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-

RIAAN House 2nd Floor,, LIC Chowk,, Kingway Sadar,, Near NIT Building, Nag-
ation by policy [or certificate of insurance] hold-
pur-440001 PH:0712-2815300
er,policy/claim servicing, notices and or summons
SAURABH ANILRAO IN-
Insured Name Policy Number OG-23-2101-1871-00000405
GALE

Welcome to Bajaj Allianz Family

SAURABH ANILRAO INGALE
AYODHYA NAGAR S O PLOT NO 59, JAWAHAR NAGAR GALLI NO 5
MANEWADA ROAD NR DR TAMBATKAR HOUSE , MANEWADA ROAD,
NAGPUR, MAHARASHTRA-440024

Customer ID : 285196875
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 [email protected] 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 [email protected] 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 SAURABH ANILRAO INGALE,

We wish to inform you that the contract under policy number 'OG-23-2101-1871-00000405' 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 : SAURABH ANILRAO INGALE
2. Proposer Address : AYODHYA NAGAR S O PLOT NO 59, JAWAHAR NAGAR GALLI NO 5
MANEWADA ROAD NR DR TAMBATKAR HOUSE
, MANEWADA ROAD, NAGPUR, MAHARASHTRA-440024
3. Proposer Mobile Number : 9420246467
4. Proposer Residential Number : NA
5. Proposer e-mail id : [email protected]
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
MH49BS926 OCT/2021 ROYAL EN- CLASSIC BLACK 346 Petrol 2021 2
2 FIELD 350

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.)
J3A5FLM216401 ME3J3C5FLM20 180000 0 0 0 1,80,000.00
3 01437
 C. Coverage opted

From : 30-OCT-2022 00:01 (Hrs)

1. Own Damage Standalone Cover Period of Insurance
To : 29-OCT-2023 Midnight
From : 30-OCT-2021
Period of Insurance
To : 29-OCT-2026
Details of Active Third Party
2. Reliance General Insurance
Liability Policy Name of Insurance Company
Company Limited.
Policy Number 991292123750013906

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. Is any additional compulsory deductible imposed and agreed upon : No.
Amount of additional compulsory deductible imposed : NA.
8. Whether geographical area extension is opted : No.
Details of Countries to which geographical area extension cover is given : NA.
9. Pre Existing damages in the vehicle : NA.
10. Total Premium (excluding GST) for OD coverages, quoted and agreed upon is :
11. Do you have valid PUC certificate of the vehicle : NA
12. NCB (No Claim Bonus) claimed by you and granted by us based on your : -20 %.
declaration of no claim during your previous policy
13. Previous Own Damage Policy Detail
(i) Insurer Name Reliance General Insurance Company Limited..
(ii) Previous Policy No. 991292123750013906, Previous Policy Expiry Date :29-OCT-2022
14. Whether your vehicle is Hypothecated and if so the details of Pledgee whose name is registered by us: No.
Name of Pledgee : NA.
15. Whether PA cover is opted for owner-driver : No.
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 : [email protected]
Website : www.bajajallianz.com
Contact our policy servicing branch at: RIAAN House 2nd Floor,, LIC Chowk,, Kingway Sadar,, Near NIT Building,
Nagpur-440001 PH:0712-2815300.
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 RIAAN House 2nd Floor,, LIC Chowk,,
Certificate of Insurance for claim, service request, notice, summons, etc: Kingway Sadar,, Near NIT Building,
Nagpur-440001 PH:0712-2815300
Insured Name SAURABH ANILRAO Policy Number OG-23-2101-1871-00000405
INGALE
Certificate No. NA

INSURED DETAILS POLICY DETAILS

Insured Address AYODHYA NAGAR S O PLOT Policy Issued on 15-OCT-2022
NO 59, JAWAHAR NAGAR Period of Insurance For Own Damage Section For Third Party Liability
GALLI NO 5 MANEWADA Section
ROAD NR DR TAMBATKAR
HOUSE , MANEWADA ROAD, From : 30-OCT-2022 From : 30-OCT-2021
NAGPUR, 00:01 (Hrs) To : 29-OCT-2026
MAHARASHTRA-440024 To : 29-OCT-2023
Midnight
Third Party Liability Name of Insurance Co Policy Number
Section Reliance General 991292123750013906
Insurance Company
Limited.
Customer ID 285196875 Policy Status ISSUED
GSTIN / UIN NA Cover Note Details /
Place of Supply/State 27 - Maharashtra Previous Policy No 991292123750013906 / Reliance General Insurance
Code/Name Company Limited.
Particulars of Vehicle Insured:
Registration Number Place of Registration Engine Number Chassis Number Make & Model
MH49BS9262 NAGPUR J3A5FLM2164013 ME3J3C5FLM200143 ROYAL ENFIELD -
7 CLASSIC 350

Sub Type Year of Mfg NCB % CC Seating Capacity

BLACK 2021 -20 346 2

Name of Registration Authority : NAGPUR

Name and Address of Insured : SAURABH ANILRAO INGALE
: AYODHYA NAGAR S O PLOT NO 59, JAWAHAR
NAGAR GALLI NO 5 MANEWADA ROAD NR DR
TAMBATKAR HOUSE, MANEWADA ROAD,
NAGPUR, MAHARASHTRA-440024
Geographical Area : India
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
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
[email protected] or Visit our Website www.bajajallianz.com
Corporate Identification Number U66010PN2000PLC015329
Latest Schedule - 15-Oct-2022 13:07:22 PM- Silent_Printing (Web) (NA)
22, & Plan Name:Drive Assure Basic & Plan Description: depreciation shield ,
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 provisions of Chapter X and Chapter XI of M.V. Act, 1988.
For & On Behalf of
Bajaj Allianz General Insurance Company Ltd.
Now carry your m-policy on your mobile. Click here to download. https://bagic.page.link/NzJFwp

Authorized Signatory
   

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

POLICY SCHEDULE
IRDAN113RP0002V01201920
Policy issuing office and Correspondence address for communication by policyholder for claim, service request, notice, summons, etc:
RIAAN House 2nd Floor,, LIC Chowk,, Kingway Sadar,, Near NIT Building, Nagpur-440001 PH:0712-2815300
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 SAURABH ANILRAO INGALE Policy Number OG-23-2101-1871-00000405
AYODHYA NAGAR S O PLOT NO 59, Policy Issued on 15-OCT-2022 13:05 PM
JAWAHAR NAGAR GALLI NO 5
Insured MANEWADA ROAD NR DR TAM- From :30-OCT-2022
BATKAR HOUSE , MANEWADA
Address ROAD, NAGPUR, MAHARASHTRA- Details of Own 00:01 (Hrs)
440024 Policy Period
Damage Stan- To :29-OCT-2023
Geographical India dalone Cover
Area Midnight
Customer ID From : 30-OCT-2021
285196875 Policy Period
To : 29-OCT-2026
Bank Reference Details of Active Reliance General Insur-
No 1 Name of Insur-
Third Party Liab- ance Company Lim-
ance Co.
GSTIN / UIN NA ility Policy ited.
Place of Supply/ 27 - Maharashtra 991292123750013906
State Code/Name Policy Number
Company 27AABCB5730G1ZX
GSTIN Cover Note
/
Company PAN AABCB5730G Details
Invoice No 363192125/1
991292123750013906 / Reliance Gener-
Previous Policy No
al Insurance Company Limited.

Make & Mod-

Registration Number Place of Registration Engine Number Chassis Number SubType
el
ROYAL EN-
ME3J3C5FLM200
MH49BS9262 NAGPUR J3A5FLM2164013 FIELD - BLACK
1437
CLASSIC 350
Year Of Manufactur- Trailer Registra-
NCB % CC/KW Seating Capacity Hypothecation Details
ing tion Number
-20 346 2 2021 -,-
Non electrical Electrical/Elec- Value of CNG/
Vehicle IDV Value For Trailers Total Value
accessories tronic accessories LPG kit
180000 0 0 0 0 1,80,000.00

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-
[email protected] or Visit our Website www.bajajallianz.com
Corporate Identification Number U66010PN2000PLC015329
Latest Schedule - 15-Oct-2022 13:07:22 PM- Silent_Printing (Web) (NA)
   

Own Damage Premium(Rs.) Final Premium(In Words): Rupees Three Thousand

Own Damage Premium 3230 Eight Hundred Twelve Only
State GST (9%) 291
Central GST (9%) 291
Final Premium Rs. 3812

**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

Agency Code BAG100022624 Contact No. 9420246467/09420246467

Agency Name JYOTI MAHESH CHAUDHARI
E-Mail ID. [email protected]

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. 2101-00508088, Date 15-OCT-22 ** 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
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.
For & On Behalf of
Bajaj Allianz General Insurance Company Ltd.

Stamp
Duty Rs.
0.5

Authorized Signatory
   

This document is digitally signed, hence counter signature / stamp is not required.
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.

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.

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-
[email protected] or Visit our Website www.bajajallianz.com
Corporate Identification Number U66010PN2000PLC015329
Latest Schedule - 15-Oct-2022 13:07:22 PM- Silent_Printing (Web) (NA)
 Bajaj Allianz General Insurance Company Ltd.
RIAAN House 2nd Floor, LIC Chowk, Kingway Sadar, Near NIT Building, Nagpur - 440001
Contact No:Contact No: 0712-2815300; Fax No: 0712 - 6616700

RECEIPT

Receipt Number 2101-00508088

Receipt Date 15/10/2022
Business Channel ML

Received with thanks from SAURABH ANILRAO INGALE

(Customer ID : 285196875 ) a total sum of Rupees Three Thousand Eight Hundred Twelve
Only by,

Instrument Instrument No. Instrument Bank Name Branch Name Amount

Type Date
Online Pay- 95483767 15/10/2022 NA NA 3,812
ment

Total Amount Rs. 3,812.00

Issuance of this receipt does not amount to acceptance of the risk by Bajaj Allianz General In-
surance Company Limited. The insurance cover for the risk shall be as per the terms and con-
ditions of the Insurance Policy if and when issued.
* Cheque/DD/PO receipt is valid subject to realisation of the instrument.

For & on behalf of

Bajaj Allianz General Insurance Company Ltd.

Authorised Signatory

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

 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