Bajaj Allianz General Insurance Company Limited.
Servicing Office : 6th Floor, Mani Square, 164,, 6th Floor, Mani Square, 164,, Canal Circle road, Mani Square
Premises,, KOLKATA, WEST BENGAL (State Code:19) -700054
Private Car Package Policy UIN --IRDAN113RP0025V01200102
Certificate Cum Policy Schedule (FORM 51 OF THE CENTRAL MOTOR VEHICLE RULES, 1989)
PAN :AABCB5730G GSTIN: 19AABCB5730G1ZU CIN :U66010PN2000PLC015329 IRDAI Reg:113
Policy No: OG-26-2401-1801-00000368 Proposal No. & Date: HIIB14991916, 11-APR-2025
Policy Issued On: 11-Apr-2025 12:13 HRS Previous Policy No.: OG-24-2401-1870-00004404
Insured Name: MR. SATYAKI CHAKRABORTY Previous Insurer: Bajaj Allianz General Insurance Company Limited.
Period of Own Damage : 21-APR-2025 (00:00) To 20-APR-2026 (1 YEAR)
FL 2E AGATE AKASH THAKDARI PANCHAYAT RD NEAR BALAKA
Period of Liability Cover: 21-APR-2025 (00:00) To 20-APR-2026 (1 YEAR)
Insured Address: BUS TERMINUS NEWTOWN, KOLKATA , WEST BENGAL (State
Code:19) -700102 Period of Compulsory 21-APR-2025 (00:00) To 20-APR-2026 (1 YEAR)
Personal Accident Cover:
Customer Type PAN GSTIN Name Age (Yr.) Relation
Customer Details Nominee Details
INDIVIDUAL XXXXX0958P NA RUMA MUKHERJEE 35 SPOUSE
Vehicle Details
Make Model Variant Cubic Capacity Manufacturing Year Seating capacity
HYUNDAI VENUE 1.0 TURBO GDI IMT SX 998 2022 5
Body Type Registration No. RTO Hypothecation/Lease* Fuel Type VIN/Chassis No.
SUV 22 BH 7386 A BARASAT YES PETROL MALFC81ALNM324911
Vehicle IDV Electrical Accessories Non-Electrical Accessories BI Fuel Kit Total IDV Engine No
635,732 0 0 0 635,732 G3LCNM547084
Own Damage Premium (A) Amount(INR) Liability Premium (B) Amount(INR)
Basic Own Damage Premium Basic Third Party Liability Premium 2,094
Vehicle 4,830 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) 2,094
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) 331
IMT 23 Premium 0 PA Cover for 0 Unnamed Passengers Rs 0 Each (IMT-16) 0
Sub Total (Basic Premium) 4,830 PA cover for Paid Driver of Rs 2 Lac (IMT-17) 0
Discount/Deductibles Sub Total PA Cover 331
Voluntary Deductibles (0) (IMT-22A) 0 Legal Liability
Anti Theft Device (IMT-10) 0 Paid Driver (IMT-28) 50
AA Membership (IMT-8) 0 Employees (for 0 persons) (IMT-29) 0
No Claim Bonus (20%) 966 Sub Total (Legal Liability) 50
Handicapped Discount (IMT-12) 0 Net Liability Premium (B) 2,475
Sub Total (Deductibles) 966 Total Premium (A+B) 11,405
Total Own Damage Premium 3,864 SGST(9%) 1,027
Add On Coverages ( ZD,KP,PB ) 5066 CGST(9%) 1027
Net Own Damage Premium (A) 8,930 Gross Premium Paid 13,459
Add-on Cover Opted in the Policy: Depreciation Shield(IRDAN113RP0025V01200102/A0001V01200910), Keys and Lock Replacement Cover(IRDAN113RP0025V01200102/A0001V01201213),
Personal Baggage Cover(IRDAN113RP0025V01200102/A0009V01201213)
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: India
during the subsistence of the Policy.
5.The policy is subject to compulsory deductible of INR 1000
4. Policy issuance is subject to realization of cheque if premium is paid by cheque
(IMT-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: STATE BANK OF INDIA - KOLKATA - KOLKATA Payment Mode: CUSTOMER 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 : WEST BENGAL(State Code : 19)
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. Scan for Renewal For & On Behalf of
Corporate Office:16th Floor, Building No. 9A, DLF Cybercity, Phase III, Gurugram, (Valid from 90 Days Prior to Expiry) Bajaj Allianz General Insurance Company Limited.
Haryana 122001
Broker Code: 822 (Valid UPTO:30/05/2025) MISP NAME-J J AUTOMOTIVE PRIVATE
CIN No.: U67200HR2021PTC098982 LIMITED
GST: 06AAGCH0310P1ZP MISP CODE-HIIB-MHY-0352
Email ID: connect@hiib.in DP NAME-PRAHALAD ROY SHARMA
Contact No: 0124-6833000
Authorized Signatory
For Claims, Policy Servicing & Renewal, Kindly contact (J J AUTOMOTIVE LTD BENGAL HYUNDAI) at +91-8017017517
