Bajaj Allianz General Insurance Company Limited

4TH FLOOR, NE PLAZA, BESIDE BMW SHOWROOM, ERRAMANZIL

CIRCLE,HYDERABAD.,HYDERABAD,TELANGANA,500082
GSTIN Number: 36AABCB5730G1ZY
IRDA Registration No: 113 UIN No: IRDAN113RP0008V01201819
MOTOR TWO - WHEELERS POLICY BUNDLED CUM RECEIPT
(Form 51 of the central motor vehicle rules, 1989)
Policy No/Issue Dt & Time YHM/BAG2312117875 / 14-Dec-2023 13:32 Proposal No. & Date YC2312141148432766 & 14-Dec-2023 13:32
Insured Name Mr MOHD SHAHRUKH ALI Period Of Own Damage Cover 14-Dec-2023 (13:32) to 13-Dec-2024 (Midnight)
Period Of Liability Cover 14-Dec-2023 (13:32) to 13-Dec-2028 (Midnight) Period Of PA Owner Driver 14-Dec-2023 (13:32) to 13-Dec-2024 (Midnight)
Previous Insurer N/A Previous Policy No N/A
Reg. Address 8-1-398/PM/41 DECCAN APPT HYDERABAD TELANGANA 500008 Comm. Address 8-1-398/PM/41 DECCAN APPT HYDERABAD TELANGANA 500008

Make Model Sub Model Cubic Capacity Manufacturing Year Seating Capacity
YAMAHA AEROX ((MGP)) BLV4 155 2023 2
D.O.B Mobile Number Email Pan Number GSTIN Product Type
03-Nov-2000 96*****8475 NA NA NA ADDON
Body Type Registration No. RTO Hypothecation/Lease* Fuel Type Chassis No
SOLO NEW HYDERABAD Yes PETROL ME1SG752BP0011255
Engine No Invoice Date Vehicle IDV Elec. Accessories Non-Elec. Accessories Total IDV
G3U1E0011279 14-Dec-2023 140885 0 0 140885
Schedule of Premium (Amount in Rs.)
Own Damage Premium (A) Liability Premium (B)
Basic Premium Basic Third Party Liability (Including TPPD - 250) 7115
Vehicle 2526 Sub Total (Third Party Liability) 7115
Non-Elec. Accessories 0 PA Cover For Owner Driver of Rs.1500000(IMT-15) For 1 Year 331
Elec. Accessories (IMT-24) 0 Legal Liability To Passenger 0
Sub Total (Basic Premium) 2526 PA Cover (0 Per Person) for 2 Persons(IMT-16) 0
IMT 33 0 Geographical Area Extension (IMT-1) 0
Add On Coverages (Nil Depreciation) 423 Sub Total (PA Cover) 331
Add On Coverages (RTI) 0 Net Liability Premium (B) 7446
Add On Coverages (Engine Protector) 0
Add On Coverages (EMI Cover) 0
Add On Coverages (Helmet Cover) 0
Add On Coverages (EME Cover) 0
Geographical Area Extension (IMT-1) 0 Total Premium (A+B) 10395
Sub Total-Addition 423 SGST(9 %) 936
Deductibles CGST( 9%) 936
Voluntary Deductibles (0) (IMT-22A) 0 IGST(0 %) 0
Anti Theft Device (IMT-10) 0
AA Membership (IMT-8) 0 Gross Premium Paid 12267
No Claim Bonus (0%) 0 Note: 1.Policy issuance is subject to realization of cheque
Handicap Discount (IMT-12) 0 2.Consolidated Stamp duty paid to state exchequer
Sub Total (Deductibles) 0 3.The policy is subject to compulsory deductible of Rs.100 (IMT-22)
Net Own Damage Premium (A) 2949 *Subject to IMT Endt. Nos.& Memorandum: 15,22,20
UIN Details: Nil Depreciation IRDAN113RP0008V01201819/A0024V01201819

Name of Nominee Age Relationship with Insured Name of Appointee Relationship with Nominee
HAJERA SULTANA 54 MOTHER
Insured Declared Value :The schedule of age-wise insured declared(IDV) as shown in the below table is applicable for the purpose of Total loss including Theft/Constructive Total Loss (TL/CTL)
claims only on basis of loss date falling in the respective year. A vehicle will be considered to be a CTL, where the aggregate cost of retrieval and/or repair of the vehicle subject to terms and
conditions of the policy exceeds 75% of the IDV.
Tenure 14-Dec-2023 to 13-Dec-2024 - - - -
IDV 140885 0 0 0 0
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.
Drivers 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 Liablity 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 Rs.6000 PA Cover Under Section III for Owner-
Driver is Rs. 1500000 .
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
Hypothecation Details: ICICI BANK LTD, GACHI BOWLI, RANGAREDDY , CPA Waiver reasons : NA
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 interpretation, English version will hold good.
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 Motor Vehicle Act, 1988 In case this policy is cancelled for any reason before 31st October of the following year,
the refund calculated as per terms of the policy along with corresponding amount of GST would be refunded. However, in case this policy is cancelled beyond the said date (31st October of the following year), only the refund calculated as per terms of the policy would be refunded and any GST
amount would NOT be refunded owing to the restrictions prescribed under the GST law. However, an unregistered GST customers can apply for refund of the GST amount from the government directly in FORM GST RFD-01 (along with relevant documents), within the prescribed timelines as per
Circular No. 188/20/2022-GST dated 27/12/2022.
Receipt No:YC2312141148432766 , Payment Mode:ICICI Credit Card
Scan QR To View Policy MISP Details Broker Details Signature
For & On Behalf of Bajaj Allianz General Insurance
Company Limited
MISP Code : TTIBI/Y/102432571 Broker Code : DB-403/08

SAC:997134 , Broker Name : Toyota Tsusho Insurance Brokers

Description Of Service:MOTOR VEHICLE India Pvt Ltd
INSURANCE SERVICES, Broker Address :No 53(NP) Developed Plots,
Place Of Supply:TELANGANA (State Code :36) Industrial Estate, Ekkattuthangal, Chennai – 600032

Authorized Signatory
Please contact for Renewal assistance - /9849404545 , Claims assistance - :7675080242,HYD AUTOFORTE PRIVATE LIMITED, TELANGANA (or) For Renewal/Claim Visit Our Website : https://wcym.ttibi.co.in/customer/login