Important Notice

Policy Details

Generation Date: Name of Insured: Address:

19-Apr-2013 Subhash M Bhat Sri Ram Nilaya, Site No 1405, 11th Cross, 21st Main, H S R Layout, Sector -1 Near Mantri Sarovar Apts,Bangalore-560102 - City:Bangalore - State:KARNATAKA

Mobile:
Dear Subhash M Bhat,

9902633997

We thank you for choosing Bajaj Allianz General Insurance Company Ltd for insuring your Private Car - Package Policy .

Your Policy No is OG-14-1701-1801-00002617 .

We thank you for utilizing the online services of Bajaj Allianz General Insurance Co. Ltd to renew your policy online. This has reference to your policy number BajajAllianz-OG-14-1701-1801-00002617 for your Private Car - Package Policy. Please find enclosed the policy schedule. As a valued customer, we would like to provide regular updates on your policy, launch of new products and promotions so that you can take advantage of the same. However if you do not wish to receive any such updates, you can register for 'Do Not Call' services on our website www.bajajallianz.com .

Assuring you of our best services always and thanking you once again for insuring with us. With Best Regards,

Ms Anamika Rashtrawar Head - Corporate & Direct marketing

Bajaj Allianz General Insurance Company Ltd. Grd Flr,No.31,TBR Tower, 1st Cross,New Mission Rd Near Bangalore Stock Exchange Bangalore 560027 (080)22075301/02/156 22075302/22075156

Receipt
Receipt Number: 1701-00970911 Receipt Date: 19-APR-2013 Business Channel: ML

Received with Thanks from:

Subhash M Bhat

(Customer ID : 428457 ) a total sum of Three thousand four hundred seventeen rupees only .

Instrument Type CREDIT CARD Total Amount Received for this Policy

Instrument Date 19-APR-13

Amount 3417 3417

Receiving the Premium amount and issuance of this receipt does not automatically amount to underwriting risk by Bajaj Allianz General Insurance Company Ltd. Our assuming risk arises only after Proposer completing all required formalities for our taking underwriting call, upon which our Company specifically takes underwriting call to assume risk and accordingly informs the Proposer by way of issuing Policy Schedule or Cover Note, but not before. Our standard terms and conditions shall apply upon our assuming risk.

Please note: This is an electronically generated receipt and does not require signature. Regd Office : GE Plaza, Airport Road, Yerwada, Pune - 411 006

Certificate Cum Policy Schedule

Policy Details
Policy Issuing Office: Cover Note No.: Policy Number: Period of Insurance: Insured Name: Insured Address: Policy Holder ID: Hypothecation: OG-14-1701-1801-00002617 Subhash M Bhat Grd Flr,No.31,TBR Tower,, 1st Cross,New Mission Rd, Near Bangalore Stock Exchange, Bangalore-560027 Ph:(080)22075301/02/156 Policy Issued On: Product: Zone: From: 16-May-2013, 00:00 To: 15-May-2014 Midnight A SRI RAM NILAYA, SITE NO 1405, 11TH CROSS, 21ST MAIN, H S R LAYOUT, SECTOR -1NEAR MANTRI SAROVAR APTS, , BANGALORE-560102 428457 NOT APPLICABLE Intermediary: Sub Imd Code: 10009458 - SAIKIRAN B S 0 19-Apr-2013 10:53:44 Private Car - Package Policy

Vehicle Details
Registartion No. KA03MH7589 Seat Cap. 5 Vehicle IDV 128250 Schedule Of Premium A. Own Damage Total Own Damage Premium: B. Liability Basic Third Party Liability PA Cover for Owner-Driver of Rs.200000 LL To Person For Operation/Maintenance for 1 Person Bonus/ Malus Total Liability Premium: C. Special Discount D. Net Premium (A+B) E. Service Tax F. Education Cess Final Premium Rs.(D+E+F) ***All Premium Figures are in Rupees No Claim Bonus: 1110 100 50 0 1260 0 3041 365 11 3417 -50% 1781 Make OPEL CC 1389 Chassis No. 212045 Model CORSA CNG/LPG Unit 0 Engine No. 6B0004158 Sub Type Year Of Mfg. 1.4 GSI 2002 Elec.Acc Non- Elec. Acc. 0 0 Total Insured Declared Value 128250

I/We declare that I have read the policy schedule and the rate of NCB claimed by me/us is correct and that no claim as arisen in the existing policy period (copy of the policy enclosed). I further undertake that if this declaration is found to be incorrect, all benefits under the policy in respect of section 1 of the policy will stand forteited. I hereby agree to confirm within 7 days in case of any objection or disagreement with the above.

Geographical Area Compulsary Deductible Previous Policy Expired On:

India Rs. 1000 15-MAY-13

Additional Excess Voluntary Excess Previous Policy Number

Rs. 0 Nil OG13-1701-1801-00001852

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 Extn., Imported Vehicle etc wherever applicable). Limits Of Liability: Under section II-I(i) of the policy -> Death of or bodily injury : Such amount as is necessary to meet there requirements of the Motor Vehicles Act, 1988. Under section II-I(ii) of the policy -> Damage to Third Party Property : Rs. 750000 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 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 Vehicles Rules, 1989. 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. Subject to IMT Endorsement Nos: 22,7,25, 24, 28, Policy wordings attached herewith
Plan Description: 24x7 SPOT ASSISTANCE,Accidental Medical Expenses Cover

*** If premium paid through cheque, the policy is void ab-initio in case of dishonor of cheque. Premium Collection Details: - [Receipt No/Collection No/Amount] 1701-00970911,/25657085,/ Rs.3417,

This certificate of insurance is issued in accordance with the provision of Chapter X and Chapter XI of M.V.Act, 1988. ***** In case of any claim, please contact our 24 Hour Call centre at 1800-22-5858, 1800-102-5858, 1800-209-5959 (Toll Free) / 91-020-30305858 (chargeable, add area code before this number in case of mobile call) or email us at 'info@bajajallianz.co.in' ***** Damage Details:Kindly contact our nearest / local offices for No Claim Bonus Confirmations. For & Behalf of Bajaj Allianz General Insurance Company Ltd.

Authorized Signatory Bajaj Finserv,1st Floor , Survey # 208/1-B, Behind Weikfield IT-Park, Viman Nagar, Pune-411014 Bajaj Finserv,1st Floor , Survey # 208/1-B, Behind Weikfield IT-Park, Viman Nagar, Pune-411014