Important Notice

Policy Details

Generation Date: Name of Insured: Address:

20-Nov-2011 Mr Malakari S Shendage MALAKARI.SHENDAGE C/O B C PUJARI AMBUJA NILAY OPP NEW COURT COMPLEX, NAVARASPUR COLONY BIJAPUR MAHARASHTRA BIJAPUR -KARNATAKA

Mobile:
Dear Mr Malakari S Shendage,

9766696711

We thank you for choosing Bajaj Allianz General Insurance Company Ltd for insuring your Private Car - Package Policy .

Your Policy No is OG-12-2004-1801-00002055 .

We thank you for utilizing the online services of Bajaj Allianz General Insurance Co. Ltd to renew your policy online. This has reference to your policy number BajajAllianz-OG-12-2004-1801-00002055 for your Private Car - Package Policy. Please find enclosed the policy schedule. As a valued customer, we would like to provide regular updates on your policy, launch of new products and promotions so that you can take advantage of the same. However if you do not wish to receive any such updates, you can register for 'Do Not Call' services on our website www.bajajallianz.com .

Assuring you of our best services always and thanking you once again for insuring with us. With Best Regards,

Ms Anamika Rashtrawar Head - Corporate & Direct marketing

Bajaj Finserv,1st Floor , Survey # 208/1-B, Behind Weikfield IT-Park, Viman Nagar, Pune-411014

Bajaj Allianz General Insurance Company Ltd. City Pride Office No. 4 - 8, IInd floor 162,Railway lines Nr Employment Chowk Solapur 413001 0217-6450164

Receipt
Receipt Number: 2004-00035389 Receipt Date: 20-NOV-2011 Business Channel: BA

Received with Thanks from:

Mr Malakari S Shendage

(Customer ID : 36922963 ) a total sum of Rupees Twenty thousand five hundred thirty-six rupees only .

Instrument Type DIRECT CREDIT PAYMENT Total Amount Received for this Policy

Instrument Date 20-NOV-11

Amount 20536 20536

Issuance of this receipt does not amount to acceptance of the risk by Bajaj Allianz General Insurance Company Limited. The insurance cover for the risk shall be as per the terms and conditions of the Insurance Policy if and when issued.

Please note: This is an electronically generated receipt and does not require signature. Regd Office : GE Plaza, Airport Road, Yerwada, Pune - 411 006

Certificate Cum Policy Schedule

Policy Details
Policy Issuing Office: Cover Note No.: Policy Number: Period of Insurance: Insured Name: Insured Address: Policy Holder ID: Hypothecation: OG-12-2004-1801-00002055 Mr Malakari S Shendage 36922963 THE KARUR VYASYA BANK LTD City Pride, Office No. 4 - 8, IInd floor, 162,Railway lines, Nr Employment Chowk Solapur-413001 Ph:0217-6450164 Policy Issued On: Product: Zone: Intermediary: Sub Imd Code: From: 25-Nov-2011, 00:00 To: 24-Nov-2012 Midnight B 10003028 - KARUR VYSYA BANK LTD 2117 A/P-KARKAL, TAL-SOUTH SOLAPURSOLAPUR, , SOLAPUR-413001 20-Nov-2011 18:16:22 Private Car - Package Policy

Vehicle Details
Registartion No. MH13 Seat Cap. 8 Vehicle IDV 882602 Schedule Of Premium A. Own Damage Total Own Damage Premium: B. Liability Basic Third Party Liability PA Cover for 8 Passengers of Rs.800000 PA Cover for Owner-Driver of Rs.200000 LL To Person For Operation/Maintenance for 1 Person Bonus/ Malus Total Liability Premium: C. Special Discount D. Net Premium (A+B) E. Service Tax F. Education Cess Final Premium Rs.(D+E+F) ***All Premium Figures are in Rupees No Claim Bonus: 2750 400 100 25 0 3275 0 18618 1862 56 20536 -20% 15343 Make TOYOTA CC 2494 Chassis No. MBJ11JV4007246744 Model INNOVA CNG/LPG Unit 0 Engine No. 2KD6666074 Sub Type Year Of Mfg. 2.5 GX (Diesel) 2010 Elec.Acc Non- Elec. Acc. 0 0 Total Insured Declared Value 882602

I/We declare that I have read the policy schedule and the rate of NCB claimed by me/us is correct and that no claim as arisen in the existing policy period (copy of the policy enclosed). I further undertake that if this declaration is found to be incorrect, all benefits under the policy in respect of section 1 of the policy will stand forteited. I hereby agree to confirm within 7 days in case of any objection or disagreement with the above.

Geographical Area Compulsary Deductible Previous Policy Expired On:

India Rs. 1000 24-NOV-11

Additional Excess Voluntary Excess Previous Policy Number

Rs. 0 Nil OG11-2004-1801-00001547

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 Extn., Imported Vehicle etc wherever applicable). 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. 750000 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 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. 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: 22,7,24, 28, 16, Policy wordings attached herewith *** If premium paid through cheque, the policy is void ab-initio in case of dishonor of cheque. Premium Collection Details: - [Receipt No/Collection No/Amount] 2004-00035389,/1,/ Rs.20536,

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 24 Hour Call centre at 1800-22-5858, 1800-102-5858, 1800-102-5858, 1800-209-5959(Toll Free)/ 91-020-30305858(chargeable, add area code before this number in case of mobile call),or email us at 'info@bajajallianz.co.in' ***** Damage Details:Kindly contact our nearest / local offices for No Claim Bonus Confirmations. This document is a pre signed document and will not be valid unless QC Verified and Signed/Counter Signed by an authorized signatory of Bajaj Allianz General Insurance Co.Ltd. For & Behalf of Bajaj Allianz General Insurance Company Ltd. QC Verified and Signed/Counter Signed by
Stamp Duty Rs. 0.25

Authorized Signatory Printed , Signed and Executed at Pune

QC Verified and Signed/Counter Consolidated stamp Duty paid vide Receipt No: .73333 dated Signed by 26-AUG-11 Regd Office : GE Plaza,Airport Road, Yerwada Pune-411006 (India)

Bajaj Finserv,1st Floor , Survey # 208/1-B, Behind Weikfield IT-Park, Viman Nagar, Pune-411014