Bajaj Allianz General Insurance Company Ltd.

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

CERTIFICATE CUM POLICY SCHEDULE

Policy issuing office and Correspondence address for communication by policyholder for claim, service request, notice, summons, etc;
497/498, 5th floor, Isana Kattima building,, Poonamallee High Road, Arumbakkam,, , , Chennai-600106 Phone No :044-43904400
Policy Number OG-19-1809-1713-00001356 Product Commercial Vehicle - Package Policy
Vehicle Type Auto Rickshaw- Public Carrier
Period Of Insurance From: 26-April-2019 00:01 Policy issued on 26-April-2019
To: 25-April-2020 Midnight Cover Note No /
Application No Scrutiny No 86690723
KONNI PRIYA
Insured Name Zone C
Insured Address W/O. SRINIVASA RAO
D.NO.1-1/2
DHARMAJIGUDEM
LINGAPALEM, WEST GODAVARI Premium Payer ID 13793877
ANDHRA PRADESH Transaction Id VIZAG-RO
Customer ID : 117688625 Policy Status ISSUED
HYPOTHECATED WITH :
STATE CODE / NAME 37 - Andhra Pradesh
Registration Make SubType Model GVW Mfg year Seat Cap Vehicle/Trailer Engine Number
No. Chassis No
BAJAJ RE AUTO MD2A41AZXGWB
AP37TE6816 AUTO LTD MAXIMA RICKSHAW 876 2016 4 15897 BBZWGB17100
DIESEL
BSIII
Vehicle IDV Elec Acc Non Elec Acc Trailer Trailer Reg No CNG/LPG Unit Total Sum Insured
0 0 0 0 0
SCHEDULE OF PREMIUM
OWN DAMAGE LIABILITY
Total Own Damage Premium: Basic Third Party Liability 6318
PA Cover For Owner-Driver Of Rs. 200000 100
LL For Operation/Maintenance For 1 Person 50
Total Liability Premium: 6468
Total premium 6468
Special Discount 0
Net Premium 6468
Integrated GST (18%) 582
Final Premium Rs. 7632 ***All premium Figures are in Rupees
Geographical Area : INDIA No Claim Bonus : -0% Voluntary Excess : Nil
Compulsory Deductible : Rs.500 Additional Compulsory Deductible : Rs.0
Previous Insurer - The New India Assurance Company LimitedPrevious Policy No -10003/31/18/071318
Ex-piry On - 30-OCT-18
The above Total OD Premium is inclusive of all applicable Loading/Discounts viz (Automoble Association Membership,Voluntary Excess,Anti-Theft,Handicap Per-
son,Driver Tution,Fibre Glass,Cng/Lpg Unit,Geographical Extn,Imported Vehicle etc wherever applicable)
LIMITS OF LIABILITY: Under Section II-1(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-1(ii) of the policy -> Damage to Third Party Property : Rs.750000/-
LIMITATION AS TO USE: The Policy covers use only under a permit within the meaning of the Motor Vehicle Act, 1988 or such a carriage falling under Sub-
section 3 of Section 66 of the Motor Vehicle's Act 1988. The Policy does not cover use for : Organised racing, Pace Making, Reliability Trials, Speed Testing
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 disquali-
fied from holding or obtaining such a licence. Provided also that the person holding an effective Learner's licence may also drive the vehicle when not used
for the transport of goods at the time of the accident 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 : 21, 7, 39 & Policy wordings attached herewith

Contact No : 0/0
Email -
Damage Details as per Annexure I
Premium Collection Details :- [Receipt No/Collection No/Amount] 500059 / 86690723 / Rs. 21252 ,
*** If premium paid through cheque, the policy is void ab-initio in case of dishonour of cheque.
This certificate of insurance is issued in accordance with the provision of Chapter X and Chapter XI of M.V. Act, 1988.
Damage Details Annexure : - NA
Remarks Motor New Business TDPGDO703110001

In case of any claim, please contact our 24 Hour Call centre at 1800-22-5858, 1800-102-5858 (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'.
86690723/-/10043754/43754094/-
This is a one page Policy Document [without enclosing the Terms and Conditions (T&C) of the Policy] issued by the Company, pursuant to the authorization of Insured to display the T&C of the Policy on its website (www.bajajallianz.com) that enables access by the
In-sured. The T&C of the Policy are available on the Company's website and can be accessed by the Insured.
Kindly contact our nearest / local office(s) for No Claim Bonus Con firmations.

This is the 'Digital Print' and original Policy would follow and the Original policy, duly countersigned, to be relied on for all legal purposes.

For & On Behalf of Bajaj Allianz General Insurance Company Ltd.

Stamp
Duty Rs.
0.5

Authorized Signatory
null
Regd. Office : GE Plaza, Airport Road, Yerawada,Pune - 411006 (India),A Company incorporated under Indian Companies Act, 1956 and licensed by Insurance Regulatory
and Development Authority of India [IRDA] vide Reg No.113, Corporate Identification Number U66010PN2000PLC015329.BAGIC GST No : 33AABCB5730G1Z4 | Princip-
al Location : 497/498, 5th floor, Isana Kattima building, Poonamallee High Road, Arumbakkam, Chennai - 600106 PH:044-43904400 | Services Accounting Code :
997134 - Motor vehicle insurance services. No reverse charge is payable on these services. | Invoice No. : 96982698/1 - Latest Schedule - 04-Jun-2018 12:50:29 PM
Consolidated Stamp Duty of Rs.0.5/- paid towards Insurance Stamps vide Challan No.
MH012474147201718M Defaced No. 0006825599201718 dated 28-MAR-18 timing 17:26:07 of
General Stamp Office,Mumbai,India.
Generated by vijayawada@stfc in