BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LTD.

CERTIFICATE CUM POLICY SCHEDULE
Policy Servicing Office
Policy Number
Period Of Insurance
Insured Name
Insured Address

Customer Id
Application No

608-609, IInd Block, White House, Begumpet, Hyderabad-500016 PH:040-44320100/44380100,

OG-14-1801-1802-00000348
Product
Two Wheeler - Package Policy
Policy issued on
03-APR-2013
From: 24-MAR-2013 00:00 (Hrs)
Cover Note No.
MC1003848173
To: 23-MAR-2014 Midnight
FIVESS POWER PROJECTS PRIVATE LIM- Zone
A
ITED
PLOT NO: 122, ROAD NO: 23, IAS & IPS
COLONY, PRASHAN NAGAR ROAD NO:22,,
JUBILEE HILL HYDERABAD, HYDERABAD500033
33560456
Premium Payer Id
39683404
0
Scrutiny No
25364569
Policy Status
ISSUED

Coinsurance Details : NA.

Registration No
AP02Q2946
Vehicle IDV
15958

Make
TVS

Model
STAR CITY

Elec. Accessories
0

SubType
STD

Non-Elec. Acc.
0

CC
100
Side Car
0

Year Of Mfg
2007

Seat Cap
2

Chassis number.
MD625KF5171A60832

Trailer Reg No
-,-

CNG/LPG Unit
0

Engine No.
BF5A71057412
Total Sum Insured
15958

SCHEDULE OF PREMIUM
Own Damage
Total Own Damage Premium

Total Premium
Special Discount
Net Premium
Service Tax
Edu Cess
Final Premium Rs.

Liability
186 Basic Third Party Liability
PA Cover For 2 Passanger Of Rs. 40000 each
Total Act Premium:
599
0
599
72
2
673 *** All Premium Figures are in Rupees

357
56
413

Geographical Area : India

No Claim Bonus : -35%
Voluntary Excess : Nil
Compulsory Deductible : Rs. 100
Additional Compulsory Deductible : Rs. 0
Previous Insurer - Bajaj Allianz General Insurance Co Ltd. Previous Policy No - OG-12-1801-1802-00082883 Expiry On - 23-MAR-13
The above Total OD Premium is inclusive of all applicable Loading/Discounts viz (Automobile Association Membership,Voluntary Excess,Anti-Theft,Handicap Person,Driver Tution,Fibre 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 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. 100000
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.
Past Claim Reference :
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, 18, & Policy wordings attached herewith

Broker Code 15323143

Channel Name : MD
Broker Name : COASTAL INSURANCE BROKERS PVT LIMITED
Contact No : 0/0
Email Premium Collection Details :- [Receipt No/Collection No/Amount] Rs. 673, By Float No : 15323143
*** If premium paid through cheque, the policy is void ab-initio in case of dishonor of cheque.
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 ,1800-102-5858,1800-209-5959(Toll Free) /
91-020-30305858 (chargeable, add area code before this number in case of mobile call) or email us at 'customercare@bajajallianz.co.in'
25364569/-/15323143/0/MC1003848173
PIN NO : NA Damage Details: Remarks :
Kindly contact our nearest / local office(s) for No Claim Bonus Confirmations.
For & On Behalf of Bajaj Allianz General Insurance Company Ltd.
Stamp
Duty Rs.
0.25
Authorized Signatory
Printed , Signed and Executed at Pune

Consolidated stamp Duty paid vide Receipt No: .8 dated 17-JAN-13

Regd Office : GE Plaza,Airport Road, Yerwada Pune-411006 (India)

Regd. Office : GE Plaza, Airport Road, Yerawada,Pune - 411006 (India)

Service Tax Reg. No. AABCB5730G-ST-001

-Latest Schedule- 03-Apr-2013 15:34:59 PM (Web)
Generated by uv karunasri