Bajaj Allianz General Insurance Company Limited.
Servicing Office : 4th Floor, Atlantis Heritage, B/h Atlantis Heights, Opp. Swagat Petrol Pump Sarabhai Main Road, VADODARA,
GUJARAT (State Code:24) -390007
Private Car Policy - Bundled UIN --IRDAN113RP0007V01201819
Certificate Cum Policy Schedule (FORM 51 OF THE CENTRAL MOTOR VEHICLE RULES, 1989)
PAN :AABCB5730G GSTIN: 24AABCB5730G1Z3 CIN :U66010PN2000PLC015329 IRDAI Reg:113
Policy No: OG-25-2201-1825-00003902 Proposal No. & Date: HIIB14465545, 13-MAR-2025
Policy Issued On: 13-MAR-2025 14:51 HRS Previous Policy No.: NA
Insured Name: MR. HITESHKUMAR RATILAL PARMAR Previous Insurer: NA
Period of Own Damage : 13-MAR-2025 (00:00) To 12-MAR-2026 (1 YEAR)
B/60-TAKSH AASHARAY,NEAR SIKANDARPURA, AJWA ROAD , Period of Liability Cover: 13-MAR-2025 (00:00) To 12-MAR-2028 (3 YEARS)
Insured Address:
VADODARA , GUJARAT (State Code:24) -390019
Period of Compulsory 13-MAR-2025 (00:00) To 12-MAR-2028 (3 YEARS)
Personal Accident Cover:
Customer Type PAN GSTIN Name Age (Yr.) Relation
Customer Details INDIVIDUAL XXXXX2228R NA Nominee Details RASHMIBEN HITESHKUMAR
34 SPOUSE
PARMAR
Vehicle Details
Make Model Variant Cubic Capacity Manufacturing Year Seating capacity
HYUNDAI AURA 1.2MT KAPPA S 1197 2025 5
Body Type Registration No. RTO Hypothecation/Lease* Fuel Type VIN/Chassis No.
SALOON NEW VADODARA YES PETROL MALB241CLSM352881
Vehicle IDV Electrical Accessories Non-Electrical Accessories BI Fuel Kit Total IDV Engine No
701,290 0 0 0 701,290 G4LASM306535
Own Damage Premium (A) Amount(INR) Liability Premium (B) Amount(INR)
Basic Own Damage Premium Basic Third Party Liability Premium 10,640
Vehicle 22,379 Bi-Fuel Kit 0
Non-Elec. Accessories (IMT-24) 0 Geographical Area Extension (IMT-1) 0
Elec. Accessories (IMT-24) 0 Sub Total (Third Party Liability) 10,640
Bi-Fuel Kit (IMT-25) 0 Personal Accident (PA) Cover
Geographical Area Extension (IMT-1) 0 Compulsory PA Cover for Owner Driver Rs 1500000 (IMT-15) 909
IMT 23 Premium 0 PA Cover for 5 Unnamed Passengers Rs 200000 Each (IMT-16) 1,500
Sub Total (Basic Premium) 22,379 PA cover for Paid Driver of Rs 2 Lac (IMT-17) 0
Discount/Deductibles Sub Total PA Cover 2,409
Voluntary Deductibles (0) (IMT-22A) 0 Legal Liability
Anti Theft Device (IMT-10) 0 Paid Driver (IMT-28) 150
AA Membership (IMT-8) 0 Employees (for 0 persons) (IMT-29) 0
No Claim Bonus (0%) 0 Sub Total (Legal Liability) 150
Handicapped Discount (IMT-12) 0 Net Liability Premium (B) 13,199
Sub Total (Deductibles) 0 Total Premium (A+B) 41,137
Total Own Damage Premium 22,379 SGST(9%) 3,703
Add On Coverages ( ZD,CM,EP,RTI,KP,PB ) 5559 CGST(9%) 3703
Net Own Damage Premium (A) 27,938 Gross Premium Paid 48,543
Add-on Cover Opted in the Policy: Depreciation Shield-Bundled(IRDAN113RP0007V01201819/A0009V01201819), Consumable Expenses-Bundled
(IRDAN113RP0007V01201819/A0020V01201819), Engine Protector-Bundled(IRDAN113RP0007V01201819/A0015V01201819), Vehicle Replacement Advantage-Bundled
(IRDAN113RP0007V01201819/A0010V01201819), Keys and Lock Replacement Cover-Bundled(IRDAN113RP0007V01201819/A0016V01201819), Personal Baggage Cover-Bundled
(IRDAN113RP0007V01201819/A0017V01201819)
Notes: 1. Consolidated Stamp Duty of Rs.0.5/- paid towards Insurance Stamps vide Challan No. MH002405964202122M Defaced No. 0001482221202122 dated 05-JUL-21 timing 12:58:03 of General Stamp
Office,Mumbai,India.
2.This policy has been issued upon declaration by the Insured that a valid Pollution Under Control (PUC) Certificate is held on the date of
commencement of the Policy. The insured undertakes to renew and maintain a valid and effective PUC and/or fitness Certificate, as applicable, 3.Geographical Area Ext. extended to (IMT-1): NA
during the subsistence of the Policy.
5.The policy is subject to compulsory deductible of INR 1,000 (IMT-
4. Policy issuance is subject to realization of cheque if premium is paid by cheque 22) & Voluntary Deductible of INR 0 .
6. This policy is to be read in conjunction with the Policy /Add-on wordings T&C available on the insurer website http://www.bajajallianz.com
*Hypothecation Details: HDFC BANK LTD - VADODARA - VADODARA Payment Mode: Online
Limitations as to use:The policy covers use of the vehicle for any purpose other than (1) Hire or Reward (2) Carriage of goods (other than samples or personal luggage) (3) Organized racing (4) Pace
making (5) Speed testing (6) Reliability trials (7) Any purpose in connection with motor trade.
Driver's Clause: Any person including the insured: Provided that the person driving holds an effective driving license at the time of the accident and is not disqualified from holding or obtaining such
license. Provided also that the person holding an effective learners license may also drive the vehicle & that such a person satisfies the requirements of Rule 3 of the Central Motor Vehicle Rules, 1989.
Limits of Liability Clause: Under Section II-1(i) of the policy-Death of or bodily injury: Such amount as is necessary to meet the requirements of the Motor Vehicle Act 1988.Under Section II-1 (ii) of
the policy-Damage to third party property is INR 7.5 Lakhs, PA Cover Under Section III for Owner-Driver is INR 15 Lakhs.
No Claim Bonus: The insured is entitled for a No Claim Bonus (NCB) on the own damage section of the policy, if no claim is made or pending during the preceding year(s) - 20%, preceding
two consecutive years - 25%, preceding three consecutive years - 35%, preceding four consecutive years - 45%, preceding five consecutive years - 50% of NCB on OD Premium.
NCB is allowed provided the policy is renewed within 90 days of the expiry date of the previous policy.
Declaration on Tax Invoice 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.
Important Notice: The insured is not indemnified if the vehicle is used or driven otherwise than in accordance with the schedule. Any payment made by the company by reasons 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 & RIGHT
OF RECOVERY" For legal interruption, English version will hold good.
Grievance Clause: For resolution of any query or grievance, Insured may check Grievance redressal policy at https://www.bajajallianz.com/about-us/customer-service.html or connect with the respective
servicing office of insurance company. In the event of unsatisfactory response,he/she may approach the insurance ombudsman for the redressal of grievance at www.irdai.gov.in or on website of General
Insurance Council: www.gicouncil.in
HSN/SAC : 997134, Description of Service : Motor Vehicle Insurance Services, Place of Supply : GUJARAT(State Code : 24)
I/we hereby certify that the policy to which this certificate relates as well as this certificate of insurance are issued in accordance with the provisions of Chapter X and XI of Motor Vehicle Act, 1988.
Insurance Broker Name : Hyundai India Insurance Broking Pvt. Ltd. For & On Behalf of
Corporate Office:16th Floor, Building No. 9A, DLF Cybercity, Phase III, Gurugram, Scan for Renewal Bajaj Allianz General Insurance Company Limited.
Haryana 122001 (Valid from 90 Days Prior to
Expiry)
Broker Code: 822 (Valid UPTO:30/05/2025) MISP NAME-SHIVANSHU MOTORS LLP
CIN No.: U67200HR2021PTC098982 MISP CODE-HIIB-MHY-0158
GST: 06AAGCH0310P1ZP DP NAME-POOJA KINNARKUMAR
Email ID: connect@hiib.in GANDHI
Contact No: 0124-6833000
Authorized Signatory
For Claims, Policy Servicing & Renewal, Kindly contact (SHIVANSHU MOTORS LLP) at +91-6359021212
