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BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LTD,
CERTIFICATE CUM POLICY SCHEDULE Policy Servicing Office 8-6-126, 1st Floor, Near Koti Bomma Circle, Kothirampur, Karimnagr-505001 PH 0878-6450733 Policy Number OG-12-1810-1802-0012336 Product Two-Wheeler-Package Policy Period Of Insurance From: 2-FEB-2013 00:00(Hrs) Policy Issued on 2-FEB-2013 To: 1-FEB-2014 Midnight Cover Note No. Insured Name MR SRAVAN KUMAR BODDULA Zone B Zone B S/O SAILU, HO #16-10-147, KALYAN NAGAR,
GODAVARIKHANI , KARIMNAGR- 505209 Insured Id 32024063 Premium Payer Id 32024063 Application No null Scrutiny No 8546777 0: Policy Status ISSUED
Registration No Make Model Gub Type CC Year of Mfg
Seat Cap Chassis No. Engine No.
AP15BA0724 YAMAHA FZ-S KICK DRUM & ALLOY 153 2011 2 ME121C08AB2031957 21C8032280
Vehicle IDV Elec. Accessories Non-Elec. Acc. Side Car CNG/LPG Unit Total Sum Insured
42310 0 0 null 0 42310 SCHEDULE OF PREMIUM
Own Damage Liability Total Own Damage Premium 402 Basic Third Party Liability 300
PA Cover of Owner-Driver of Rs. 100000 50 Total Act Premium: 350 Total Premium 920
*** All Premium Figures are in Rupees
Special Discount 0 Net Premium 920 Service Tax 120 Edu Cess 5 Final Premium Rs. 1045
Geographical Area: India No Claim Bonus: -25% Voluntary Excess: Nil Company Deductible: Rs.50 Additional Compulsory Deductible: Rs.0 Previous Policy No. OG-10-1810-1802-00003193 Expired on 26-JAN-13 The above Total OD Premium is inclusive of all applicable Loading/Discounts viz (Automobile Association Membership, Voluntary Excess, Anti-Theft, Handicap Person, Driver Tuition, Fibre Glass, Cng, Lpg Unit, Geographical Extn, Imported Vehicle etc wherever applicable) LIMITS OF LIABLITY: Under section-II-I (i) of the Policy -> Death of bodily injury: such amount is necessary to meet there is a requirement for the Motor Vehicle Act, 1998. 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 Good (other than samples or personal luggage), Organized 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 that prime time of 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 for driven otherwise than in accordance with this schedule. Any payment made by the Company by reason of wider terms appearing in the Certified 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 & Policy wordings attached her with
Agency Code Agency Name:
Contact No: Email -
Premium Collection Details: - [Receipt No/Collection No/ Amount] 1801-00717157,/,/Rs.829, ***If premium paid through cheque, the policy is void an-initio in case of dishonr 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, 1800-209-5959(Toll free) / 91-020-303035858 (chargeable, add area code before this number in case of mobile call) or email us at ‘[email protected]’ 8546777/-/0/90030456/- Damage Details:- Remarks: Kindly contact our nearest / local office(s) for No Claim Bonus Confirmations. This document is a presigned document and will not be valid unless QC Verified and Signed/Counter Signed by an authorized signatory of Bajaj Allianz General Insurance Co. Lts. For & On Behalf of Allianz General Insurance Company Ltd.
Authorized Signatory QC Verified and Signed/ Source Signed by Consolidated stamp Duty paid vide Receipt No: Printed, Signed and Executed at Pune 23998 dated 09-JAN-13
Service Tax Reg. No. AABCB5730G-ST-001 Regd. Office: GE Plaza, Airport Road, Yerawada, Pune – 412006 (India) -Latest Schedule- 2-FEB-2013 10:33:47 AM (SAT)
