BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LTD.

Regd. Office & Head Office: Bajaj Allianz House, Airport Road, Yerawada, Pune-411006.
IRDAI Registration No.113
Corporate Identity Number: U66010PN2000PLC015329

Policy Issuing,correspondence address for communic- BAJAJ ALLIANZ GENERAL INSURANCE CO LTD., CORPORATION BANK
ation by policy [or certificate of insurance] hold- BUILDING, FIRST FLOOR, KESHAB ROAD, ,OPP COOCHBEHAR PALACE
er,policy/claim servicing, notices and or summons GATE NO.2, COOCH BEHAR-736101 PH:03582-226023
Insured Name ASHIT PAUL Policy Number OG-25-2472-1871-00000720

Welcome to Bajaj Allianz Family

ASHIT PAUL
S/O-JAHARLAL PAUL, BOXIRHAT- , BHANUKUMARI, COOCH BEHAR,
WEST BENGAL-736131

Customer ID : 285958810
Dear Customer,
Thank you for choosing Bajaj Allianz General Insurer as your preferred insurer. Bajaj Allianz General Insurance Company Limited, a con-
sistently profitable insurer enjoys a reputation of expertise, stability and strength. We are a customer focused market leader present in over
200 locations across India. As an organization we strive to understand the risk management needs of our consumers and translate it into af-
fordable products and services of global quality that deliver value for money. Bajaj Allianz has an ISO Certified claims,Operations and Ser-
vices processes and has received iAAA rating for the last three consecutive years from ICRA Limited, an associate of Moody's Investors Ser-
vice, for claims paying ability. The rating indicates highest claims paying ability and a fundamentally strong position in the industry.

We request you to kindly go through the contents of the policy schedule and the terms and conditions. In case of any clarification or dis-
agreement, please write to us at [email protected] within fifteen days of receipt of this policy.
We assure you the best of our services and look forward to a continual patronage and association with you.

For & on the behalf

Bajaj Allianz General Insurance Company Ltd.

Authorized Signatory

For help and more information:

Contact our 24 Hour Call Centre at 1800-102-5858, 1800-209-5858, Toll Free: 30305858( chargeable, add area code before this number in case of mobile call) Email us at [email protected] or
Visit our Website www.bajajallianz.com
Corporate Identification Number U66010PN2000PLC015329
 Bajaj Allianz General Insurance Company Ltd.
Regd. Office & Head Office: Bajaj Allianz House, Airport Road, Yerawada, Pune-411006
IRDAI Registration No. 113
Corporate Identity Number: U66010PN2000PLC015329
Transcript of Proposal for Standalone Own Damage Cover for Two Wheeler

Dear ASHIT PAUL,

We wish to inform you that the contract under policy number 'OG-25-2472-1871-00000720' has been finalized based on the
proposal / information and declaration given by you, the transcript whereof is mentioned below. You are requested to
reconfirm the same. In case of any disagreement or objection or any changes with respect to information mentioned below, we
request you to please revert back within a period of 15 days from date of your receipt of this transcript along with Policy
failing which it will be deemed that you have positively confirmed/ are satisfied with the correctness of the details mentioned
below. Kindly note that as the contents and declarations contained in this transcript is the basis on which we have issued the
policy to you, we advise you to please ensure that you have provided/disclosed and or not withheld any material
facts/information and declarations, as Policy becomes Void ab initio if material facts are not provided/disclosed and or
withheld and in such case no claim, if any, will be considered by us apart from forfeiture of the premium.
Details provided by you:

A. Proposer details
1. Proposer Name : ASHIT PAUL
2. Proposer Address : S/O-JAHARLAL PAUL, BOXIRHAT-
, BHANUKUMARI, COOCH BEHAR, WEST BENGAL-736131
3. Proposer Mobile Number : 7063270587
4. Proposer Residential Number : NA
5. Proposer e-mail id : NA
6. Proposer Profession : NA

B.Vehicle Details
Registration Month / Year Vehicle Vehicle Vehicle Sub Cubic Capa- Fuel Type Year of Man- Seating Ca-
Number of Regn Make Model Type city ufacture pacity
WB64AB608 OCT/2022 BAJAJ PULSAR TWIN DISC 150 Petrol 2022 2
8 150 DTSI - BS6

Engine Number Chassis Number Vehicle IDV (in Electrical Non-Electrical CNG/LPG Unit Total IDV (in
Rs.) Accessories Accessories (Extra fitted) Rs.)
IDV (in Rs.) IDV (in Rs.) IDV (in Rs.)
DHXPNG76648 MD2A11CX7NP 78025 0 0 0 78,025.00
G29962
 C. Coverage opted

From : 24-OCT-2024 00:00 (Hrs)

1. Own Damage Standalone Cover Period of Insurance
To : 23-OCT-2025 Midnight
From : 24-OCT-22 To :
Period of Insurance
23-OCT-27
Details of Active Third Party
2. Bajaj Allianz General Insurance
Liability Policy Name of Insurance Company
Co Ltd.
Policy Number OG-24-2472-1871-00000660

3. Is your vehicle fitted with external LPG/CNG kit : No.

4. Electrical Accessories cover Opted (If Applicable) : No.
5. Non - Electrical Accessories cover Opted (If Applicable): : No.
6. Is Voluntary Excess opted : No.
Amount of voluntary excess opted : Rs.NA.
7. compulsory deductible : Rs.100.00
8. Is any additional compulsory deductible imposed and agreed upon : Yes.
Amount of additional compulsory deductible imposed : Rs.
9. Whether geographical area extension is opted : No.
Details of Countries to which geographical area extension cover is given : NA.
10. Pre Existing damages in the vehicle : NA.
11. Total Premium (excluding GST) for OD coverages, quoted and agreed upon is : Rs.294
12. Do you have valid PUC certificate of the vehicle : NA
13. NCB (No Claim Bonus) claimed by you and granted by us based on your : -25 %.
declaration of no claim during your previous policy
14. Previous Own Damage Policy Detail
(i) Insurer Name Bajaj Allianz General Insurance Co Ltd..
(ii) Previous Policy No. OG-24-2472-1871-00000660, Previous Policy Expiry Date :23-OCT-2024
15. Whether your vehicle is Hypothecated and if so the details of Pledgee whose name is registered by us : Yes.
Name of Pledgee : BAJAJ AUTO FINANCE LTD.
16. Add on Cover(s) opted : No.Plan name:NA

17. To support our Go Green initiative, send policy copy link on registered mobile number / email id:

Please note Cover Note No. / issued to you basing on the above information.
In case of Disagreement or objection or any changes with respect to information and contents mentioned hereinabove, please
contact our toll free number & register your objections/changes/disagreement to the contents of this transcript or you may also
send us email or written correspondence at the following details within a period of 15 days from date of your receipt of this
transcript along with Policy:
I/We hereby unconditionally allow the Company to share all my / our information being collected in this proposal form or
through telephonic / email / web-inputs means or other means, as updated from time to time within group entities.
Toll free Number : 1800-102-5858,1800-209-5858
Email address : [email protected]
Website : www.bajajallianz.com
Contact our policy servicing branch at: BAJAJ ALLIANZ GENERAL INSURANCE CO LTD., CORPORATION BANK
BUILDING, FIRST FLOOR, KESHAB ROAD, ,OPP COOCHBEHAR PALACE GATE NO.2, COOCH BEHAR-736101
PH:03582-226023.
INSURANCE ACT, 1938 SECTION 41 - PROHIBITION OF REBATES
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 respect 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 a policy
accept any rebate, except such rebate as may be allowed in accordance with the published prospectus or tables of the insurer.
ANY PERSON IN BREACH OF COMPLYING WITH THE PROVISIONS OF THIS SECTION SHALL BE PUNISHABLE
WITH FINE WHICH MAY EXTEND TO RUPEES TEN LAKH.Bajaj Allianz General Insurance Co Ltd
  

BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LIMITED

Regd. Office & Head Office: GE Plaza, Airport Road, Yerwada,Pune-411006(India)
IRDAI Registration No. 113
Corporate Identity Number: U66010PN2000PLC015329
STANDALONE OWN DAMAGE COVER FOR TWO WHEELER
Certificate of Insurance
UIN : IRDAN113RP0002V01201920
Policy issuing office and correspondence address for communication by holder of BAJAJ ALLIANZ GENERAL
Certificate of Insurance for claim, service request, notice, summons, etc: INSURANCE CO LTD.,
CORPORATION BANK BUILDING,
FIRST FLOOR, KESHAB ROAD, ,OPP
COOCHBEHAR PALACE GATE NO.2,
COOCH BEHAR-736101
PH:03582-226023
Insured Name ASHIT PAUL Policy Number OG-25-2472-1871-00000720
Certificate No. NA

INSURED DETAILS POLICY DETAILS

Insured Address S/O-JAHARLAL PAUL, Policy Issued on 23-OCT-2024
BOXIRHAT- , Period of Insurance For Own Damage Section For Third Party Liability
BHANUKUMARI, COOCH Section
BEHAR, WEST
BENGAL-736131 From : 24-OCT-2024 From : 24-OCT-22 To :
00:00 (Hrs) 23-OCT-27
To : 23-OCT-2025
Midnight
Third Party Liability Name of Insurance Co Policy Number
Section Bajaj Allianz General OG-24-2472-1871-00000660
Insurance Co Ltd.
Customer ID 285958810 Policy Status ISSUED
GSTIN / UIN NA Cover Note Details /
Place of Supply/State 19 - West Bengal Previous Policy No OG-24-2472-1871-00000660 / Bajaj Allianz General
Code/Name Insurance Co Ltd.
Particulars of Vehicle Insured:
Registration Number Place of Registration Engine Number Chassis Number Make & Model
WB64AB6088 WB64-COOCH BE- DHXPNG76648 MD2A11CX7NPG299 BAJAJ - PULSAR 150
HAR 62 DTSI

Sub Type Year of Mfg NCB % CC Seating Capacity

TWIN DISC - BS6 2022 -25 150 2

Name of Registration Authority : WB64-COOCH BEHAR

Name and Address of Insured : ASHIT PAUL
: S/O-JAHARLAL PAUL, BOXIRHAT-,
BHANUKUMARI, COOCH BEHAR, WEST
BENGAL-736131
Geographical Area : .00
Business or Profession : NA
Persons or Class of Persons entitled to drive:
Any person including the insured:
a) Provided that a person driving holds an effective driving license at the time of the accident and is not disqualified from
holding or obtaining such a license.
b) Provided also that the person holding an effective learner's license may also drive the vehicle and that such a person satisfies
the requirements of Rule 3 of the Central Motor Vehicles Rules, 1989.

For help and more information:

Contact our 24 Hour Call Centre at 1800-102-5858, 1800-209-5858, Toll Free: 30305858( chargeable, add area code before this number in case of mobile call) Email us at
[email protected] or Visit our Website www.bajajallianz.com
Corporate Identification Number U66010PN2000PLC015329
Latest Schedule - 23-Oct-2024 20:47:16 PM- Silent_Printing (Web) (0)
IMT-Endorsements/Add on Package
22,7
Beneficier Details:
Beneficier1 Beneficier2 Beneficier3 Beneficier4 Beneficier5

Limitations as to Use:
The Policy covers use for any purpose other than
a) Hire or Reward, b) Carriage of goods (other than samples or personal
luggage), c) Organized racing, d) Pace Making, e) Speed testing, f)
Reliability Trials, g) Any purpose in connection with Motor Trade
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 provi-
sions of Chapter X and Chapter XI of M.V. Act, 1988.
For & On Behalf of
Bajaj Allianz General Insurance Company Ltd.

Authorized Signatory
  

BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LIMITED

Regd. Office & Head Office: GE Plaza, Airport Road, Yerwada,Pune-411006(India)
IRDAI Registration No. 113
Corporate Identity Number: U66010PN2000PLC015329

STANDALONE OWN DAMAGE COVER FOR TWO WHEELER

POLICY SCHEDULE
IRDAN113RP0002V01201920
Policy issuing office and Correspondence address for communication by policyholder for claim, service request, notice, summons, etc:
BAJAJ ALLIANZ GENERAL INSURANCE CO LTD., CORPORATION BANK BUILDING, FIRST FLOOR, KESHAB ROAD, ,OPP
COOCHBEHAR PALACE GATE NO.2, COOCH BEHAR-736101 PH:03582-226023
Note:-
The coverage under this policy is only for Own Damage and no other liability in connect with the vehicle.
Policy will be void ab initio in case of misrepresentation/ fraud or non-existence of valid Third party liability policy for the full Policy
period of this Standalone own damage cover-Two Wheeler policy
INSURED DETAILS POLICY DETAILS
Insured Name ASHIT PAUL Policy Number OG-25-2472-1871-00000720
S/O-JAHARLAL PAUL, BOXIRHAT- , Policy Issued on 23-OCT-2024 20:47 PM
Insured BHANUKUMARI, COOCH BEHAR,
WEST BENGAL-736131 From :24-OCT-2024
Address
Details of Own 00:00 (Hrs)
Geographical .00 Policy Period
Area Damage Stan- To :23-OCT-2025
Customer ID dalone Cover Midnight
285958810
From : 24-OCT-22 To
Policy Period
Bank Reference : 23-OCT-27
No 1
Details of Active Name of Insur- Bajaj Allianz General
GSTIN / UIN NA Third Party Liab- ance Co. Insurance Co Ltd.
Place of Supply/ ility Policy OG-
19 - West Bengal
State Code/Name
Policy Number 24-2472-1871-0000066
Company 19AABCB5730G1ZU
GSTIN 0
Company PAN AABCB5730G Cover Note
Invoice No 396954426/3 /
Details
OG-24-2472-1871-00000660 / Bajaj Al-
Previous Policy No
lianz General Insurance Co Ltd.

Make & Mod-

Registration Number Place of Registration Engine Number Chassis Number SubType
el
BAJAJ -
WB64-COOCH BE- MD2A11CX7NPG TWIN DISC -
WB64AB6088 DHXPNG76648 PULSAR 150
HAR 29962 BS6
DTSI
Year Of Manufactur- Trailer Registra-
NCB % CC/KW Seating Capacity Hypothecation Details
ing tion Number
-25 150 2 2022 -,- BAJAJ AUTO FINANCE LTD
Non electrical Electrical/Elec- Value of CNG/
Vehicle IDV Value For Trailers Total Value
accessories tronic accessories LPG kit
78025 0 0 0 0 78,025.00

For help and more information:

Contact our 24 Hour Call Centre at 1800-102-5858, 1800-209-5858, Toll Free: 30305858( chargeable, add area code before this number in case of mobile call) Email us at Ba-
[email protected] or Visit our Website www.bajajallianz.com
Corporate Identification Number U66010PN2000PLC015329
Latest Schedule - 23-Oct-2024 20:47:16 PM- Silent_Printing (Web) (0)
  

Own Damage Premium(Rs.) Final Premium(In Words): Rupees Three Hundred

Own Damage Premium 294 Forty Six Only
State GST (9%) 26
Central GST (9%) 26
Final Premium Rs. 346
**Note: The above Total OD Premium is inclusive of all applicable Loading /Discounts viz (Automobile association membership, Voluntary Excess,
Anti Theft, Handicap Person, Driver Tuition, Fiber Glass, CNG/LPG Unit, Geographical Extension, Imported Vehicle Etc. wherever Applicable)

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
I/We hereby declare that though our aggregate turnover in any preceding financial year from 2017-18 onwards is more than the aggregate turnover noti-
fied 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.

MISP Code 40000909 Contact No. 8373050490/09733300418

MISP Name BRAHMACHARI AUTO
E-Mail ID. [email protected]

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 li-
cense at the time of the accident and is not disqualified from holding or obtaining such a license.
Provided also that the person holding an effective Learner's license may also drive the vehicle
when not used for the transport of goods/passengers at the time of the accident and that such a
person satisfies the requirements of Rule 3 of the Central Motor Vehicle Rules, 1989.
No Claim Bonus
Existing Damage Details NA
Nominee Details Name :NA - Relationship :NA
Subject to Warranties/ 22,7
IMT-Endorsements/
Add on Package
Additional Details Coinsurance Details: - . Transaction Id: -
Premium Details Receipt No. 2472-00105535, Date 23-OCT-24 ** If Premium paid through Cheque, the Policy is
void ab-initio in case of dishonour of Cheque.
Excess Details Compulsory Excess: Rs.100.00 Additional Excess: Rs. Voluntary Excess: Rs..00
Theft Excess: Rs.0
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.
It is mandatory to keep your policy with updated contact (Mobile No., Email ID and PAN Card) and bank account details, to process any of
your service requests faster and hassle-free in future.
You can update the same through Caringly yours App {Link}, WhatsApp Service { Say Hi on WhatsApp - +91 75072 45858}, Contact our
24-Hour Call Center at 1800-209-5858, 1800-102-5858, Give a Missed Call on 8080945060, SMS WORRY to 575758, Email ba-
[email protected], website {http://www.bajajallianz.com}, contact your agent or nearest branch.
For & On Behalf of
Bajaj Allianz General Insurance Company Ltd.

Stamp
Duty Rs.
0.25
  

Authorized Signatory
This document is digitally signed, hence counter signature / stamp is not required.
Consolidated Stamp Duty of Rs. 0.25/- paid for insurance policy stamps vide Order No. CSD/36/2024-25/2886 dated 01-AUG-24 of General Stamp Office, Mumbai, India.

Principal Location : 6th Floor, Mani Square, 164, 6th Floor, Mani Square, 164, Canal Circle road, Mani Square Premises, KOLKATA -
700054 PH:033-30212900 | Services Accounting Code : 997134 - Motor vehicle insurance services. No reverse charge is payable on these
services.

For help and more information:

Contact our 24 Hour Call Centre at 1800-102-5858, 1800-209-5858, Toll Free: 30305858( chargeable, add area code before this number in case of mobile call) Email us at Ba-
[email protected] or Visit our Website www.bajajallianz.com
Corporate Identification Number U66010PN2000PLC015329
Latest Schedule - 23-Oct-2024 20:47:16 PM- Silent_Printing (Web) (0)
 Bajaj Allianz General Insurance Company Ltd.
BAJAJ ALLIANZ GENERAL INSURANCE CO LTD., CORPORATION BANK BUILDING, FIRST
FLOOR, KESHAB ROAD, OPP COOCHBEHAR PALACE GATE NO.2, COOCH BEHAR - 736101
Contact No:Contact No: 03582-226023

RECEIPT

Receipt Number 2472-00105535

Receipt Date 23/10/2024
Business Channel MD

Received with thanks from ASHIT PAUL

(Customer ID : 285958810 ) a total sum of Rupees Three Hundred Forty Six Only by,

Instrument Instrument No. Instrument Bank Name Branch Name Amount

Type Date
Online Pay- 106666690 23/10/2024 NA NA 346
ment

Total Amount Rs. 346.00

Issuance of this receipt does not amount to acceptance of the risk by Bajaj Allianz General In-
surance Company Limited. The insurance cover for the risk shall be as per the terms and con-
ditions of the Insurance Policy if and when issued.
* Cheque/DD/PO receipt is valid subject to realisation of the instrument.

For & on behalf of

Bajaj Allianz General Insurance Company Ltd.

Authorised Signatory

Regd.Office: Bajaj Allianz House,Airport Road, Yerwada, Pune - 411006