DUPLICATE COPY

BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LTD. EXTRACT/COPY OF PARTICULARS CONTAINED IN CERTIFICATE CUM POLICY SCHEDULE
Policy Servicing Office Policy Number Period Of Insurance Insured Name Insured Address D#6-1-57, Palakonda Rd, Next to KVB Bank, Chowkward, ,, ,, Srikakulam-532001 PH:08942 -645255 OG-12-1819-1802-00005172 Product Two Wheeler - Package Policy Policy issued on 15-DEC-2011 From: 08-DEC-2011 00:00 (Hrs) Cover Note No. To: 07-DEC-2012 Midnight MR SATYANARAYANA NAIDU B V Zone B S/O BV NAIDUTV9 REPORTER,, CHOWK ROADBESIDE PRAKASH BOOK STALL,C/O MY GURU ONLINE SERVICES LTD , , SRIKAKULAM-532001 32104761 Premium Payer Id 32104761 null Scrutiny No 15164576 Policy Status ISSUED Model CBZ X TREME SubType DISC SELF START CC 150 Year Of Mfg 2008 Side Car null Seat Cap 2 Chassis number. GL09193 CNG/LPG Unit 0 Liability 390 Basic Third Party Liability PA Cover for Owner-Driver of Rs. 100000 Total Act Premium: 770 0 770 77 2 849 *** All Premium Figures are in Rupees 330 50 380 Engine No. GL09267 Total Sum Insured 35790

Customer Id Application No Coinsurance Details : NA. Registration No Make AP30H5868 HERO HONDA Vehicle IDV 35790

Elec. Accessories 0

Non-Elec. Acc. 0

SCHEDULE OF PREMIUM Own Damage Total Own Damage Premium

Total Premium Special Discount Net Premium Service Tax Edu Cess Final Premium Rs.

Geographical Area : India No Claim Bonus : -35% Voluntary Excess : Nil Compulsory Deductible : Rs. 50 Additional Compulsory Deductible : Rs. 0 Previous Insurer - Bajaj Allianz General Insurance Co Ltd. Previous Policy No - OG-11-1819-1802-00005568 Expiry On - 07-DEC-11 The above Total OD Premium is inclusive of all applicable Loading/Discounts viz (Automobile Association Membership,Voluntary Excess,Anti-Theft,Handicap Person,Driver Tution,Fibre Glass,Cng/Lpg Unit,Geographical Extn,Imported Vehicle etc wherever applicable) LIMITS OF LIABILITY: Under section II-I(i) of the policy -> Death of or bodily injury : Such amount is necessary to meet there requirements of the Motor 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. Past Claim Reference : 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

Agency Code 10019623 Contact No : 0/9440977423 Email -

Agency Name : A SATISH KUMAR

Premium Collection Details :- [Receipt No/Collection No/Amount] Rs. 849, By Float No : 10019623 *** 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 ,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 'customercare@bajajallianz.co.in'
15164576/-/10019623/0/Damage Details : PIN NO : NA Remarks : Kindly contact our nearest / local office(s) for No Claim Bonus Confirmations.
This document is a pre signed document and will not be valid unless QC Verified and Signed/Counter Signed by an authorized signatory of Bajaj Allianz General Insurance Co.Ltd. For & On Behalf of Bajaj Allianz General Insurance Company Ltd. Stamp Duty Rs. 0.25 Authorized Signatory Printed , Signed and Executed at Pune QC Verified and Signed/Counter Signed by

Regd. Office : GE Plaza, Airport Road, Yerawada,Pune - 411006 (India)

Consolidated stamp Duty paid vide Receipt No: .78460 dated 05-OCT-11 Service Tax Reg. No. AABCB5730G-ST-001

-Latest Schedule- 27-Mar-2012 18:21:21 PM (Web)

Regd Office : GE Plaza,Airport Road, Yerwada Pune-411006 (India)

Regd. Office : GE Plaza, Airport Road, Yerawada,Pune - 411006 (India)

Service Tax Reg. No. AABCB5730G-ST-001 -Latest Schedule- 27-Mar-2012 18:21:21 PM (Web)