BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LTD,

CERTIFICATE CUM POLICY SCHEDULE

Policy Servicing Office 8-6-126, 1st Floor, Near Koti Bomma Circle, Kothirampur, Karimnagr-505001 PH
0878-6450733
Policy Number
OG-12-1810-1802-0012336
Product
TwoWheeler-Package Policy
Period Of Insurance
From: 2-FEB-2013 00:00(Hrs)
Policy Issued on
2-FEB-2013
To: 1-FEB-2014 Midnight
Cover Note No.
Insured Name
MR SRAVAN KUMAR BODDULA
Zone B Zone
B
S/O SAILU, HO #16-10-147, KALYAN NAGAR,
GODAVARIKHANI , KARIMNAGR505209
Insured Id
32024063
Premium Payer Id
32024063
Application No
null
Scrutiny No
8546777
0:
Policy Status
ISSUED
Registration
No

Make

Model

Gub Type

CC

Year of
Mfg

Seat
Cap

Chassis
No.

Engine
No.

AP15BA0724

YAMAHA

FZ-S

KICK DRUM &

ALLOY

153

2011

ME121C08
AB203195
7

21C80322
80

Vehicle IDV

Elec. Accessories

42310

Non-Elec. Acc.

Side Car

CNG/LPG Unit

Total Sum
Insured

null

42310

SCHEDULE OF PREMIUM
Own Damage
Total Own Damage
Premium

Liability
402

Basic Third Party Liability

PA Cover of Owner-Driver of Rs. 100000
Total Act Premium:

Total Premium
Special Discount

920
0

Net Premium

920

Service Tax

120

Edu Cess
Final Premium Rs.

5
1045

*** All Premium Figures are in Rupees

Geographical Area: India

No Claim Bonus: -25%
Voluntary Excess: Nil
Company Deductible: Rs.50
Additional Compulsory Deductible: Rs.0
Previous Policy No. OG-10-1810-1802-00003193 Expired on 26-JAN-13
The above Total OD Premium is inclusive of all applicable Loading/Discounts viz (Automobile Association
Membership, Voluntary Excess, Anti-Theft, Handicap Person, Driver Tuition, Fibre Glass, Cng, Lpg Unit,
Geographical Extn, Imported Vehicle etc wherever applicable)
LIMITS OF LIABLITY: Under section-II-I (i) of the Policy -> Death of bodily injury: such amount is
necessary to meet there is a requirement for the Motor Vehicle Act, 1998. Under section II-I (ii) of the

30

35

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 Good (other than samples or personal luggage), Organized 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 that prime time of accident and is not disqualified from holding or obtaining such a licence, Provided
also that the person holding an effective Learners 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 for driven otherwise than in
accordance with this schedule. Any payment made by the Company by reason of wider terms appearing in
the Certified 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 her with

Agency Code
Contact No:

Agency Name:
Email -

Premium Collection Details: - [Receipt No/Collection No/ Amount] 1801-00717157,/,/Rs.829,

***If premium paid through cheque, the policy is void an-initio in case of dishonr 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,
1800-209-5959(Toll free) / 91-020-303035858 (chargeable, add area code before this number
in case of mobile call) or email us at into@bajajallianz.co.in 8546777/-/0/90030456/Damage Details:Remarks:
Kindly contact our nearest / local office(s) for No Claim Bonus Confirmations.
This document is a presigned document and will not be valid unless QC Verified and
Signed/Counter Signed by an authorized signatory of Bajaj Allianz General Insurance Co. Lts.
For & On Behalf of Allianz General Insurance Company Ltd.
Authorized Signatory
QC Verified and Signed/ Source Signed by
Consolidated stamp Duty paid vide Receipt No: Printed, Signed and Executed at Pune
23998 dated 09-JAN-13

Service Tax Reg. No.

AABCB5730G-ST-001
Regd. Office: GE Plaza, Airport Road, Yerawada, Pune 412006 (India) -Latest Schedule- 2FEB-2013 10:33:47 AM (SAT)