Dear Gaurav Kadam,: Policy Details
Dear Gaurav Kadam,: Policy Details
Dear Gaurav Kadam,: Policy Details
We thank you for choosing Bajaj Allianz for your Insurance needs. We are one of India's leading general insurance companies with iAAA
rating from ICRA for the last ten consecutive years indicating the company's high claims paying ability and fundamentally strong position in the
industry. Please be assured that you have made the right choice by choosing us and we will stand by you in your hour of need.
To provide you with the best customer experience, here are a few important things for you to note:
Policy Details
Maharashtra
Please find enclosed the policy schedule. We wish to inform you that the policy issued is based on the information submitted in the proposal
form as well as the acceptance of the terms and conditions, and this will be verified at the time of filing of claim. Request you to kindly go
through the same once again and in case of any disagreement, discrepancy or clarifications - let us know within 15 days of the letter date. For
policy wordings containing detailed terms, conditions and exclusions of your insurance coverage, you will receive a hard copy on your
correspondence address.
Once again, we welcome you to the Bajaj Allianz family and look forward to a long association with you.
Sourabh Chatterjee
Senior Vice President, Head-Web Sales
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Proposal Form For Long Term Two Wheeler Package Policy
Personal Information Policy Address
First Name GAURAV House No. / Building A/304, Shree Swami Society
Name / Flat No
Middle Name Street / Locality / Land- Near Amba Bhavani Temple
mark
Surname KADAM State MAHARASHTRA
Email Address [email protected] City THANE
Mobile Number 9773519551 Area KALYAN
PAN Number NA Pincode 421202
Mailing Address
House No. / Building A/304, Shree Swami Society, Near Street / Locality / Land- , , THANE-421202
Name / Flat No Amba Bhavani Temple mark
State Maharashtra City THANE
Area KALYAN Pincode 421202
Vehicle Information
Vehicle Reg No MH05CW4027 PA Covered for Owner
Driver
Policy Start Date 31-MAY-2017 PA cover for co- 0
passengers worth
Vehical Make TVS Vehicle IDV/Sum Insured 39065
Vehical Model JUPITER Vehicle under a bank NO
loan
Vehical Subtype ZX Bank Name NA
Year Of Manufacture 2016 Engine Number 72432
Fuel Type Petrol Chassis Number 73937
Value Of Elec Accessor- 0 Previous NCB 0%
ies
Value Of Non-elec Ac- 0 NCB Offered 20%
cessories
Value Of CNG Kit Voluntary Excess 0
Previous Policy Number 1105262312000324 Previous Policy Expiry 04-APR-2017
Date
Previous Insurer Reliance General Insurance Com-
pany Limited.
Was there any ownership change in your existing policy? N
No. of claims in your existing policy 0
No. of claims in your last year's policy 0
Declaration:
I/We, the undersigned hereby declare and warrant that the insurance policy is issued by Bajaj Allianz General Insurance Company Ltd [Company] sub-
ject to the declarations, warranties, statements and particulars given in this proposal form during the process of my/our online purchase through web.
The statements and particulars given in this proposal form are complete, true and accurate to the best of my/our personal knowledge and belief. I/we
have understood the terms and conditions to the contract and agree that the statements and particulars given in this proposal form shall be held to be
promissory and shall be the basis of the insurance contract between me/us and the Company and the Company shall have no liability under the insur-
ance contract if it is found that any of the statements or particulars or declarations in this proposal form or other documents are incorrect and or untrue
or suppressed any information or provided misleading or false information in any respect on any matter to the grant of a cover. I/we will accept the usual
conditions and form of the policy prescribed and issued by Company.I/We declare that I have read the policy schedule and the rate of NCB claimed by
me/ us is correct and that no claim has arisen in the expiring policy period. I/We further undertake that if this declaration is found to be incorrect,all bene-
fits under the policy will stand forfeited with no liability to refund the premium. I hereby agree to confirm within 7 days in case of any objection or dis-
agreement with the above.
Statutory Warning:
No person shall allow or offer to allow, either directly or indirectly, as an inducement to any person to take out or renew or continue an insurance in re-
spect of any kind of risk relating to lives or property in India, any rebate of the whole or part of the commission payable or any rebate of the premium
shown on the policy, nor shall any person taking out or renewing or continuing a policy accept any rebate, except such rebate as may be allowed in ac-
cordance with the published prospectus or tables of the insurer.
Date: 28-MAY-17
Bajaj Finserv,1st Floor , Survey # 208/1-B, Behind Weikfield IT-Park, Viman Nagar, Pune-411014
Bajaj Allianz General Insurance Company Ltd.
Registered and Head Office: GE Plaza, Airport Road, Yerwada, Pune
A. Proposer details
1. Proposer Name : GAURAV KADAM
2. Proposer Address : A/304, Shree Swami Society, Near Amba Bhavani Temple ,
, THANE, Maharashtra-421202
3. Proposer Mobile Number : 9773519551
4. Proposer Residential Number : NA
5. Proposer e-mail id : [email protected]
6. Proposer Profession : NA
B.Vehicle Details
Registration Month / Year Vehicle Make Vehicle Mod- Vehicle Sub Cubic Capa- Fuel Type Year of Man- Seating Ca-
Number of Regn el Type city ufacture pacity
MH05CW402 APR/2016 TVS JUPITER ZX 110 Petrol 2016 2
7
Engine Number Chassis Number Vehicle IDV (in Electrical Non-Electrical CNG/LPG Unit Total IDV (in Rs.)
Rs.) Accessories IDV Accessories IDV (Extra fitted) IDV
(in Rs.) (in Rs.) (in Rs.)
72432 73937 39065 0 0 0 39065
C. Coverage opted
Receipt
Business Channel: WS
Receiving the Premium amount and issuance of this receipt does not automatically amount to underwriting risk by Ba-
jaj Allianz General Insurance Company Ltd. Our assuming risk arises only after Proposer completing all required
formalities for our taking underwriting call, upon which our Company specifically takes underwriting call to assume risk
and accordingly informs the Proposer by way of issuing Policy Schedule or Cover Note, but not before. Our standard
terms and conditions shall apply upon our assuming risk.
Please note: This is an electronically generated receipt and does not require signature.
Policy Details
Policy Issuing Office: Bajaj Finserv Building, 1st Floor, Behind Weikfield IT-Park, Viman Nagar Pune-411014 Ph:1800-209-0144
Cover Note No.: Policy Issued On: 28-May-2017 11:02:53
Policy Number: OG-18-9906-1843-00004333 Product: Long Term Two Wheeler Package Policy
Period of Insurance: From: 31-May-2017, 00:00 To: 30-May-2020 Midnight
Insured Name: GAURAV KADAM Zone: B
Insured Address: A/304, Shree Swami Society, Near Amba Bhavani Temple , , THANE, Maharashtra-421202
Policy Holder ID: 96413491 Intermediary: 55555557 - WEB SALES
Hypothecation: Sub Imd Code: 9906
Vehicle Details
Registartion No. Make Model Sub Type Year Of Mfg.
MH05CW4027 TVS JUPITER ZX 2016
Seat Cap. CC CNG/LPG Unit Elec.Acc Non- Elec. Acc.
2 110 0 0 0
Vehicle IDV Chassis No. Engine No. Total Insured Declared Value
39065 73937 72432 39065
Schedule Of Premium
A. Own Damage
Total Own Damage Premium: 723
B. Liability
Basic Third Party Liability 2160
PA Cover for Owner-Driver of Rs.100000 150
PA Cover For 0 Paid Driver(s) of Rs. 0 each 0
Bonus/ Malus 0
Total Liability Premium: 2310
C. Special Discount 0
D. Net Premium (A+B) 3033
E. Service Tax Details
Service Tax 425
Swachh Bharat Cess 15
Krishi Kalyan Cess 15
Final Premium Rs.(D+E) 3488
***All Premium Figures are in Rupees
No Claim Bonus: -20%
I/We declare that I have read the policy schedule and the rate of NCB claimed by me/us is correct and that no claim as arisen in the existing policy period
(copy of the policy enclosed). I further undertake that if this declaration is found to be incorrect, all benefits under the policy in respect of section 1 of the
policy will stand forfeited. I hereby agree to confirm within 7 days in case of any objection or disagreement with the above.
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), Organ-
ised 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 per-
son 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: 22, Policy wordings attached herewith
Plan Name: 24x7 - Spot Assistance
Plan Description: 24x7 spot assistance,
*** If premium paid through cheque, the policy is void ab-initio in case of dishonor of cheque.
Premium Collection Details: - [Receipt No/Collection No/Amount] 9906-01273027,/69863392,/ Rs.3488,
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, 1800-209-5959 (Toll Free) / 91-020-30305858
(chargeable, add area code before this number in case of mobile call) or email us at '[email protected]' *****
Damage Details:-
Kindly contact our nearest / local offices for No Claim Bonus Confirmations.
Insured Declared Value:
Policy Year Tenure From Tenure To Total Sum Insured
1 31-MAY-17 30-MAY-18 39065
2 31-MAY-18 30-MAY-19 34182
3 31-MAY-19 30-MAY-20 29299
The schedule of age wise Insured Declared Value (IDV) as shown in the above table is applicable for the purpose of Total Loss including Theft/ Con-
structive Total Loss (TL/CTL) claims only on basis of loss date falling in the respective year. A vehicle will be considered to be a CTL, where the ag-
gregate cost of retrieval and / or repair of the vehicle subject to terms and conditions of the policy exceed 75% of the IDV.
null
For & Behalf of Bajaj Allianz General Insurance Company Ltd. null
Authorized Signatory
Bajaj Finserv,1st Floor , Survey # 208/1-B, Behind Weikfield IT-Park, Viman Nagar, Pune-411014
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