment 20

Total Amount Rs. 1,652.00

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

 TWO WHEELER STANDALONE OD POLICY: ADD ON COVERS(Plan Name:Drive Assure-Basic): POLICY
WORDINGS

S3 - DEPRECIATION SHIELD
A. Endorsement Wordings
(UIN No. IRDAN113RP0002V01201920/A0019V01201920)
In consideration of payment of additional premium, it is hereby agreed and declared that this Policy extends to cover the
depreciation amount, partly or fully, on assessed damaged parts allowed for replacement during repairs in the event of a
Partial Loss to the Insured Vehicle .
In the event You have opted for co-payment, Your contribution shall be to the extent agreed by You as shown in the
Schedule for the depreciation amount on the assessed parts for each and every Partial Loss claim.
The benefits under 'Depreciation Shield' would be available only if the Insured Vehicle is repaired at Our authorized
workshops. In case You have opted to repair the Insured Vehicle at a non-authorized workshop, Our liability will be
restricted to 90% of the assessed total claim amount under this cover.
B. Conditions
(1) Claims made by You against Us under 'Depreciation Shield' are subject to the terms and conditions set forth
under the Motor Insurance Policy. (2) In case of transfer of ownership of the Insured Vehicle , the cover under
'Depreciation Shield' shall expire. (3) The benefits under 'Depreciation Shield' can be utilized for a maximum of
two times during the Policy Period
C. Exclusions
In addition to the exclusions mentioned under Motor Insurance Policy, We will not be liable to indemnify You for the
following events:
(1) Where the Own Damage Claim made by You against Us under the Motor Insurance Policy is not payable (2)
Depreciation pertaining to any part/ sub part/ accessories not approved for replacement by Us under Motor Insur-
ance Policy. (3) Loss or damage to tyres and/or battery of the Insured Vehicle . (4) Consequential loss of any
kind arising out of claims lodged under 'Depreciation Shield'. (5) Where a loss is covered under Motor Insurance
Policy or any other type of insurance policy with any other insurer or manufacturer's warranty or recall campaign
or under any other such packages at the same time
If You do not agree whether any of these exclusions apply to Your claim, You agree to accept the burden of proving that
they do not apply.
D. Definitions
The words and phrases listed have special meanings We have set below whenever they appear in bold type and initial
capitals. Please note that references to the singular or to the masculine also include references to the plural or to the fe-
male the context permits and if appropriate.
(1) You,Your,Yourself: The person or persons We insure as set out in the Schedule .(2) We, Our, Us: Bajaj Alli-
anz General Insurance Company Limited. (3) Accident, Accidental: A sudden, unintended and fortuitous external
and visible event.(4) Policy/Motor Insurance Policy: Two Wheeler Package Policy issued by Us to which this
cover is extended (5) Insured Vehicle : The vehicle insured by Us under the Motor Insurance Policy and as
shown on the Schedule .(6) Policy Period: The period between and including the commencement date and expiry
date as shown in the Motor Insurance Policy Schedule . (7) Schedule : The Schedule and any Annexure or En-
dorsement to it which sets out Your personal details and the insurance cover in force. (8) Own Damage Claim:
The claims raised by You against Us for loss or damage to the Insured Vehicle due to the perils mentioned under
Section 1 of Motor Insurance Policy. (9) Total Loss/ Constructive Total Loss: A loss under the Motor Insur-
ance Policy where the aggregate cost of retrieval and/ or repair of the Insured Vehicle , subject to terms and con-
ditions of the Policy, exceeds 75% of the IDV of the Insured Vehicle . (10)Partial Loss: Any loss falling into a
category other than (A) the loss mentioned under Sr. No. 9 above and (B) theft of the Insured Vehicle