CERTIFICATE CUM MOTOR POLICY SCHEDULE

Policy Details
Policy Issuing Office Policy Number Period Of Insurance Policy Issued On Cover Note No. The Insured Insured Address Insured ID Hypothicated with IMD/SUBIMD code
1/82-2, Nanjammas complex, 1st Floor, Vishwanatha puram, Thudiyalur Coimbatore-641034 Ph:0422-2646628 OG-11-1004-1802-00007747 From : 30-Dec-2010 08:27 30-Dec-2010 20:14:13 Mr Satyanarayana Raju J PLOT NO-77,FLAT NO-202,MADHAVI SOCIETY,KUKATPALLY, KUKATPALLI, , HYDERABAD-500072 37374789 55555558 / 1004

Schedule Of Premium
Own Damage
Total Own Damage Premium 618

Liability
Basic Third Party Liability PA Cover for Owner-Driver of Rs. 100000 Total Act Premium: Total Premium Special Discount Net Premium Service Tax and Cess Final Premium Rs. 300 50 350 968 0 968 97 1068

Product To Date Zone

Two Wheeler - Package Policy

29-Dec-2011(Midnight)
B

*** All Premuim Figures are in Rupees

Voluntary Excess

Nil

Vehicle Details
Reg. No.
AP28AU6246

The above Total OD Premium is inclusive of all applicable Loading/Discounts viz (Automoble Association MemModel
PULSAR 150 DTSI 0

Make
BAJAJ

CC
150

Year Of Mfg.
2007

Seat Capacity
2

Chassis No.
12793

Engine No.
50770

bership,Voluntary Excess,Anti-Theft,Handicap Person,Driver Tution,Fibre Glass,Cng/Lpg Unit,Geographical Extn,Imported Vehicle etc wherever applicable)

Vehicle IDV
36896

Elec. Acc.

Non Elec.Acc
0

Side Car
0

CNG/LPG Unit
0

Total Sum Insured

36896

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. Subject to IMT Endorsement Nos: 22, Premium Collection Details :- [Receipt No/Collection No/Amount] 1801-00722346,1801-00722136,/1,1,/ Rs.38,1030,
*** If premium paid through cheque, the policy is void ab-initio in case of dishonor of cheque.

Compulsory Deductible :Rs. 50

Limits Of Liability :
Under section II-I(i) of the policy -> Death of or bodily injury : Such amount as is necessary to meet there requirements of the Motor Vehicles Act,1988. Under section II-I(ii) of the policy -> Damage to Third Party Property : Rs. 100000

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. This certificate of insurance is issued in accordance with the provision of Chapter X and Chapter XI of M.V.Act, 1988. *** In case of any claim, Please Contact Our Call Center: 1800225858(Toll Free) / 30305858 (Local Call at your location)

Driver :
Any person including the insured Provided that a person driving holds an effective driving licence at the time of the accident and is not disqualified from holding or obtaining such a licence. Provided also that the person holding an effective Learner's licence may also drive the vehicle and that such a person satisfies the requirements of Rule 3 of the Central Motor Vehicles Rules, 1989.
Past Claim Reference : Damage Details : 39204327

For & on the behalf of Bajaj Allianz General Insurance Company Ltd. Authorized Signatory