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• Hariharan Mokkarala

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BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LTD. Policy Servicing Office Policy Number Period Of Insurance Insured Name Insured Address Customer Id Application No

Bajaj Finserv,1st Floor , Survey # 208/1-B, Behind Weikfield IT-Park, Viman Nagar 411014, Pune-411014 PH:020-66495000 OG-13-9906-1802-00022827 Product Two Wheeler - Package Policy Policy issued on 19-NOV-2012 From: 23-NOV-2012 (Hrs) Cover Note No. To: 22-NOV-2013 Midnight JANYA ASSOCIATES Zone B FLAT NO 103, UJWALA APTS, TIRUMALGIRY OPP BIRYANI DARBAR , , , -500010 47305549 Premium Payer Id 47305549 0 Scrutiny No 21958170 Policy Status ISSUED

Coinsurance Details : NA. Registration No AP10AG8362 Vehicle IDV 22609

Make BAJAJ

Model DISCOVER 125

Elec. Accessories 0

SubType ELECTRIC START

Non-Elec. Acc. 0

CC 125

Year Of Mfg 2006

Side Car 0

Seat Cap 2

Chassis number. MD2DSDSZZMCL57320

Trailer Reg No -,-

CNG/LPG Unit 0

Engine No. DSGBML33339 Total Sum Insured 22609

SCHEDULE OF PREMIUM Own Damage Total Own Damage Premium

Liability 169 Basic Third Party Liability PA Cover for Owner-Driver of Rs. 100000 Total Act Premium: 576 0 576 69 2 647 *** All Premium Figures are in Rupees

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

357 50 407

Geographical Area : India No Claim Bonus : -50% Voluntary Excess : Nil Compulsory Deductible : Rs. 100 Additional Compulsory Deductible : Rs. 0 Previous Insurer - ICICI Lombard General Insurance CO. Ltd. Previous Policy No - 30056213632901000 Expiry On - 22-NOV-12 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 & Policy wordings attached herewith Premium Collection Details :- [Receipt No/Collection No/Amount] 9906-00130730,/21958170,/ Rs.647, *** 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 '[email protected]' 21958170/-/55555557/99060001/Damage Details : PIN NO : Remarks : PDA MODULE Kindly contact our nearest / local office(s) for No Claim Bonus Confirmations. This is a pre signed document and will not be valid unless QC Verified and Signed/Countersigned by an authorized signatory of Bajaj Allianz General Insurance Co.Ltd.

For & On Behalf of Bajaj Allianz General Insurance Company Ltd. Stamp Duty Rs. 0.5 Authorized Signatory Printed , Signed and Executed at Pune

QC Verified and Signed/Countersigned by

Consolidated stamp Duty paid vide Receipt No: .15346 dated 02-AUG-12

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

. Bajaj Allianz General Insurance Company Ltd. Regd. Office : GE Plaza, Airport Road, Yerawada,Pune - 411006 (India)

Service Tax Reg. No. AABCB5730G-ST-001 -Latest Schedule- 19-Nov-2012 17:22:58 PM (Web) Generated by Silent_Printing

  

Bajaj Finserv,1st Floor , Survey # 208/1-B, Behind Weikfield IT-Park, Viman Nagar 411014, Pune411014 Contact No:020-66495000,

RECEIPT Receipt Number

9906-00130730

Receipt Date

19/11/2012

Business Channel

Received with thanks from

JANYA ASSOCIATES

(Customer ID : 47305549 ) a total sum of Rupees Six Hundred Forty Seven Only by,

Instrument Instrument No. Type

Instrument Date

Credit Card

19/11/2012

Bank Name

Branch Name

Amount 647

Total Amount

Rs.

647.00

Issuance of this receipt does not amount to acceptance of the risk by Bajaj Allianz General Insurance Company Limited. The insurance cover for the risk shall be as per the terms and conditions of the Insurance Policy if and when issued. * Receipt Subject to realisation of cheque(s)

For & on behalf of Bajaj Allianz General Insurance Company Ltd.

Authorised Signatory

Regd.Office: GE Plaza,Airport Road, Yerwada, Pune - 411006

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

Service Tax Reg. No. AABCB5730G-ST-001 -Latest Schedule- 19-Nov-2012 17:22:58 PM (Web) Generated by Silent_Printing