Welcome to Bajaj Allianz Family

Policy issuing office and Correspondence address for communication RUDRAPUR-1st Floor ,Guru Govind Singh Tower ,Tikonia ,
by policyholder for claim, service request, notice, summons, etc. Nainital Road ,Nainital,Uttarakhand,263139,INDIA

Insured Name Mr Rahul Policy number 12-8428-0000625856-00

Name: Mr Rahul
Address:
Line1: A-15,Ishwar Colony
Line2: Rudarpur
City: UDHAM SINGH NAGAR State: 05 - UTTARAKHAND
Post Code: 263153
Email ID: sulemana3@gmail.com
Mobile Number: 8171095895
Customer ID: PI31887377

Dear Mr Rahul,

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 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
bagichelp@bajajallianz.co.in within 15 days of the letter date.For policy wordings containing detailed terms, conditions and exclusions
of your insurance coverage follow below link
https://www.bajajallianz.com/download-documents/health-insurance/global-personal-guard/GPGP_PW.pdf
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
Date: 2024.10.15 11:52:50
11:52:44 IST
Authorized Signatory

Bajaj Allianz General Insurance Co. Ltd. Bajaj Allianz House,Airport Road,Yerwada,Pune - 411 006. Reg. No.: 113 CIN: U66010PN2000PLC015329

Give a Missed Call on 8080945060 ,SMS 'WORRY' to 575758 http://www.facebook.com/BajajAllianz

Contact our 24-Hour Call Center at 1800-209-5858 http://twitter.com/BajajAllianz

www.bajajallianz.com www.bit.do/bjazgi

bagichelp@bajajallianz.co.in Demystify Insurance http://support.bajajallianz.com

CSC-Global Personal Guard Policy (Individual)- POLICY SCHEDULE
UIN: BAJPCSP19131V011819

Policy issuing office and Correspondence address for communication RUDRAPUR-1st Floor ,Guru Govind Singh Tower ,Tikonia ,Nainital
by policyholder for claim, service request, notice, summons, etc. Road ,Nainital,Uttarakhand,263139,INDIA

Proposer Details
Proposer Name Mr Rahul

Proposer Address A-15,Ishwar Colony, RUDARPUR, UDHAM SINGH NAGAR, UTTARAKHAND, 263153, INDIA

Phone No 8171095895 Email ID sulemana3@gmail.com

Customer ID PI31887377

Previous Policy No NA Previous Policy Expiry Date NA

Policy Details
Policy Number 12-8428-0000625856-00 Endorsement No NA

Policy Issued on 15/10/2024 Policy Status ACTIVE

Period of Insurance From 15/10/2024 00:00 Hrs To 14/10/2025 Midnight Expiry Date 14/10/2025

GSTIN / UIN Unregistered

Place of Supply/State
05 - UTTARAKHAND
Code/Name
Company GST No: 05AABCB5730G1Z3

Company PAN AABCB5730G Invoice No: 052410I000083373

Insured Member Details

Nominee Name & First Policy
Member Name Customer ID Gender Date of Birth Age Relation Occupation
Relation Inception Date
Other Class 1. Kanti Swaroop
Mr Rahul PI31887377 Male 01/07/1978 46 Self 15/10/2024
2 Sharma - Father
Insured Address A-15,Ishwar Colony, RUDARPUR, UDHAM SINGH NAGAR, UTTARAKHAND, 263153, INDIA

Cover Details
Accidental Death Permanent Total Disability Permanent Partial Disability
Member Name Premium
Cumulative Cumulative Cumulative
Sum Insured Sum Insured Sum Insured
Bonus ( %) Bonus ( %) Bonus ( %)

Mr Rahul 452 400000 0 (0%) 350000 0 (0%) 250000 0 (0%)

Optional Cover
Accidental Adventure Sports Benefit Air Coma Due to
Children's EMI
Hospitalization Ambulance Accidental
Education Benefit Payment Cover
Expenses Accidental Death PTD Cover Bodily Injury
Member Name

Sum Insured Sum Insured Sum Insured Sum Insured Sum Insured Sum Insured Sum Insured

Mr Rahul NA NA NA NA NA NA 0

Loan Road Travel

Loss of Income due to
Fracture Care Hospital Cash Benefit Protector Ambulance Expenses
Member Disability from Accident
Cover Cover Benefit
Name
Per Day Number of Weekly
Sum Insured Sum Insured Sum Insured Sum Insured Sum Insured
Benefit Days Benefit Amt.

Mr Rahul NA NA NA 0 NA 0 NA 0
CSC-Global Personal Guard Policy (Individual)- POLICY SCHEDULE
UIN: BAJPCSP19131V011819

Add on Cover

Member Name Health Prime Rider BAJHLIA24087V022324

Mr Rahul No

Premium Details
Description Amount Description Amount

Base Premium 384 Family Discount 0

Premium on Add-on Cover 0 Long Term Policy Discount 0

Premium on Health Prime Rider 0 Employee Discount 0

Discount on Health Prime Rider 0 Online Discount/Direct Customer 0

Gross Premium: Four Hundred Fifty-One Rupees Net Premium 383

State GST(9%) 34

Central GST(9%) 34

IGST 0

UTGST 0

CESS 0

Gross Premium 451

"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."

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

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 – {https://play.google.com/store/apps/details?id=com.ba.cp.controller&hl=en_IN},
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 – {bagichelp@bajajallianz.co.in}, website – {www.bajajallianz.com}, contact your agent or
nearest branch.

Exclusions
Member Name Exclusion

Mr Rahul NA
CSC-Global Personal Guard Policy (Individual)- POLICY SCHEDULE
UIN: BAJPCSP19131V011819
Special Exclusion at Policy
Level NA

Loan Details

Assignment Details Mr Rahul, A-15,Ishwar Colony,Pin-263153

Type of Assignment Full Assignment

Parties to the assignment [Insured, assignee] should satisfy themselves before forwarding the policy
document to Bajaj Allianz General Insurance Company Limited, for the registration of assignment.
The assignment of a policy shall automatically cancel any nomination made in the policy, except where
the policy is assigned to the Company, in which case the nominees' right shall always be subject to the
Company's interest in the policy.
This assignment shall not be effectual against the Company unless it is duly executed and signed and
delivered to and is received by the Company under written acknowledgement by the Company.

(a) I do hereby transfer, assign and convey, absolutely and unconditionally, in favour of the Assignee
named below Mr Rahul., all my/our rights and benefits under the Global Personal Guard Policy
(Individual), I may be entitled to, only upon happening of incident/s leading to making claim [subject
Assignment Wordings always only if the claim is admissible as per decision of the Company] as per Terms and Conditions of
Global Personal Guard Policy (Individual) that is issued or will be issued by Bajaj Allianz General
Insurance Company Limited in my favour, on the basis of the information furnished in this Declaration. I
hereby further agree and authorize the Company to register this assignment in favour of Assignee and
accordingly recognize below named Assignee as entitled to receive such rights, benefits as may be
admissible and settled under the claim as per decision of the Company as per Terms and conditions of
Global Personal Guard Policy (Individual). I also declare, agree and undertake that if no specified
incident leading to claim happens as mentioned inGlobal Personal Guard Policy (Individual), then no
claim can be made by Assignee against the Company and my this assignment become Null and Void.
(b) I further undertake and agree that this assignment is irrevocable and I shall not transfer, assign or
otherwise convey my rights, benefits and duties under Global Personal Guard Policy (Individual) to any
other person other than to Assignee.
Additional Remarks NA
This is to certify that Mr Rahul has paid Rs.452 towards Health Insurance premium for Period and Policy
Number as mentioned on the Policy Schedule and is eligible for Deduction under Section 80-D of
Income Tax (Amendment) Act, 1986
Notes:
80 D Certificate 1. This is subject to the provisions of Section 80D of income tax (Amendment) Act, 1986 as amended
from time to time.
2. This certificate must be surrendered to the company in case of cancellation of this policy.
3. In event of incorrect representation of this declaration the liability shall be upon the policy holder.
4. This certificate will not be valid if premium payment has been made in cash.
Receipt Number: SYS-24-000008239462 Date: 15/10/2024 Premium Payer ID: PI31887377 Float: NF;
Premium Details Payment Frequency: Single Premium ** If Premium paid through Cheque, the Policy is void ab-initio in
case of dishonour of Cheque
Financial Institution Ref. No. NA

For & on the behalf

Consolidated Stamp Duty of Rs. 1/- paid towards insurance policy stamps vide Challan No.
Bajaj Allianz General Insurance Company Ltd. MH003479644202425M Defaced No. 0002709637202425 Order No. LOA/ENF-1/CSD/36/2024-25
Order Dated 15/07/2024 Defaced Dated 10/07/2024 timing 15:00:00 of General Stamp Office,
Signature Not Verified Mumbai, India.
Digitally signed by DS BAJAJ
ALLIANZ GENERAL INSURANCEStamp Duty This document is digitally signed,hence counter signature / stamp is not required
COMPANY LIMITED
Date: 2024.10.15 11:52:50
11:52:43 IST Rs.1/- Principal Location : Bajaj Allianz House, Airport Road, Yerwada, Pune- 411006 PH-66026666 |
Services Accounting Code : 997133 Accident and health insurance services.
No reverse charge is payable on these services.
Authorized Signatory

SUB 10042624 / 344623770011

CSC-Global Personal Guard Policy (Individual)- POLICY SCHEDULE
UIN: BAJPCSP19131V011819

“The amounts present in the document are calculated with INR currency if not mentioned otherwise.”

Policy Verification Claim Registration

Our Insurance Expert will call you for hassle free renewal and industry best offers on your coverage
Bajaj Allianz General Insurance Co.Ltd. Bajaj Allianz House,Airport Road,Yerwada,Pune - 411006. Reg.No.:113 CIN:U66010PN2000PLC015329

Give a Missed Call on 8080945060, SMS 'WORRY' to 575758 http://www.facebook.com/BajajAllianz

Contact our 24-Hour Call Center at 1800-209-5858 http://twitter.com/BajajAllianz

www.bajajallianz.com http://www.linkedin.com/company/bajaj-allianz-general-insurance
Transcript of Proposal for ([11-8428-0004171128-00] GLOBAL PERSONAL GUARD
POLICY (INDIVIDUAL)) [(UIN):BAJPCSP19131V011819]

Dear Mr Rahul,
We wish to inform you that your contract will be based on the information and declaration given by you through telephonic conversation / email / web-
inputs / TAB /CSC Centers or other means which would be considered as the final proposal, the transcript of which is as follows:

You are requested to yourself reconfirm the same at your end. In case of any disagreement or objection or any changes with respect to information
mentioned below, we request you to please revert within a period of 15 days from the date of your receipt of this document. In case of our non-receipt
of your disagreement or objection or any changes [as mentioned hereinabove] with respect to information mentioned below, it shall be deemed that
you have positively confirmed to us the correctness of the below mentioned transcript and declaration. Where you disagree to any of
information/contents of this transcript, standard Terms or conditions, you have the option to return the original Policy stating the reasons for your
objection, and upon our receipt of original Policy together with your request to cancel the Policy, you shall be entitled to a refund of the premium paid,
subject only to there being no claim made under the Policy and also subject to a deduction of the expenses incurred by us and the stamp duty
charges.

Proposer Details
Proposer Name Mr Rahul

Are you an Existing Bajaj Allianz Customer: Yes/No If Yes, please mention the policy No

Gender Male Date of Birth 01/07/1978

PAN No CIHPR8774H UID/Unique ID 623725231392

Bajaj Allianz Employee Code, if Proposer is BAGIC/BALIC Employee NA

Marital Status Married No of children NA

Occupation Other Class 2

Address
Permanent/ Residential Address Correspondence Address
(All the communications will be sent to the below address)

Address Line 1 A-15,Ishwar Colony Address Line 1 A-15,Ishwar Colony

Address Line 2 RUDARPUR Address Line 2 Rudarpur

Address Line 3 NA Address Line 3 NA

City/District UDHAM SINGH NAGAR City/District UDHAM SINGH NAGAR

State UTTARAKHAND State UTTARAKHAND

Pin Code 263153 Pin Code 263153

Telephone NA Telephone NA

Mobile 8171095895 Mobile 8171095895

Email sulemana3@gmail.com Email sulemana3@gmail.com

Educational Qualification Post Graduate

Family Monthly Income 22400

In case of any offer, you would prefer to be contacted by 8171095895 / sulemana3@gmail.com

Nationality Indian

Policy Period 1 Year

Details of the Persons to be Insured

Relationship of
Sr Relationship DOB Gender Gross Monthly
Name Age Nominee Nominee with
No with Proposer (dd/mm/yy) (M/F) Income
Insured
1. Kanti
1 Mr Rahul Self 01/07/1978 46 Male 22400 Swaroop 1. Father
Sharma
Transcript of Proposal for ([11-8428-0004171128-00] GLOBAL PERSONAL GUARD
POLICY (INDIVIDUAL)) [(UIN):BAJPCSP19131V011819]

Base Cover Details

Any Existing Accidental Death Permanent Total Disability Permanent Partial
Member Name Occupation
Disability/ Infirmity Sum Insured Sum Insured Sum Insured

Mr Rahul Other Class 2 No 400000 350000 250000

Optional Cover Details

Accidental Adventure Sports Benefit Air Coma Due to
Children's EMI
Hospitalization Ambulance Accidental
Accidental Education Benefit Payment Cover
Expenses PTD Cover Bodily Injury
Member Name Death
Sum Insured Sum Insured Sum Insured Sum Insured Sum Insured Sum Insured Sum Insured

Mr Rahul NA NA NA NA NA NA NA

Loss of Income due to Travel

Hospital Cash Loan Protector Road Ambulance
Fracture Care Disability from Expenses
Benefit Cover**** Cover
Member Name Accident Benefit

Sum Insured Per Day Benefit Sum Insured Sum Insured Sum Insured Sum Insured

Mr Rahul NA NA(NA days) NA NA NA NA

Add on Cover

Member Name Health Prime Rider BAJHLIA24087V022324

Mr Rahul No

Loan Account Details (Please fill in details in case of Loan Protector cover and EMI Payment
Bank Name

Address

Type of Loan Loan Account Number

Sanctioned Loan
Loan Period
Amount
EMI (Rs)

Note:
*"Adventure Sports Benefit” can be opted only if the proposer has opted for Section I: Death Cover AND/ OR Section II: Permanent Total
Disability

**"Children’s Education Benefit” can be opted only if the proposer has opted for Section I: Death Cover AND/ OR Section II: Permanent
Total Disability
***"EMI Payment Cover” can be opted only if the proposer has opted for Sectio3- Permanent Partial Disability (Loan sanction letter to be
submitted mandatorily)

****"Loan Protector Cover” can be opted only if the proposer has opted for Section I: Death Cover AND/ OR Section II: Permanent Total
Disability (Loan sanction letter to be submitted mandatorily)

*****"Travel Expenses Benefit” can be opted only if the Proposer has opted for Accidental Hospitalization under optional Covers.
Transcript of Proposal for ([11-8428-0004171128-00] GLOBAL PERSONAL GUARD
POLICY (INDIVIDUAL)) [(UIN):BAJPCSP19131V011819]

Kindly note that as the information/contents and declarations/confirmations provided by you as contained in this transcript is the basis on which we are
issuing / 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.

I/We hereby give voluntary consent to BAGIC/Company to share my/our personal information and data provided in this proposal form with its group
companies or any other person in connection with the Insurance Policy or otherwise, including for providing products and services of group
companies that may be of interest to me/us, to be used in accordance with their respective privacy policies and subject to appropriate measures
being in place to safeguard my/our personal information.

Disclaimer

A. EXCLUSIONS AND TERMS AND CONDITIONS:

The detailed list of exclusions, standard terms and conditions, including the exclusion of pre-existing ailments/diseases, were fully explained to you and
for full details thereof please refer to the Policy wordings:

Answer given by You: Yes, I/we have been explained in full the details of exclusions, standard terms and conditions including the exclusion of pre-
existing ailments/diseases and knowing the same I/we have opted and proposed for this Policy.

B. The contents of the proposal [transcript of proposal of you is this document] and connected documents have been fully explained to him and you
have fully understood the significance of the proposed contract basis which you have confirmed for policy issuance.

C. In case of Disagreement or objection or any changes with respect to information, declarations, Terms and Conditions, exclusions 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.

Declaration
1. I hereby declare, on my behalf and on behalf of all persons proposed to be insured, that the above statements, answers and/or particulars given by
me are true and complete in all respects to the best of my knowledge and that I am authorised to propose on behalf of these other persons.

2. I understand that the information provided by me will form the basis of the insurance policy, is subject to the Board approved underwriting policy of
the insurer and that the policy will come into force only after full payment of the premium chargeable.

3. I further declare that I will notify in writing any change occurring in the occupation or general health of the life to be insured/proposer after the
proposal has been submitted but before communication of the risk acceptance by the company.

4. I declare that I consent to the company seeking medical information from any doctor or hospital who/which at any time has attended on the person
to be insured/proposer or from any past or present employer concerning anything which affects the physical or mental health of the person to be
insured/proposer and seeking information from any insurer to whom an application for insurance on the person to be insured /proposer has been made
for the purpose of underwriting the proposal and/or claim settlement.

5. I authorize the company to share information pertaining to my proposal including the medical records of the insured/proposer for the sole purpose of
underwriting the proposal and/or claims settlement and with any Governmental and/or Regulatory authority.

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.

Contact our Policy servicing branch at: RUDRAPUR-1st Floor ,Guru Govind Singh Tower ,Tikonia ,Nainital Road ,Nainital,Uttarakhand,INDIA,263139
** This is print of electronic records maintained by us in accordance with law and hence does not require signature.
Transcript of Proposal for ([11-8428-0004171128-00] GLOBAL PERSONAL GUARD
POLICY (INDIVIDUAL)) [(UIN):BAJPCSP19131V011819]

Bajaj Allianz General Insurance Co.Ltd. Bajaj Allianz House,Airport Road,Yerwada,Pune - 411006. Reg.No.:113 CIN:U66010PN2000PLC015329

Give a Missed Call on 8080945060, SMS 'WORRY' to 575758 http://www.facebook.com/BajajAllianz

Contact our 24-Hour Call Center at 1800-209-5858 http://twitter.com/BajajAllianz

www.bajajallianz.com http://www.linkedin.com/company/bajaj-allianz-general-insurance

bagichelp@bajajallianz.co.in Demystify Insurance https://www.bajajallianz.com/blog.html

HEALTH & WELLNESS CARD

Policy issuing office and Correspondence address for communication RUDRAPUR-1st Floor ,Guru Govind Singh Tower ,Tikonia ,Nainital Road
by policyholder for claim, service request, notice, summons, etc. ,Nainital,Uttarakhand,263139,INDIA

Proposer Name Mr Rahul Policy Number 12-8428-0000625856-00

Scan QR to view your policy details

Health Card Number: 31-8428-0016880899-0001
Customer ID: PI31887377
Policy No: 12-8428-0000625856-00
First Policy Inception
Date: 15/10/2024
Valid Up to: 14/10/2025
Member Name: Mr Rahul
Age: 46

HEALTH & WELLNESS CARD

Bajaj Allianz General Insurance Company

(A Company incorporated under Indian Companies Act, 1956 and licensed by Insurance
Regulatory and Development Authority of India [IRDAI] vide Reg No. 113)

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

Cashless hospitalization in network hospitals can be obtained only if this card is produced along
with a letter of authorization from Bajaj Allianz except for emergency cases. This is subject to
terms and conditions of the policy. Please quote your ID number for assistance. Intimation to
Bajaj Allianz Helpline is mandatory in case of any hospitalization.
HOSPITAL ALERT: In emergency, Patient may approach with id card; please call Bajaj Allianz
helpline to verify coverage and cashless authorization.

For help and more information:

Say Hi on WhatsApp on 7507245858, Give a Missed Call on 8080945060, SMS ‘WORRY’ to
575758, Contact our 24-Hour Call Center at 1800-209-5858
Email: Bagichelp@bajajallianz.co.in, Website www.bajajallianz.com
Corporate Identification Number: U66010PN2000PLC015329

Bajaj Allianz General Insurance Co. Ltd. Bajaj Allianz House,Airport Road,Yerwada,Pune - 411 006. Reg. No.: 113 CIN: U66010PN2000PLC015329

Give a Missed Call on 8080945060 ,SMS 'WORRY' to 575758 http://www.facebook.com/BajajAllianz

Contact our 24-Hour Call Center at 1800-209-5858 http://twitter.com/BajajAllianz

www.bajajallianz.com www.bit.do/bjazgi

bagichelp@bajajallianz.co.in Demystify Insurance http://support.bajajallianz.com

 TAX INVOICE
(Customer Copy)

Invoice Number 052410I000083373 Customer ID PI31887377

Invoice Date 15/10/2024 Policy No. 12-8428-0000625856-00

Recipient/ Details of Insured Supplier/ Details of Insurer

GSTIN Unregistered GSTIN 05AABCB5730G1Z3

PAN CIHPR8774H PAN AABCB5730G

Name (Proposer) Mr Rahul Name Bajaj Allianz General Insurance Company Ltd.

Address-1 A-15,Ishwar Colony Address-1 1st Floor

Address-2 Rudarpur Address-2 Guru Govind Singh Tower

Address-3 NA Address-3 Tikonia ,Nainital Road

Pin Code 263153 Pin Code 263139

City UDHAM SINGH NAGAR City NAINITAL

State UTTARAKHAND State UTTARAKHAND

Client Category NON HNI Place of Supply 05 - UTTARAKHAND

Premium Details
Description Amount Description Amount

Net Premium 0 State GST(9%) 34

Receipt Number: SYS-24-000008239462 Date: 15/10/2024
Central GST(9%) 34
Premium Payer ID: PI31887377 Float: NF; ** If Premium paid
through Cheque, the Policy is void ab-initio in case of dishonour 0
IGST(18%)
of Cheque
UTGST(9%) 0

CESS 0

Gross Premium 0

Total Invoice Value (In Words) :

Amount of Tax Subject to Reverse Charge: No reverse charge is payable on these services.
Services Accounting Code: 997133 Accident and health insurance services.
Principal Location: Bajaj Allianz House, Airport Road, Yerwada, Pune- 411006 PH-66026666
For & on the behalf
Bajaj Allianz General Insurance Company Ltd.

Signature Not Verified

Digitally signed by DS BAJAJ
ALLIANZ GENERAL INSURANCE
COMPANY LIMITED
Date: 2024.10.15 11:52:50
11:52:43 IST
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 E.
& O.E
“I/We hereby declare that though our aggregate turnover in any preceding financial year from 2017-18 onwards is more than the aggregate turnover notified
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.”

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 - 411 006. Reg. No.: 113 CIN: U66010PN2000PLC015329

Give a Missed Call on 8080945060 ,SMS 'WORRY' to 575758 http://www.facebook.com/BajajAllianz

Contact our 24-Hour Call Center at 1800-209-5858 http://twitter.com/BajajAllianz

www.bajajallianz.com www.bit.do/bjazgi

bagichelp@bajajallianz.co.in Demystify Insurance http://support.bajajallianz.com