BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LTD.

Regd. Office & Head Office: Bajaj Allianz House, Airport Road, Yerawada, Pune-411006.
IRDAI Registration No.113
Corporate Identity Number: U66010PN2000PLC015329

Policy Issuing,correspondence address for communic-

2nd Floor, Shiv Mohan Bhawan ,, Vidhan Sabha Road,, Pandri, Raipur-, , RAIPUR-
ation by policy [or certificate of insurance] hold-
492001 PH:7714288222
er,policy/claim servicing, notices and or summons
Insured Name MANOJ AHUJA Policy Number OG-25-3765-1871-00000112

Welcome to Bajaj Allianz Family

MANOJ AHUJA
S/O GULAB RAI AHUJA,, CIVIL LINE 1850 RAIPUR, HOTEL NETAJI, ,
RAIPUR, RAIPUR, CHATTISGARH-492001

Customer ID : 389222748
Dear Customer,
Thank you for choosing Bajaj Allianz General Insurer as your preferred insurer. Bajaj Allianz General Insurance Company Limited, a con-
sistently profitable insurer enjoys a reputation of expertise, stability and strength. We are a customer focused market leader present in over
200 locations across India. As an organization we strive to understand the risk management needs of our consumers and translate it into af-
fordable products and services of global quality that deliver value for money. Bajaj Allianz has an ISO Certified claims,Operations and Ser-
vices processes and has received iAAA rating for the last three consecutive years from ICRA Limited, an associate of Moody's Investors Ser-
vice, for claims paying ability. The rating indicates highest claims paying ability and a fundamentally strong position in the industry.

We request you to kindly go through the contents of the policy schedule and the terms and conditions. In case of any clarification or dis-
agreement, please write to us at bagichelp@bajajallianz.co.in within fifteen days of receipt of this policy.
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.

Authorized Signatory

For help and more information:

Contact our 24 Hour Call Centre at 1800-102-5858, 1800-209-5858, Toll Free: 30305858( chargeable, add area code before this number in case of mobile call) Email us at Bagichelp@bajajallianz.co.in or
Visit our Website www.bajajallianz.com
Corporate Identification Number U66010PN2000PLC015329
 Bajaj Allianz General Insurance Company Ltd.
Regd. Office & Head Office: Bajaj Allianz House, Airport Road, Yerawada, Pune-411006
IRDAI Registration No. 113
Corporate Identity Number: U66010PN2000PLC015329
Transcript of Proposal for Standalone Own Damage Cover for Two Wheeler

Dear MANOJ AHUJA,

We wish to inform you that the contract under policy number 'OG-25-3765-1871-00000112' has been finalized based on the
proposal / information and declaration given by you, the transcript whereof is mentioned below. You are requested to
reconfirm the same. In case of any disagreement or objection or any changes with respect to information mentioned below, we
request you to please revert back within a period of 15 days from date of your receipt of this transcript along with Policy
failing which it will be deemed that you have positively confirmed/ are satisfied with the correctness of the details mentioned
below. Kindly note that as the contents and declarations contained in this transcript is the basis on which we 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.
Details provided by you:

A. Proposer details
1. Proposer Name : MANOJ AHUJA
2. Proposer Address : S/O GULAB RAI AHUJA,, CIVIL LINE 1850 RAIPUR, HOTEL NETAJI,
, RAIPUR, RAIPUR, CHATTISGARH-492001
3. Proposer Mobile Number : 7071576000
4. Proposer Residential Number : NA
5. Proposer e-mail id : INSURANCEMB.GKM@GMAIL.COM
6. Proposer Profession : NA

B.Vehicle Details
Registration Month / Year Vehicle Vehicle Vehicle Sub Cubic Capa- Fuel Type Year of Man- Seating Ca-
Number of Regn Make Model Type city ufacture pacity
CG04NQ891 JAN/2022 HONDA ACTIVA 6G STD 110 Petrol 2022 2
9

Engine Number Chassis Number Vehicle IDV (in Electrical Non-Electrical CNG/LPG Unit Total IDV (in
Rs.) Accessories Accessories (Extra fitted) Rs.)
IDV (in Rs.) IDV (in Rs.) IDV (in Rs.)
JF91EG0499242 ME4JF913JMG4 51850 0 0 0 51,850.00
99588
 C. Coverage opted

From : 27-MAY-2024 00:01 (Hrs)

1. Own Damage Standalone Cover Period of Insurance
To : 26-MAY-2025 Midnight
From : 20-JAN-22 To :
Period of Insurance
19-JAN-27
Details of Active Third Party
2. Future Generali India Insurance
Liability Policy Name of Insurance Company
Company Limited.
Policy Number V9629135

3. Is your vehicle fitted with external LPG/CNG kit : No.

4. Electrical Accessories cover Opted (If Applicable) : No.
5. Non - Electrical Accessories cover Opted (If Applicable): : No.
6. Is Voluntary Excess opted : No.
Amount of voluntary excess opted : Rs.NA.
7. compulsory deductible : Rs.100.00
8. Is any additional compulsory deductible imposed and agreed upon : No.
Amount of additional compulsory deductible imposed : NA.
9. Whether geographical area extension is opted : No.
Details of Countries to which geographical area extension cover is given : NA.
10. Pre Existing damages in the vehicle : NA.
11. Total Premium (excluding GST) for OD coverages, quoted and agreed upon is : Rs.632
12. Do you have valid PUC certificate of the vehicle : NA
13. NCB (No Claim Bonus) claimed by you and granted by us based on your : -20 %.
declaration of no claim during your previous policy
14. Previous Own Damage Policy Detail
(i) Insurer Name Bajaj Allianz General Insurance Co Ltd..
(ii) Previous Policy No. OG-24-2325-1871-00000394, Previous Policy Expiry Date :26-MAY-2024
15. Whether your vehicle is Hypothecated and if so the details of Pledgee whose name is registered by us: No.
Name of Pledgee : NA.
16. Add on Cover(s) opted : Yes
Plan Name:Drive Assure Basic Plan Description: depreciation shield ,
Please call us on 1800 103 5858 for any emergency.

17. To support our Go Green initiative, send policy copy link on registered mobile number / email id: YES

Please note Cover Note No. / issued to you basing on the above information.
In case of Disagreement or objection or any changes with respect to information 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:
I/We hereby unconditionally allow the Company to share all my / our information being collected in this proposal form or
through telephonic / email / web-inputs means or other means, as updated from time to time within group entities.
Toll free Number : 1800-102-5858,1800-209-5858
Email address : Bagichelp@bajajallianz.co.in
Website : www.bajajallianz.com
Contact our policy servicing branch at: 2nd Floor, Shiv Mohan Bhawan ,, Vidhan Sabha Road,, Pandri, Raipur-, ,
RAIPUR-492001 PH:7714288222.
INSURANCE ACT, 1938 SECTION 41 - PROHIBITION OF REBATES
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 a policy
accept any rebate, except such rebate as may be allowed in accordance with the published prospectus or tables of the insurer.
ANY PERSON IN BREACH OF COMPLYING WITH THE PROVISIONS OF THIS SECTION SHALL BE PUNISHABLE
WITH FINE WHICH MAY EXTEND TO RUPEES TEN LAKH.Bajaj Allianz General Insurance Co Ltd
   

BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LIMITED

Regd. Office & Head Office: GE Plaza, Airport Road, Yerwada,Pune-411006(India)
IRDAI Registration No. 113
Corporate Identity Number: U66010PN2000PLC015329
STANDALONE OWN DAMAGE COVER FOR TWO WHEELER
Certificate of Insurance
UIN : IRDAN113RP0002V01201920
Policy issuing office and correspondence address for communication by holder of 2nd Floor, Shiv Mohan Bhawan ,,
Certificate of Insurance for claim, service request, notice, summons, etc: Vidhan Sabha Road,, Pandri, Raipur-, ,
RAIPUR-492001 PH:7714288222
Insured Name MANOJ AHUJA Policy Number OG-25-3765-1871-00000112
Certificate No. NA

INSURED DETAILS POLICY DETAILS

Insured Address S/O GULAB RAI AHUJA,, Policy Issued on 25-APR-2024
CIVIL LINE 1850 RAIPUR, Period of Insurance For Own Damage Section For Third Party Liability
HOTEL NETAJI, , RAIPUR, Section
RAIPUR,
CHATTISGARH-492001 From : 27-MAY-2024 From : 20-JAN-22 To :
00:01 (Hrs) 19-JAN-27
To : 26-MAY-2025
Midnight
Third Party Liability Name of Insurance Co Policy Number
Section Future Generali India V9629135
Insurance Company
Limited.
Customer ID 389222748 Policy Status ISSUED
GSTIN / UIN NA Cover Note Details /
Place of Supply/State 22 - Chattisgarh Previous Policy No OG-24-2325-1871-00000394 / Bajaj Allianz General
Code/Name Insurance Co Ltd.
Particulars of Vehicle Insured:
Registration Number Place of Registration Engine Number Chassis Number Make & Model
CG04NQ8919 CG04-RAIPUR JF91EG0499242 ME4JF913JMG49958 HONDA - ACTIVA
8

Sub Type Year of Mfg NCB % CC Seating Capacity

6G STD 2022 -20 110 2

Name of Registration Authority : CG04-RAIPUR

Name and Address of Insured : MANOJ AHUJA
: S/O GULAB RAI AHUJA,, CIVIL LINE 1850
RAIPUR, HOTEL NETAJI,, RAIPUR, RAIPUR,
CHATTISGARH-492001
Geographical Area : .00
Business or Profession : NA
Persons or Class of Persons entitled to drive:
Any person including the insured:
a) Provided that a person driving holds an effective driving license at the time of the accident and is not disqualified from
holding or obtaining such a license.
b) Provided also that the person holding an effective learner's license may also drive the vehicle and that such a person satisfies
the requirements of Rule 3 of the Central Motor Vehicles Rules, 1989.
IMT-Endorsements/Add on Package
22, & Plan Name:Drive Assure Basic & Plan Description: depreciation shield ,

For help and more information:

Contact our 24 Hour Call Centre at 1800-102-5858, 1800-209-5858, Toll Free: 30305858( chargeable, add area code before this number in case of mobile call) Email us at
Bagichelp@bajajallianz.co.in or Visit our Website www.bajajallianz.com
Corporate Identification Number U66010PN2000PLC015329
Latest Schedule - 23-Jun-2025 15:35:09 PM- Silent_Printing (Web) (NA)
Beneficier Details:
Beneficier1 Beneficier2 Beneficier3 Beneficier4 Beneficier5

Limitations as to Use:
The Policy covers use for any purpose other than
a) Hire or Reward, b) Carriage of goods (other than samples or personal
luggage), c) Organized racing, d) Pace Making, e) Speed testing, f)
Reliability Trials, g) Any purpose in connection with Motor Trade
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 provi-
sions of Chapter X and Chapter XI of M.V. Act, 1988.
For & On Behalf of
Bajaj Allianz General Insurance Company Ltd.

Authorized Signatory
   

BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LIMITED

Regd. Office & Head Office: Bajaj Allianz House, Airport Road, Yerwada,Pune-411006(India)
IRDAI Registration No. 113
Corporate Identity Number: U66010PN2000PLC015329

STANDALONE OWN DAMAGE COVER FOR TWO WHEELER

POLICY SCHEDULE
IRDAN113RP0002V01201920
Policy issuing office and Correspondence address for communication by policyholder for claim, service request, notice, summons, etc:
2nd Floor, Shiv Mohan Bhawan ,, Vidhan Sabha Road,, Pandri, Raipur-, , RAIPUR-492001 PH:7714288222
Note:-
The coverage under this policy is only for Own Damage and no other liability in connect with the vehicle.
Policy will be void ab initio in case of misrepresentation/ fraud or non-existence of valid Third party liability policy for the full Policy
period of this Standalone own damage cover-Two Wheeler policy
INSURED DETAILS POLICY DETAILS
Insured Name MANOJ AHUJA Policy Number OG-25-3765-1871-00000112
S/O GULAB RAI AHUJA,, CIVIL LINE Policy Issued on 25-APR-2024 17:25 PM
Insured 1850 RAIPUR, HOTEL NETAJI, ,
RAIPUR, RAIPUR, CHATTISGARH- From :27-MAY-2024
Address 492001
Details of Own 00:01 (Hrs)
Geographical .00 Policy Period
Area Damage Stan- To :26-MAY-2025
Customer ID dalone Cover Midnight
389222748
From : 20-JAN-22 To :
Policy Period
Bank Reference 19-JAN-27
No 1 Details of Active
Future Generali India
Third Party Liab- Name of Insur-
GSTIN / UIN NA Insurance Company
ility Policy ance Co.
Place of Supply/ Limited.
22 - Chattisgarh
State Code/Name
Policy Number V9629135
Company 22AABCB5730G1Z7
GSTIN Cover Note
AABCB5730G /
Company PAN Details
Invoice No 382701086/2
OG-24-2325-1871-00000394 / Bajaj Al-
Previous Policy No
lianz General Insurance Co Ltd.

Make & Mod-

Registration Number Place of Registration Engine Number Chassis Number SubType
el
ME4JF913JMG499 HONDA - AC-
CG04NQ8919 CG04-RAIPUR JF91EG0499242 6G STD
588 TIVA
Year Of Manufactur- Trailer Registra-
NCB % CC/KW Seating Capacity Hypothecation Details
ing tion Number
-20 110 2 2022 -,-
Non electrical Electrical/Elec- Value of CNG/
Vehicle IDV Value For Trailers Total Value
accessories tronic accessories LPG kit
51850 0 0 0 0 51,850.00

Own Damage Premium(Rs.) Final Premium(In Words): Rupees Seven Hundred

For help and more information:

Contact our 24 Hour Call Centre at 1800-102-5858, 1800-209-5858, Toll Free: 30305858( chargeable, add area code before this number in case of mobile call) Email us at Ba-
gichelp@bajajallianz.co.in or Visit our Website www.bajajallianz.com
Corporate Identification Number U66010PN2000PLC015329
Latest Schedule - 23-Jun-2025 15:35:09 PM- Silent_Printing (Web) (NA)
   

Own Damage Premium 632 Forty Six Only

State GST (9%) 57
Central GST (9%) 57
Final Premium Rs. 746
**Note: The above Total OD Premium is inclusive of all applicable Loading /Discounts viz (Automobile association membership, Voluntary Excess,
Anti Theft, Handicap Person, Driver Tuition, Fiber Glass, CNG/LPG Unit, Geographical Extension, Imported Vehicle Etc. wherever Applicable)

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 noti-
fied 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.

Agency Code 20064905 Contact No. 08120194737/09869686685

Agency Name Mayank Gupta
E-Mail ID. MAYANKGUPTA1AA4@GMAIL.COM
SP/POSP Code

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 li-
cense at the time of the accident and is not disqualified from holding or obtaining such a license.
Provided also that the person holding an effective Learner's license may also drive the vehicle
when not used for the transport of goods/passengers at the time of the accident and that such a
person satisfies the requirements of Rule 3 of the Central Motor Vehicle Rules, 1989.
No Claim Bonus
Existing Damage Details NA
Nominee Details Name :NA - Relationship :NA
Subject to Warranties/ 22, & Plan Name:Drive Assure Basic & Plan Description: depreciation shield ,
IMT-Endorsements/
Add on Package
Additional Details Coinsurance Details: - . Transaction Id: -
Premium Details Receipt No. 3765-00011109, Date 16-APR-24 ** If Premium paid through Cheque, the Policy is
void ab-initio in case of dishonour of Cheque.
Excess Details Compulsory Excess: Rs.100.00 Additional Excess: Rs.0 Voluntary Excess: Rs..00
Theft Excess: Rs.0
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.
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 initio.
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 {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 ba-
gichelp@bajajallianz.co.in, website {http://www.bajajallianz.com}, contact your agent or nearest branch.
For & On Behalf of
Bajaj Allianz General Insurance Company Ltd.
   

Stamp
Duty Rs.
0.25

Authorized Signatory
This document is digitally signed, hence counter signature / stamp is not required.
Consolidated Stamp Duty of Rs. 0.25/- paid for insurance policy stamps vide Order No. CSD/17/2023/4571 dated 10-NOV-23 of General Stamp Office, Mumbai, India.

Principal Location : Shiv Mohan Bhavan, Vidhansabha Road, Pandri, RAIPUR - 492001 PH:0771-2532368 | Services Accounting Code :
997134 - Motor vehicle insurance services. No reverse charge is payable on these services.

For help and more information:

Contact our 24 Hour Call Centre at 1800-102-5858, 1800-209-5858, Toll Free: 30305858( chargeable, add area code before this number in case of mobile call) Email us at Ba-
gichelp@bajajallianz.co.in or Visit our Website www.bajajallianz.com
Corporate Identification Number U66010PN2000PLC015329
Latest Schedule - 23-Jun-2025 15:35:09 PM- Silent_Printing (Web) (NA)
 TWO WHEELER STANDALONE OD POLICY: ADD ON COVERS(Plan Name:Drive Assure Basic): POLICY
WORDINGS

S3 - DEPRECIATION SHIELD
A. Endorsement Wordings
(UIN No. IRDAN113RP0002V01201920/A0019V01201920)
In consideration of payment of additional premium, it is hereby agreed and declared that this Policy extends to cover the
depreciation amount, partly or fully, on assessed damaged parts allowed for replacement during repairs in the event of a
Partial Loss to the Insured Vehicle .
In the event You have opted for co-payment, Your contribution shall be to the extent agreed by You as shown in the
Schedule for the depreciation amount on the assessed parts for each and every Partial Loss claim.
The benefits under 'Depreciation Shield' would be available only if the Insured Vehicle is repaired at Our authorized
workshops. In case You have opted to repair the Insured Vehicle at a non-authorized workshop, Our liability will be
restricted to 90% of the assessed total claim amount under this cover.
B. Conditions
(1) Claims made by You against Us under 'Depreciation Shield' are subject to the terms and conditions set forth
under the Motor Insurance Policy. (2) In case of transfer of ownership of the Insured Vehicle , the cover under
'Depreciation Shield' shall expire. (3) The benefits under 'Depreciation Shield' can be utilized for a maximum of
two times during the Policy Period
C. Exclusions
In addition to the exclusions mentioned under Motor Insurance Policy, We will not be liable to indemnify You for the
following events:
(1) Where the Own Damage Claim made by You against Us under the Motor Insurance Policy is not payable (2)
Depreciation pertaining to any part/ sub part/ accessories not approved for replacement by Us under Motor Insur-
ance Policy. (3) Loss or damage to tyres and/or battery of the Insured Vehicle . (4) Consequential loss of any
kind arising out of claims lodged under 'Depreciation Shield'. (5) Where a loss is covered under Motor Insurance
Policy or any other type of insurance policy with any other insurer or manufacturer's warranty or recall campaign
or under any other such packages at the same time
If You do not agree whether any of these exclusions apply to Your claim, You agree to accept the burden of proving that
they do not apply.
D. Definitions
The words and phrases listed have special meanings We have set below whenever they appear in bold type and initial
capitals. Please note that references to the singular or to the masculine also include references to the plural or to the fe-
male the context permits and if appropriate.
(1) You,Your,Yourself: The person or persons We insure as set out in the Schedule .(2) We, Our, Us: Bajaj Alli-
anz General Insurance Company Limited. (3) Accident, Accidental: A sudden, unintended and fortuitous external
and visible event.(4) Policy/Motor Insurance Policy: Two Wheeler Package Policy issued by Us to which this
cover is extended (5) Insured Vehicle : The vehicle insured by Us under the Motor Insurance Policy and as
shown on the Schedule .(6) Policy Period: The period between and including the commencement date and expiry
date as shown in the Motor Insurance Policy Schedule . (7) Schedule : The Schedule and any Annexure or En-
dorsement to it which sets out Your personal details and the insurance cover in force. (8) Own Damage Claim:
The claims raised by You against Us for loss or damage to the Insured Vehicle due to the perils mentioned under
Section 1 of Motor Insurance Policy. (9) Total Loss/ Constructive Total Loss: A loss under the Motor Insur-
ance Policy where the aggregate cost of retrieval and/ or repair of the Insured Vehicle , subject to terms and con-
ditions of the Policy, exceeds 75% of the IDV of the Insured Vehicle . (10)Partial Loss: Any loss falling into a
category other than (A) the loss mentioned under Sr. No. 9 above and (B) theft of the Insured Vehicle