Welcome to Bajaj Allianz Family
Policy issuing office and correspondence address for communication by WEB SALES-Bajaj Finserv Building,1st Floor,Behind Weikfield It-Park,Viman
policyholder for claim, service request, notice, summons, etc.: Nagar,Pune,Maharashtra,INDIA,411014
Insured Name Aman Bhardwaj Policy Number 12-1805-0002745529-00
Name: Aman Bhardwaj
Address:
Line 1: Delhi Extension Shahdara Nand Nagri, Nil, Near Nathu Colony
Line 2: ,
City: East Delhi, State: Delhi
Postcode: 110093
Customer ID: PI25154262
Dear Aman Bhardwaj,
It is our privilege to welcome you to the Bajaj Allianz General Insurance family.
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.
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 – write to us at [email protected] 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.
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.
Signature Not Verified
Digitally signed by DS BAJAJ ALLIANZ GENERAL
INSURANCE COMPANY LIMITED 01
Authorized
Date: Signatory
2023.03.16 13:26:16 IST
Bajaj Allianz General Insurance Co.Ltd. Bajaj Allianz House, Airport Road, Yerawada, Pune -411 006.IRDA Reg. No.:113 CIN:U66010PN2000PLC015329
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TRANSCRIPT OF PROPOSAL FOR
Liability Only Policy For Private Car
UIN : IRDAN113RP0040V01200102
Dear Aman Bhardwaj
We wish to inform you that your contract under policy number '12-1805-0002745529-00' will be based on the information and declaration given
by you through telephonic conversation / email / web-inputs / TAB/CSC Centres or other means which would be considered as the final proposal,
the transcript of which is as follows:
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, failing which it will be deemed that you 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:
Name Aman Bhardwaj
Mailing Address Delhi Extension Shahdara Nand Nagri, Nil, Near Nathu Colony Chowk, Delhi , Jyoti Colony East Delhi
110093 Delhi
Mobile Number 7379890315
Permanent Address Delhi Extension Shahdara Nand Nagri, Nil, Near Nathu Colony Chowk, Delhi , Jyoti Colony East Delhi
110093 Delhi
Email ID [email protected]
Profession NA
B. Vehicle Details:
Registration Month / Year of Vehicle Vehicle Vehicle Sub
CC KW Fuel Type
Number Registration Make Model Type
DL-6-CR-0889 JANUARY/2018 MARUTI BALENO NEW DELTA PETROL 1197 PETROL(P)
Electrical/Electroni Non-Electrical Value of
Year of Seating Vehicle IDV
Engine Number Chassis Number cal Accessories IDV Accessories CNG/LPG Total IDV (in Rs)
Manufacture Capacity (in Rs)
(in Rs) IDV (in Rs) (Extra Fitted)
MBHEWB22SHM2
2017 5 4356999 0 0 0
04410
C. Coverage opted:
1. Period of Insurance
For Third Party Liability Section From 18-03-2023 00:00:01 hrs to 17-03-2024 Midnight
For Compulsory Personal Accident Cover for Owner Driver From Not Applicable to Not Applicable
2. Is your vehicle fitted with external LPG/CNG kit. NO
3. Whether PA cover is opted for owner-driver No, Exemption Reason:Already having Personal Accident
Cover for Owner- Driver
4. i. Whether geographical area extension is opted No
ii. Details of Countries to which geographical area extension is covered NA
5. Is LL to person for Paid driver/Operation/Maintenance opted No
i. No of persons NA
6. Whether PA cover is opted for paid driver other than owner driver No
i. No of paid Drivers 0
ii.Sum Insured for Paid Driver 0
7.Whether PA cover is opted for passengers No
i. Number of Passengers 0
ii.Sum Insured per Passenger 0
8. Is TPPD restricted to statutory limit of Rs.6000? No
9. Premium for Liability coverage, quoted and agreed upon Rs. 3416
10. Do you have valid PUC certificate of the vehicle NA
11. Do you have valid Fitness certificate of the vehicle NA
12. About the last insurance company Bharti AXA General Insurance Company Limited
i. Insurance Provider
ii. Previous Policy No na
iii. Previous Policy Expiry Date 04/01/2023
13. Customer Level Underwriting Declaration
NA
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.
Contact our policy servicing branch at: BAJAJ FINSERV BUILDING 1ST FLOOR BEHIND WEIKFIELD IT-PARK,VIMAN NAGAR PUNE MAHARASHTRA
INDIA
Prohibition of Rebates
SECTION 41 OF INSURANCE ACT, 1938
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 or continuing a policy accept any rebate except such
rebate as may be allowed in accordance with the published prospectuses or tables of the Insurer. Any person making default in complying with
the provisions of this section shall be punishable with a penalty, which may extend to Ten Lakh Rupees.
Bajaj Allianz General Insurance Co.Ltd. Bajaj Allianz House, Airport Road, Yerawada, Pune -411 006.IRDA Reg. No.:113 CIN:U66010PN2000PLC015329
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Liability Only Policy For Private Car - POLICY SCHEDULE CUM CERTIFICATE OF INSURANCE
UIN : IRDAN113RP0040V01200102
Policy issuing office and correspondence address for communication by WEB SALES-Bajaj Finserv Building,1st Floor,Behind Weikfield It-Park,Viman
policyholder for claim, service request, notice, summons, etc.: Nagar,Pune,Maharashtra,INDIA,411014
INSURED DETAILS POLICY DETAILS
Insured Name Aman Bhardwaj Policy Number 12-1805-0002745529-00
Policy Issued on 16-03-2023 13:26:15 hrs
Delhi Extension Shahdara Nand Nagri, Nil, Near Nathu From: 18-03-2023 00:00:01 hrs
Insured
Colony Chowk, Delhi, , , Jyoti Colony,, East Delhi,, Delhi- Period of Insurance
Address To: 17-03-2024 Midnight
110093
Third Liability Cover 18-03-2023 00:00:01 hrs 17-03-2024 Midnight
Application No 11-1805-0004639211-00 Owner Driver CPA Not Applicable Not Applicable
Customer ID PI25154262 Cover Note Details NA
Hypothecated With NA Invoice Number 072303I000265779
GSTIN / UIN Company GST No 27AABCB5730G1ZX
Place of Supply/
07 - DELHI Company PAN AABCB5730G
State Code/Name
Premium Payer ID PI25154262 Zone A
Scrutiny No NA Policy Status ACTIVE POLICY
Geographical Area INDIA Bank Reference No 1
Vehicle Details:
Registration Number Vehicle Make Vehicle Model Vehicle Subtype CC KW
DL-6-CR-0889 MARUTI BALENO NEW DELTA PETROL 1197
Year of Manufacture Place of Reg Seating Capacity Chassis Number Engine Number Vehicle IDV(Rs)
2017 DL6-DELHI 5 MBHEWB22SHM204410 4356999 0
Electrical/ Electronical Non-Electrical
No of Trailer Value of CNG/LPG (Extra Fitted) IDV (Rs) Total IDV (Rs)
Accessories(Rs) accessories(Rs)
0 0 0
SCHEDULE OF PREMIUM
Total Own Damage NA Basic Third Party Liability 3416
null Total Liability Premium 3416
Total Premium 3416
IGST (18%) 615
CGST( ) 0
Cess
Final Premium 4031
Four Thousand Thirty-One
Final Premium (In Words)
Only
***All premium Figures are in Rupees.
“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 E. &
O.E.”
“In case no GSTIN or incorrect GSTIN is provided by the Proposer at Proposal stage, Bajaj Allianz General Insurance Company Ltd shall not be responsible for any
Input Tax Credit losses and no subsequent revision of invoice will be undertaken.”
Agency Details
Agency Code 55555557 Phone Number NA
Agency Name WEB SALES Email ID
Sub IMD Code 9906
SP Code SP Code: 55555557 SP Name
POSP Code NA SP/POSP Contact No
SP/POSP Aadhar No SP/POSP PAN No
Cover Details & Limitations of Use
The Policy covers use of the vehicle for any purpose other than : Hire or reward, Carriage of goods( other
Limitation as to Use than samples or personal luggage),Organised racing,Pace making, Speed testing, Reliability trials. Any
purpose in connection with Motor Trade.
Any person including the insured 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. Provided also that the person
Driver 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
Under section II-I(i) of the policy -> Death of or bodily injury : Such amount is necessary to meet there
Limits of Liability requirements of the Motor Vehicles Act,1988. Under section II-I(ii) of the policy ->Damage to Third Party
Property : Rs. 750000
No Claim Bonus NA
Existing Damage Details NA
Nominee Details Nominee Name: Relationship:
Subject to Warranties/
NA
IMT-Endorsements
Additional Details Coinsurance Details: - .Transaction Id: -NA.
54-22-000001244241/1,Date 16/03/2023** If Premium paid through Cheque, the Policy is
Premium Details
void ab-initio in case of dishonour of Cheque.
Excess Details Compulsory Excess: Rs. NA Additional Excess: Rs. NA Voluntary Excess: Rs. NA
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"
*Warranted that insured named herein or owner of the vehicle insured holds a valid Pollution Under Control (PUC) and / or Fitness
Certificate on the date of commencement of the Policy. If the PUC and/or Fitness Certificate is not found to be valid on the date of
commencement of the Policy, the Company reserves its right to consider the policy void ab initio.
For & On Behalf of Bajaj Allianz General Insurance Company Ltd.
Stamp Duty
Authorized Signatory Rs .5
Printed, Signed and Executed at Pune
This document is digitally signed, hence counter signature / stamp is not required.
Consolidated Stamp Duty of Rs. .5/- paid towards paid towards Insurance Premium Stamps Vide Challan No MH002405964202122M defaced
number 0001482221202122/order no. CSD/82/2021/2306 dated 12-APR-21 timing 13:29:05 of General Stamp of India.
Principal Location: 1000 |Service Accounting Code: 997134 Motor vehicle insurance services. No reverse charge is payable on these services.
Latest Schedule – 16-03-2023 01:26:15 PM - - Module- PARTNERPORTAL
Policy Details Caringly Yours App Claim Registration Online Grievance Whatsapp Service
Bajaj Allianz General Insurance Co.Ltd. Bajaj Allianz House, Airport Road, Yerawada, Pune -411 006.IRDA Reg. No.:113 CIN:U66010PN2000PLC015329
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Signature Not Verified
Digitally signed by DS BAJAJ ALLIANZ
GENERAL INSURANCE COMPANY LIMITED 01
Date: 2023.03.16 13:26:16 IST
RECEIPT
WEB SALES-Bajaj Finserv Building,1st Floor,Behind
Policy Issuing Office and correspondence address for communication
Weikfield It-Park,Viman
by policy holder for claim, service request, notice, summons etc.
Nagar,Pune,Maharashtra,INDIA,411014
Proposer Name Aman Bhardwaj Policy Number 12-1805-0002745529-00
Receipt Number : 54-22-000001244241/1
Receipt Date : 16/03/2023
Business Channel : Websales
Received with thanks from :Aman Bhardwaj
(Customer ID: PI25154262) a total sum of Rupees FOUR THOUSAND THIRTY-ONE ONLY by,
Instrument Type Inst./Ref. No. Instrument Date Bank Name Branch Name Amount (Rs.)
Online Payment 97830331 16-Mar-2023 BN00000146 BN00000146 4,031.00
Total Amount: 4031
Note: Issuance of this receipt does not amount of 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.
* Cheque/DD/PO receipt is valid subject to realisation of the instrument
For & on the behalf
Bajaj Allianz General Insurance Company Ltd.
Authorized Signatory
Bajaj Allianz General Insurance Co.Ltd. Bajaj Allianz House, Airport Road, Yerawada, Pune -411 006.IRDA Reg. No.:113 CIN:U66010PN2000PLC015329
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Signature Not Verified
Digitally signed by DS BAJAJ ALLIANZ
GENERAL INSURANCE COMPANY LIMITED 01
Date: 2023.03.16 13:26:16 IST
TAX INVOICE
(Customer Copy)
Invoice Number 072303I000265779 Customer ID PI25154262
Invoice Date 16/03/2023 Policy No. 12-1805-0002745529-00
Recipient/ Details of Insured Supplier/ Details of Insurer
GSTIN Unregistered GSTIN 27AABCB5730G1ZX
PAN NA PAN AABCB5730G
Name (Proposer) AMAN BHARDWAJ Name Bajaj Allianz General Insurance Company Ltd.
Delhi Extension Shahdara Nand Nagri, Nil, Near
Address-1 Address-1 Bajaj Finserv Building
Nathu Colony Chowk, Delhi
Address-2 Address-2 1st Floor
Address-3 Address-3 Behind Weikfield It-Park,Viman Nagar
Pin Code 110093 Pin Code 411014
City EAST DELHI City PUNE
State DELHI State MAHARASHTRA
Place of
Client Category NON HNI 07 - DELHI
Supply
Premium
Description Amount(INR) Description Amount(INR)
Net Premium 3416 CGST(6%) 0
Receipt Number: 54-22-000001244241 Date: 16/03/2023 SGST/UTGST(6%) 0
Premium Payer ID: PI25154262 Float: NA; ** If Premium paid
through Cheque, the Policy is void ab-initio in case of dishonour CGST(9%) 0
of Cheque
SGST/UTGST(9%) 0
IGST(12%) 0
IGST(18%) 615
Gross Premium 4031
Total Invoice Value (In figures) : 4031
Total Invoice Value (In Words) : Rupees Four Thousand Thirty-One Only
Amount of Tax Subject to Reverse Charge: No reverse charge is payable on these services.
Services Accounting Code: 997134 Motor vehicle insurance services.
Principal Location: Bajaj Allianz House, Airport Road, Yerwada, Pune- 411006 PH-66026666
For & on the behalf
Bajaj Allianz General Insurance Company Ltd.
Authorized Signatory
Important Notes:
* The invoice is issued as per Section 31 of the CGST Act
* In case no GSTIN or incorrect GSTIN is provided by the Proposer at Proposal stage, Bajaj Allianz General Insurance Company Ltd shall not be responsible for any Input
Tax Credit losses and no subsequent revision of invoice will be undertaken
* 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
This is a digitally signed document and hence no physical signature is required
Bajaj Allianz General Insurance Co.Ltd. Bajaj Allianz House,Airport Road,Yerwada,Pune -411006.IRDA Reg.No:113 CIN:U66010PN2000PLC015329
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