Bajaj Allianz General Insurance Company Limited.

Servicing Office : 4th Floor, Atlantis Heritage, B/h Atlantis Heights, Opp. Swagat Petrol Pump Sarabhai Main
Road, VADODARA, GUJARAT (State Code:24) -390007
Private Car Policy - Bundled UIN --IRDAN113RP0007V01201819
Certificate Cum Policy Schedule (FORM 51 OF THE CENTRAL MOTOR VEHICLE RULES, 1989)
PAN :AABCB5730G GSTIN: 24AABCB5730G1Z3 CIN :U66010PN2000PLC015329 IRDAI Reg:113

Policy No: OG-23-9910-1825-00148150 Proposal No. & Date: HIIB1807376, 30-MAR-2023

Policy Issued On: 30-MAR-2023 11:41 HRS Previous Policy No.: NA
Insured Name: MR. HEMANTSINH BHARATBHAI SISIDIYA Previous Insurer: NA
Period of Own Damage : 30-MAR-2023 (11:41) To 29-MAR-2024 (1 YEAR)
81 RAGHUKUL PARISAR, GANA ROAD, AT-KARAMSAD, ANAND , Period of Liability Cover: 30-MAR-2023 (11:41) To 29-MAR-2026 (3 YEARS)
Insured Address:
GUJARAT (State Code:24) -388325
Period of Compulsory 30-MAR-2023 (11:41) To 29-MAR-2026 (3 YEARS)
Personal Accident Cover:
Customer Type PAN GSTIN Name Age (Yr.) Relation
Customer Details Nominee Details
INDIVIDUAL XXXXX1922G NA NITA SISODIYA 33 SPOUSE

Vehicle Details
Make Model Variant Cubic Capacity Manufacturing Year Seating capacity
HYUNDAI AURA 1.2MT CNG S 1197 2023 5
Body Type Registration No. RTO Hypothecation/Lease* Fuel Type VIN/Chassis No.
SALOON NEW ANAND NO PETROL MALB241CLPM186843
Vehicle IDV Electrical Accessories Non-Electrical Accessories BI Fuel Kit Total IDV Engine No
769,500 0 0 0 769,500 G4LAPM487488

Own Damage Premium (A) Amount(INR) Liability Premium (B) Amount(INR)

Basic Own Damage Premium Basic Third Party Liability Premium 10,640
Vehicle 24,555 Bi-Fuel Kit 180
Non-Elec. Accessories (IMT-24) 0 Geographical Area Extension (IMT-1) 0
Elec. Accessories (IMT-24) 0 Sub Total (Third Party Liability) 10,820
Bi-Fuel Kit (IMT-25) 1,227 Personal Accident (PA) Cover
Geographical Area Extension (IMT-1) 0 Compulsory PA Cover for Owner Driver Rs 1500000 (IMT-15) 909
IMT 23 Premium 0 PA Cover for 5 Unnamed Passengers Rs 100000 Each (IMT-16) 750
Sub Total (Basic Premium) 25,782 PA cover for Paid Driver of Rs 2 Lac (IMT± 0
Discount/Deductibles Sub Total PA Cover 1,659
Voluntary Deductibles (0) (IMT-22A) 0 Legal Liability
Anti Theft Device (IMT-10) 0 Paid Driver (IMT-28) 150
AA Membership (IMT-8) 0 Employees (for 0 persons) (IMT± 0

No Claim Bonus (0%) 0 Sub Total (Legal Liability) 150

Handicapped Discount (IMT-12) 0 Net Liability Premium (B) 12,629

Sub Total (Deductibles) 0 Total Premium (A+B) 44,483
Total Own Damage Premium 25,782 SGST(9%) 4,004
Add On Coverages ( ZD, CM, EP, RTI, KP, PB ) 6072 CGST(9%) 4004
Net Own Damage Premium (A) 31,854 Gross Premium Paid 52,491
Add-on Cover Opted in the Policy: Depreciation Shield-Bundled(IRDAN113RP0007V01201819/A0009V01201819), Consumable Expenses-Bundled
(IRDAN113RP0007V01201819/A0020V01201819), Engine Protector-Bundled(IRDAN113RP0007V01201819/A0015V01201819), Vehicle Replacement Advantage-Bundled
(IRDAN113RP0007V01201819/A0010V01201819), Personal Baggage Cover-Bundled(IRDAN113RP0007V01201819/A0017V01201819)
Notes: 1. Consolidated Stamp Duty of Rs.0.5/- paid towards Insurance Stamps vide Challan No. MH002405964202122M Defaced No. 0001482221202122 dated 05-JUL-21 timing 12:58:03 of General Stamp
Office,Mumbai,India.
2.This policy has been issued upon declaration by the Insured that a valid Pollution Under Control (PUC) Certificate is held on the date of
commencement of the Policy. The insured undertakes to renew and maintain a valid and effective PUC and/or fitness Certificate, as applicable, 3.Geographical Area: India
during the subsistence of the Policy.
5.The policy is subject to compulsory deductible of INR 1000,07
4. Policy issuance is subject to realization of cheque if premium is paid by cheque
22) & Voluntary Deductible of INR 0
6. This policy is to be read in conjunction with the Policy /Add-on wordings T&C available on the insurer website http://www.bajajallianz.com
*Hypothecation Details: Payment Mode: Online
Limitations as to use:The policy covers use of the vehicle for any purpose other than (1) Hire or Reward (2) Carriage of goods (other than samples or personal luggage) (3) Organized racing (4) Pace
making (5) Speed testing (6) Reliability trials (7) Any purpose in connection with motor trade.
Driver's Clause: Any person including the insured: Provided that the person driving holds an effective driving license at the time of the accident and is not disqualified from holding or obtaining such
license. Provided also that the person holding an effective learners license may also drive the vehicle & that such a person satisfies the requirements of Rule 3 of the Central Motor Vehicle Rules, 1989.
Limits of Liability Clause: Under Section II-1(i) of the policy-Death of or bodily injury: Such amount as is necessary to meet the requirements of the Motor Vehicle Act 1988.Under Section II-1 (ii) of
the policy-Damage to third party property is INR 7.5 Lakhs, PA Cover Under Section III for Owner-Driver is INR 15 Lakhs.
No Claim Bonus: The insured is entitled for a No Claim Bonus (NCB) on the own damage section of the policy, if no claim is made or pending during the preceding year(s) - 20% preceding
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Declaration on Tax Invoice We hereby declare that though our aggregate turnover in any preceding financial year from 2017-18 onwards is more than the aggregate turnover notified 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.
Important Notice: The insured is not indemnified if the vehicle is used or driven otherwise than in accordance with the schedule. Any payment made by the company by reasons 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 & RIGHT
2)5(&29(5<´For legal interruption, English version will hold good.
Grievance Clause: For resolution of any query or grievance, Insured may check Grievance redressal policy at https://www.bajajallianz.com/about-us/customer-service.html or connect with the respective
servicing office of insurance company. In the event of unsatisfactory response,he/she may approach the insurance ombudsman for the redressal of grievance at www.irdai.gov.in or on website of General
Insurance Council: www.gicouncil.in
HSN/SAC : 997134, Description of Service : Motor Vehicle Insurance Services, Place of Supply : GUJARAT(State Code : 24), Insurer Invoice Number : HAP/HBZ/HIIB1807376
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 provisions of Chapter X and XI of Motor Vehicle Act, 1988.
Insurance Broker Name : Hyundai India Insurance Broking Pvt. Ltd. Scan for Renewal For & On Behalf of
Corporate Office:16th Floor, Building No. 9A, DLF Cybercity, Phase III, Gurugram, (Valid from 90 Days Prior to Expiry) Bajaj Allianz General Insurance Company Limited.
Haryana 122001
Broker Code: 822 (Valid UPTO:30/05/2025) MISP NAME-DOWNTOWN MOTORS
CIN No.: U67200HR2021PTC098982 PRIVATE LIMITED
GST: 06AAGCH0310P1ZP MISP CODE-HIIB-MHY-0161
Email ID: connect@hiib.in DP NAME-DHAVALKUMAR MAHESHBHAI
Contact No: 0124-6833000 PATEL
Authorized Signatory
For Claims, Policy Servicing & Renewal, Kindly contact (DOWNTOWN MOTORS PRIVATE LIMITED) at +91-9033044738