Bajaj Allianz General Insurance Company Ltd.
Bajaj Allianz House, Airport Road, Yerwada, Pune - 411006(India)
LIABILITY ONLY POLICY FOR TWO WHEELER CERTIFICATE CUM POLICY SCHEDULE
UIN : IRDAN113RP0041V01200102
Policy issuing office and Correspondence address for communication by policyholder for claim, service request, notice, summons,
etc; Bajaj Allianz General Insurance Co. Ltd.,, Bajaj Allianz House,291-Xtrium,4th Floor,, Next to Holy Family Church,Andheri Kurla Road,,
Chakala, Andheri (East),, Mumbai-400093 Phone No :022- 66027777
Policy Number OG-26-1904-1806-00080382 Product Liability Only Policy For Two Wheeler
Period Of Insurance From: 29-May-2025 Policy issued on 27-May-2025 -
To: 28-May-2026 Midnight Cover Note No /
Application No 451716939 Scrutiny No
Insured Name MOHAN SINGH B Zone
Insured Address S / O : BIKAR SINGH . PATTI, PLO, PATTI
PLO, RAJOKE, TARN, ,, AMRITSAR - 143305
Customer ID 468541304 Premium Payer ID 468541304
Transaction Id
Policy Status ISSUED
GSTIN / UIN NA Place of Supply/State 03 - Punjab
Code/Name
Invoice No. 454888431/1
Company GST No 27AABCB5730G1ZX
Company PAN No AABCB5730G
Registration Make SubType Model CC/KW Mfg Seat Cap Vehicle/ Engine Num-
No. year Trailer ber
Chassis
No
PB46X9543 HERO MOTO- SELF ALLOY SPLENDOR 97 2017 2 MBLHA10 HA10ERH4A01
CORP DRUM 100 PLUS CGH4A017 743
MILLION EDI- 03
TION BS VI
SCHEDULE OF PREMIUM
OWN DAMAGE LIABILITY
Total Own Damage Premium: Basic Third Party Liability 664.00
Total premium 664.00 Total Liability Premium: 664.00
Special Discount 0
Net Premium 664.00
Integrated GST (18%) 120.00
Final Premium Rs. 784.00 ***All Premium Figures are in Rupees
Geographical Area : No Claim Bonus : 0% Theft Excess: Rs. 0
Nominee Details Name : NA Relationship : NA
Previous Insurer - NA Previous Policy No -200045043 Expiry On - 16-FEB-25
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
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.
Nominee Details Name : Relationship :
LIMITS OF LIABILITY: Under Section II-1(i) of the policy -> Death of or bodily injury : Such amount as is necessary to meet there requirements of the Motor
Vehicles Act,1988. Under Section II-1(ii) of the policy -> Damage to Third Party Property : Rs.6,000.00/-
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 disquali-
fied 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 recoverable from the Insured. See
the clause headed "AVOIDANCE OF CERTAIN TERMS AND RIGHT OF RECOVERY".
Subject To IMT Endorsement Nos : 20 & Policy wordings attached herewith
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 ini-
tio.
Broker Code 10043559 Channel Name : MARET
Broker Name : Turtlemint Insurance Broking Service Pvt Ltd
Contact No : 18002660101/18002660101
Email - support@turtlemint.com
SP/POSP Code :
Damage Details as per Annexure I
Premium Collection Details :- [Receipt No/Collection No/Amount] 1904-02283307 / 451716939 / Rs. 784.00 ,
*** If premium paid through cheque, the policy is void ab-initio in case of dishonour of cheque.
This certificate of insurance is issued in accordance with the provision of Chapter X and Chapter XI of M.V. Act, 1988.
Damage Details Annexure : - NA
Remarks PDA MODULE
In case of any claim, please contact our 24 Hour Call centre at 1800-102-5858 (Toll Free) / 91-020-30305858 (chargeable, add area
code before this number in case of mobile call) or email us at 'Bagichelp@bajajallianz.co.in'.
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.
Regd. Office : Bajaj Allianz House, Airport Road, Yerawada,Pune - 411006 (India),A Company incorporated under Indian Companies Act, 1956 and licensed by Insurance
Regulatory and Development Authority of India [IRDA] vide Reg No.113, Corporate Identification Number U66010PN2000PLC015329.Principal Location : Bajaj Allianz
House, Airport Road, Yerwada, Pune - 411006 PH:66026666 | Services Accounting Code : 997134 - Motor vehicle insurance services. No reverse charge is payable on
these services. - Latest Schedule - 27-May-2025 10:43:29 AM (Web)
You can update the same through Caringly yours App {Link}, 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 {http://www.bajajallianz.com}, contact your agent or
nearest branch.
451716939/-/10043559/0/-
This is a one page Policy Document [without enclosing the Terms and Conditions (T&C) of the Policy] issued by the Company, pursuant to the authorization of Insured to display the T&C of the Policy on its website (www.bajajallianz.com) that enables access by the In-
sured. The T&C of the Policy are available on the Company's website and can be accessed by the Insured.
Kindly contact our nearest / local office(s) for No Claim Bonus Confirmations.
For & On Behalf of Bajaj Allianz General Insurance Company Ltd.
Stamp Duty Rs. 0.50
Authorized Signatory This document is digitally signed, hence counter signature / stamp is not required
Printed , Signed and Executed at Pune
Consolidated Stamp Duty of Rs. 0.50/- paid for insurance policy stamps vide Order No. CSD/19/2025/816 dated 01-MAR-25 of General Stamp Office, Mumbai, In-
dia.
Generated by Silent_Printing
Regd. Office : Bajaj Allianz House, Airport Road, Yerawada,Pune - 411006 (India),A Company incorporated under Indian Companies Act, 1956 and licensed by Insurance
Regulatory and Development Authority of India [IRDA] vide Reg No.113, Corporate Identification Number U66010PN2000PLC015329.Principal Location : Bajaj Allianz
House, Airport Road, Yerwada, Pune - 411006 PH:66026666 | Services Accounting Code : 997134 - Motor vehicle insurance services. No reverse charge is payable on
these services. - Latest Schedule - 27-May-2025 10:43:29 AM (Web)
