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 Raagavis Center, Ground, 1st and 2nd Floor,, 21A, Nethaji
policyholder for claim, service request, notice, summons, etc: Nagar, Nanjundapuram Main Road,Ramanathapuram, , COIM-
BATORE-641045 Phone No :0422 4392345
Policy Number OG-18-1503-1831-00001314 Product Commercial Vehicle - Liability Only
Vehicle Type Passenger Carrying - 4 Wheel & Carrying Capacity <= 6
Period Of Insurance From: 24-Feb-2018 23:45 Policy issued on 23-Feb-2018
To: 23-Feb-2019 Midnight Cover Note No -0/
Application No Scrutiny No 82472494
Insured Name GEORGE ANTO P Zone A
Insured Address 31 G K SQUARE STREET, SUNDARAPURAM, ,,
COIMBATORE - 641024
Customer ID 113750615 Premium Payer ID 113750615
Transaction Id
Policy Status ISSUED
GSTIN / UIN NA STATE CODE / NAME 33 - Tamil Nadu
Registration No. Make

TN21AU4115 TATA

Vehicle IDV Elec Acc

0 0
SCHEDULE OF PREMIUM
OWN DAMAGE
Total Own Damage Premium:

Total premium
Special Discount
Net Premium
State GST (9%)
Central GST (9%)
Final Premium Rs.
Geographical Area : INDIA No Claim Bonus : 0% Voluntary Excess :
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. Un der Section II-1(ii) of the policy -> Damage to Third Part y 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 Test-
ing,Use whilst drawing a railer
t except the towing (other than for reward) of any one disabled Mechanically propelled vehicle.
DRIVER : Any person including the insured : Provided that a person driving holds an effective driving licence at the t me of the acc dent and is not disquali-
: i i
fiedtransport
the from holding or obtaining
of passengers such
at the a licence.
time Provided
of the accident andalso
thatthat theaperson
such personholding
satisfiesantheeffective Learner's
requirements licence
of Rule 3 ofmay also ral
the Cen drive the vehicle when not used for
t Motor Vehicles Rules, 1989.
IMPORTANT NOTICE: The Insured is not indemnified if the vehicle is used or driven otherwise than in accordance with his Schedule. Any payment made by
t
the clause
the Company by reason
headed of wider terms
"AVOIDANCE appearingTERMS
OF CERTAIN in the Certificate
AND R GHT in order
OF to comply with the Motor Vehicle Act, 1988 is recoverable from the Insured. See
RECOVERY".
I
Subject To IMT Endorsement Nos : 17 & Policy wordings attached herewith

Contact No : 0/0
Email -
Damage Details as per Annexure I
Premium Collection Details :- [Receipt No/Collection No/Amount] 1503-00675076 / 82472494 / Rs. 14996 ,
*** 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 PDA MODULE

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'.
82472494/-/55555559/BG16927/0
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 Confirmations.

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

Stamp
Duty Rs.
0.5

Authorized Signatory
Printed , Signed and Executed at Pune

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. : 93914650/1 - Latest Schedule - 23-Feb-2018 10:35:39 AM

Consolidated Stamp Duty of Rs.0.5/- paid towards Insurance Stamps vide Challan No.
MH009810140201718M Defaced No. 0005634861201718 dated 03-FEB-18 timing 15:16:21 of General
Stamp Office,Mumbai,India.

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