Bajaj Allianz General Insurance Company LTD
Bajaj Allianz General Insurance Company LTD
Bajaj Allianz General Insurance Company LTD
Registered and Head Office: Bajaj Allianz House, Airport Road, Yerwada, Pune
Transcript of POS Proposal for Liability Only Policy for Two Wheeler
A. Proposer details
B.Vehicle Details
Registration
Month / Vehicle Vehicle Vehicle Fuel Type Cubic Ca- Year of Man- Seating Capa-
Number Year of Make Model Sub Type pacity/ ufacture city
Regn Kilowatt
GJ01MD522 JUL-2010 BAJAJ PULSAR ELECTRIC PETROL 150 2010 2
2 150 START
Engine Num- Chassis Num- Vehicle IDV Electrical Non-Electrical Ac- CNG/LPG Unit Total IDV (in Rs.)
ber ber (in Rs.) IDV (in Rs.) cessories IDV (in (Extra fitted)
Rs.) IDV (in Rs.)
TD85121 CD97029 0 0 0 0 0
C. Coverage opted
Policy issuing office and Correspondence address for communication by policyholder for claim, service request, notice, summons,
etc; 4th Floor, Turquoise, Nr. Panchvati Circle, C.G Road, Ellisbridge, Ahmedabad-380006 Phone No :079-26432000
Policy Number OG-21-2202-1806-00001341 Product POS - Liability Only Policy For Two Wheeler
Period Of Insurance From: 13-Jul-2020 12:41 Policy issued on 10-Jul-2020 -
To: 12-Jul-2021 Midnight Cover Note No /
Application No Scrutiny No 191560156
Insured Name DUSHYANT ARUNKUMAR RAVAL Zone A
Insured Address 2671 PATEL KHADKI, RAIPUR, ,RAIPUR
AHMEDABAD, AHMEDABAD - 380001
Customer ID 186099363 Premium Payer ID 186099363
Transaction Id
Policy Status ISSUED
GSTIN / UIN NA Place of Supply/State 24 - Gujarat
Code/Name
Invoice No. 190875167/1
Company GST No 24AABCB5730G1Z3
Company PAN No AABCB5730G
Registration Make SubType Model CC/KW Mfg year Seat Cap Vehicle/ Engine Number
No. Trailer
Chassis
No
GJ01MD5222 BAJAJ ELECTRIC PULSAR 150 150 2010 2 CD97029 TD85121
START
SCHEDULE OF PREMIUM
OWN DAMAGE LIABILITY
Total Own Damage Premium: Basic Third Party Liability 752.00
Total premium 752.00 Total Liability Premium: 752.00
Special Discount
Net Premium 752.00
State GST (9%) 68.00
Central GST (9%) 68.00
Final Premium Rs. 888.00 ***All Premium Figures are in Rupees
Geographical Area : No Claim Bonus : 0%
Nominee Details Name : NA Relationship : NA
Previous Insurer - Shriram General Insurance Company Limited.Previous Policy No -45615621+65 Expiry
On - 04-FEB-14
As per the GST regulations, the amount of GST will not be refunded if the policy / endorsement is cancelled after 30th
September of the next financial year
Contact No : 9173849465/09173849465
Email - [email protected]
POS PAN Number : CXFPS7510B POS Contact No : POS Name :
Damage Details as per Annexure I
Premium Collection Details :- [Receipt No/Collection No/Amount] 2202-02911958 / 191560156 / Rs. 888.00 ,
*** 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 -
In case of any claim, please contact our 24 Hour Call centre at 1800-102-5858 (Toll Free) / 91-020-30305858 (chargeable, add area
code before this number in case of mobile call) or email us at '[email protected]'.
191560156/-/20023239/NA/-
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.
Regd. Office : Bajaj Allianz House, 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.Principal Location : 4th Floor, Tur-
quoise, Nr. Panchvati Circle, C.G Road, Ellisbridge, Ahmedabad - 380006 PH:079-26432000 | Services Accounting Code : 997134 - Motor vehicle insurance services. No
reverse charge is payable on these services. - Latest Schedule - 27-Feb-2021 09:21:35 AM (Web)
Stamp
Duty Rs.
0.5
Authorized Signatory This document is digitally signed, hence counter signature / stamp is not required
Printed , Signed and Executed at Pune
Consolidated Stamp Duty of Rs.0.5/- paid towards Insurance Stamps vide Challan No. MH011254450201920M Defaced No. 0006230296201920 ORDER
NO.CSD/322/2020/740/2020 ORDER DATED 15.02.2020DEFACED DATE dated 15-FEB-20 timing 12:17:16 of General Stamp Office,Mumbai,India.
Generated by Silent_Printing
Regd. Office : Bajaj Allianz House, 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.Principal Location : 4th Floor, Tur-
quoise, Nr. Panchvati Circle, C.G Road, Ellisbridge, Ahmedabad - 380006 PH:079-26432000 | Services Accounting Code : 997134 - Motor vehicle insurance services. No
reverse charge is payable on these services. - Latest Schedule - 27-Feb-2021 09:21:35 AM (Web)
Bajaj Allianz General Insurance Company Ltd.
4th Floor, Turquoise, Nr. Panchvati Circle, C.G Road, Ellisbridge, Ahmedabad - 380006
Contact No:Contact No: 079-26432000; Fax No: 26408009
RECEIPT
Authorised Signatory