Bajaj Allianz General Insurance Company Ltd.

GE Plaza, Airport Road, Yerwada, Pune - 411006

CERTIFICATE CUM POLICY SCHEDULE
Policy Issuing Office 57, chowringhee road,, 2nd floor, Horizon building, , A Kolkata-700071 Ph:033-40034298
Policy Number OG-11-2401-1802-00016194 Product Two Wheeler - Package Policy
Period Of Insurance From: 19-Sep-2010, 00:00 Policy issued Online On 17-Sep-2010 18:42:57
To : 18-Sep-2011 Midnight Cover Note No
Insured Name Sarat Chandra Bhattacharyya Zone B
Insured Address VILL- NATUNPARA, PO- Insured ID 31210159
JETHIA, , 24PGNS(N)-743135
Premium Payer ID 31210159
Intermediary 55555556 - HDFC DSA
Sub Imd Code 14704001HT
Hypothecated with : Policy Status ISSUED
Registration Make Model CC Year Of Mfg Seat Cap Chassis No. Engine No.
Number
NEW BAJAJ PULSAR 150 150 2009 2 MD2DHDHZZS DHJBSD08666
DTSI CD13155
Vehicle IDV Elec. Accessories Non-Elec. Acc. Side Car CNG/LPG Unit Total Sum Insured
52118 0 0 0 0 52118

SCHEDULE OF PREMIUM
Own Damage Liability
Total Own Damage Premium: 795 Basic Third Party Liability 300
PA Cover for Owner-Driver of 50
Rs. 100000
Total Act Premium: 350
Total Premium 1145
Special Discount 0
Net Premium 1049
Service Tax 105
Education Cess : 3
Final Premium Rs. 1157
Geographical Area : India No Claim Bonus : -20% Voluntary Excess : Nil
Compulsory Deductible : Rs. 50 Additional Compulsory Deductible : Rs. 0
Previous Policy No : OG-10-2401-1802-00014363 Expired On : 18-SEP-10
The above Total OD Premium is inclusive of all applicable Loading/Discounts viz (Automoble Association Membership,Voluntary
Excess,Anti-Theft,Handicap Person,Driver Tution,Fibre Glass,Cng/Lpg Unit,Geographical Extn,Imported Vehicle etc wherever ap-
plicable)
LIMITS OF LIABILITY:
Under section II-I(i) of the policy -> Death of or bodily injury : Such amount as is necessary to meet there requirements of the Mo-
tor Vehicles Act,1988.
Under section II-I(ii) of the policy -> Damage to Third Party Property : Rs. 100000
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 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 person 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 recov-
erable from the Insured. See the clause headed AVOIDANCE OF CERTAIN TERMS AND RIGHT OF RECOVERY.
Warranted that the information provided in the online insurance proposal form is the basis of providing insurance cover
and such online proposal form is a part and parcel of this policy.The cover would become null and void if the information
therein is incorrect
Subject to IMT Endorsement Nos: 22, & Policy wordings attached herewith
Not Received
Endorsement issued on this Policy are: OG-10-2401-1802-00014363-EN02
Premium Collection Details :- [Receipt No/Collection No/Amount] 9906-00027960,/1,/ Rs.1157,
*** If premium paid through cheque, the policy is void ab-initio in case of dishonor of cheque.
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 (Toll Free) / 30305858
(chargeable, add area code before this number in case of mobile call).
Kindly contact our nearest / local office(s) for No Claim Bonus Confirmations.
For & on the behalf of
Bajaj Allianz General Insurance Company Ltd.
This document is a pre signed document and will not be valid unless QC Verified and Signed/Counter Signed by an authorized signat-
ory of Bajaj Allianz General Insurance Co.Ltd.
For & Behalf of Bajaj Allianz General Insurance Company Ltd. QC Verified and Signed/Counter Signed by
Stamp
Duty
Rs. 0.25

Authorized Signatory
Printed , Signed and Executed at QC signed and verified Consolidated stamp Duty paid vide Receipt No: .12313 dated
Pune 25-JUN-10
Regd Office : GE Plaza,Airport Road, Yerwada Pune-411006 (India)
Regd. Office : GE Plaza, Airport Road, Yerwada, Pune - 411006