Bajaj Allianz General Insurance Company Limited

GALAXY-HOUSE (4TH FLOOR),BESIDE P.C MITTAL BUS TERMINUS,SEVOKE-ROAD,2ND

MILE,DARJILING,WEST BENGAL,734001
GSTIN Number: 19AABCB5730G1ZU
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/BAG22042795 / 23-Apr-2022 13:58 Proposal No. & Date YC2204231354516647 & 23-Apr-2022 13:58
Insured Name Mr AMIT ROY PRODHAN Period Of Own Damage Cover 23-Apr-2022 (13:58) to 22-Apr-2023 (Midnight)
Period Of Liability Cover 23-Apr-2022 (13:58) to 22-Apr-2027 (Midnight) Period Of PA Owner Driver 23-Apr-2022 (13:58) to 22-Apr-2023 (Midnight)
Previous Insurer N/A Previous Policy No N/A
Reg. Address 48 NO KISAMAT BOXIGANJ HALDIBARI COOCH Comm. Address 48 NO KISAMAT BOXIGANJ HALDIBARI COOCH
BEHAR WEST BENGAL 735122 BEHAR WEST BENGAL 735122
Customer GSTIN N/A
Product Type:STANDARD
Make Model Sub Model Cubic Capacity Manufacturing Year Seating Capacity
YAMAHA MT15 BKJ1 155 2022 2
Body Type Registration No. RTO Hypothecation/Lease* Fuel Type Chassis No
SOLO NEW COOCHBEHAR No PETROL ME1RG6824N0004121
Engine No Invoice Date Vehicle IDV Elec. Accessories Non-Elec. Accessories Total IDV
G3N4E0265362 23-Apr-2022 153615 0 0 153615
Schedule of Premium (Amount in Rs.)
Own Damage Premium (A) Liability Premium (B)
Basic Premium Basic Third Party Liability (Including TPPD) 5453
Vehicle 1352 Sub Total (Third Party Liability) 5453
Non-Elec. Accessories (IMT-24) 0 PA Cover For Owner Driver of Rs.1500000(IMT-15) For 1 Year 331
Elec. Accessories (IMT-24) 0
Sub Total (Basic Premium) 1352 PA Cover (0 Per Person) for 2 Persons(IMT-16) 0
IMT 33 0 Geographical Area Extension 0
Add On Coverages (Nil Depreciation) 0 Sub Total (PA Cover) 331
Add On Coverages (RTI) 0 Net Liability Premium (B) 5784
Add On Coverages (Engine Protector) 0
Geographical Area Extension (IMT-1) 0 Total Premium (A+B) 7136
Sub Total-Addition 0 SGST(9 %) 643
Deductibles CGST( 9%) 643
Voluntary Deductibles (0) (IMT-22A) 0 IGST(0 %) 0
Anti Theft Device (IMT-10) 0
AA Membership (IMT-8) 0 Gross Premium Paid 8422
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) 1352 *Subject to IMT Endt. Nos.& Memorandum: 15,22
UIN Details:
Name of Nominee Age Relationship with Insured Name of Appointee Relationship with Nominee
SINKU ROY PRODHAN 47 FATHER
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 23-Apr-2022 to 22-Apr-2023 - - - -
IDV 153615 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.1
lakhs PA Cover Under Section III for Owner-Driver is Rs. 1500000 .
Grievance Clause : : For resolution of any query or grievance, Insured may contact the respective branch office of the company or may call at (1800-209-5858) or may write an email at (www.bajajallianz.com).In case the insured is not satisfied with the
response of the office, insured may contact the Grievance Officer of the Company at ([email protected]). In the event of unsatisfactory response from the Grievance Office, he/she may, subject to vested jurisdiction, approach the Insurance
Ombudsman for the redressal of grievance. Details of Insurance Ombudsman offices are available at IRDA website:www.irdaindia.org , or on the website of General Insurance Council: www.generalinsurancecouncil.org.in or on the company website
([email protected]). The Policy wording is available on request at free of cost. The Same can be downloaded from our Website(www.bajajallianz.com).
Hypothecation Details: 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
For & On Behalf of Bajaj Allianz General Insurance
Company Limited

MISP Code : TTIBI/Y/151802402

Authorized Signatory

SAC:997134 , Description Of Service:MOTOR VEHICLE INSURANCE SERVICES, Place OF Supply:WEST BENGAL (State Code :33) , Receipt No:YC2204231354516647
, Payment Mode:APD Wallet,
Broker Name & Address : Toyota Tsusho Insurance broker India Pvt. Ltd., No 53(NP) Developed Plots, Industrial Estate, Ekkattuthangal, Chennai – 600032
Broker Code : DB-403/08
For Renewal/Claims assistance - please contact Ins.Co. & Broker through :MS GLOBAL MOTORS, WEST BENGAL at (9732553200 / 9732553200)