Welcome to Bajaj Allianz Family

Policy issuing office and correspondence address for communication by WEB SALES-Bajaj Finserv Building,1st Floor,Behind Weikfield It-Park,Viman
policyholder for claim, service request, notice, summons, etc.: Nagar,Pune,Maharashtra,INDIA,411014

Insured Name Manyam Ganesh Manyam Policy Number 12-1831-0005237259-00

Name: Manyam Ganesh Manyam

Address:
Line 1: 4-71 Marlabanda Bhoomireddipalle Kasirala Yadamari Chittoor
Line 2: ,
City: Chittoor, State: Andhra Pradesh
Postcode: 517422
Customer ID: PI30527831

Dear Manyam Ganesh Manyam,

It is our privilege to welcome you to the Bajaj Allianz General Insurance family.

We thank you for choosing Bajaj Allianz for your Insurance needs. We are one of India's leading general insurance companies with iAAA rating
from ICRA for the last ten consecutive years indicating the company's high claims paying ability and fundamentally strong position in the industry.
Please be assured that you have made the right choice by choosing us and we will stand by you in your hour of need.

Please find enclosed the policy schedule. We wish to inform you that the policy issued is based on the information submitted in the proposal form
as well as the acceptance of the terms and conditions, and this will be verified at the time of filing of claim. Request you to kindly go through the
same once again and in case of any disagreement, discrepancy or clarifications – write to us at [email protected] within 15 days of the
letter date. For policy wordings containing detailed terms, conditions and exclusions of your insurance coverage, you will receive a hard copy on
your correspondence address.

Once again, we welcome you to the Bajaj Allianz family and look forward to a long association with you.

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.

Signature Not Verified

Digitally signed by DS BAJAJ ALLIANZ GENERAL
INSURANCE COMPANY LIMITED
Authorized
Date: Signatory
2024.05.18 15:54:52 IST

Bajaj Allianz General Insurance Co.Ltd. Bajaj Allianz House, Airport Road, Yerawada, Pune -411 006.IRDA Reg. No.:113 CIN:U66010PN2000PLC015329

Give a Missed Call on 8080945060, SMS ‘WORRY’ to 575758 http://www.facebook.com/BajajAllianz

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www.bajajallianz.com www.bit.do/bjazgi

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TRANSCRIPT OF PROPOSAL FOR
Liability Only Policy for Commercial Vehicle
UIN : IRDAN113RP0042V01200102
Dear Manyam Ganesh Manyam

We wish to inform you that your contract under policy number '12-1831-0005237259-00' will be based on the information and declaration given
by you through telephonic conversation / email / web-inputs / TAB/CSC Centres or other means which would be considered as the final proposal,
the transcript of which is as follows:
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, failing which it will be deemed that you 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:
Name Manyam Ganesh Manyam
4-71 Marlabanda Bhoomireddipalle Kasirala Yadamari Chittoor , Gollapalle Chittoor 517422 Andhra
Mailing Address
Pradesh
Mobile Number 9676071477
4-71 Marlabanda Bhoomireddipalle Kasirala Yadamari Chittoor , Gollapalle Chittoor 517422 Andhra
Permanent Address
Pradesh
Email ID [email protected]
Profession NA

B. Vehicle Details:

Registration Vehicle Vehicle Sub Carrying

Vehicle Make CC KW GVW Mfg Year Chassis Number
Number Model Type Capacity

AP-09-TVA-1301 TATA SUMO VICTA DI GX (6+1) 2956 2009 6 MAT44636199F1541

7

Non-
Vehicle Engine Electrical/Electronical CNG/LPG Kit
Fuel Type No of Trailer Vehicle IDV (in Rs) Electrical Total IDV (in Rs)
Number Accessories IDV (in Rs) IDV (in Rs)
Accessories

497SPTC42FQZ617977 DIESEL(D) 0 0 0 0

C. Coverage opted:
1. Period of Insurance
For Third Party Liability Section From 20-05-2024 00:00:01 hrs to 19-05-2025 Midnight
For Compulsory Personal Accident Cover for Owner Driver From 20-05-2024 00:00:01 hrs to 19-05-2025 Midnight
2. Is your vehicle fitted with external LPG/CNG kit NO
3. Whether PA cover is opted for owner-driver Yes
i. PA cover is exempted for owner-driver with Reason NA
4. i. Whether geographical area extension is opted No
ii. Details of Countries to which geographical area extension is covered NA
5. Is LL to person for Paid driver/Operation/Maintenance opted No
i. No of persons NA
6. Whether PA cover is opted for paid driver other than owner driver Yes
i. No of paid Drivers 1
ii.Sum Insured for Paid Driver 100000
7.Whether PA cover is opted for passengers No
i. Number of Passengers 0
ii.Sum Insured per Passenger 0
8. Is TPPD restricted to statutory limit of Rs.6000? No
 9. Premium for Liability coverage, quoted and agreed upon Rs. 17616
10. Do you have valid PUC certificate of the vehicle NA
11. Do you have valid Fitness certificate of the vehicle NA
12. About the last insurance company
i. Insurance Provider
ii. Previous Policy No
iii. Previous Policy Expiry Date
13. Customer Level Underwriting Declaration
NA

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 give voluntary consent to BAGIC/Company to share my/our personal information and data provided in this proposal form with its
group companies or any other person in connection with the Insurance Policy or otherwise, including for providing products and services of group
companies that may be of interest to me/us, to be used in accordance with their respective privacy policies and subject to appropriate measures
being in place to safeguard my/our personal information.

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.

Contact our policy servicing branch at: BAJAJ FINSERV BUILDING 1ST FLOOR BEHIND WEIKFIELD IT-PARK,VIMAN NAGAR PUNE MAHARASHTRA
INDIA

Prohibition of Rebates

SECTION 41 OF INSURANCE ACT, 1938

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 or continuing a policy accept any rebate except such
rebate as may be allowed in accordance with the published prospectuses or tables of the Insurer. Any person making default in complying with
the provisions of this section shall be punishable with a penalty, which may extend to Ten Lakh Rupees.

Bajaj Allianz General Insurance Co.Ltd. Bajaj Allianz House, Airport Road, Yerawada, Pune -411 006.IRDA Reg. No.:113 CIN:U66010PN2000PLC015329

Give a Missed Call on 8080945060, SMS ‘WORRY’ to 575758 http://www.facebook.com/BajajAllianz

Liability Only Policy for Commercial Vehicle - POLICY SCHEDULE CUM CERTIFICATE OF
INSURANCE
UIN : IRDAN113RP0042V01200102
Policy issuing office and correspondence address for communication by WEB SALES-Bajaj Finserv Building,1st Floor,Behind Weikfield It-Park,Viman
policyholder for claim, service request, notice, summons, etc.: Nagar,Pune,Maharashtra,INDIA,411014

INSURED DETAILS POLICY DETAILS

Insured Name Manyam Ganesh Manyam Policy Number 12-1831-0005237259-00
4-71 Marlabanda Bhoomireddipalle Kasirala Yadamari Vehicle Type 27-Passenger Carrying - 4 Wheel & Carrying
Chittoor, , ,, Chittoor,, Andhra Pradesh-517422
Insured Policy Issued on 18-05-2024 15:54:50 hrs
Address
From: 20-05-2024 00:00:01 hrs
Policy Period
Application No 11-1831-0010877467-00 To: 19-05-2025 Midnight

Customer ID PI30527831 Third Liability Cover 20-05-2024 00:00:01 hrs 19-05-2025 Midnight
Hypothecated With NA Owner Driver CPA 20-05-2024 00:00:01 hrs 19-05-2025 Midnight
GSTIN / UIN Cover Note Details NA
Place of Supply/ Invoice Number 372405I000147850
37 - ANDHRA PRADESH
State Code/Name
Company GST No 27AABCB5730G1ZX
Premium Payer ID PI30527831
Company PAN AABCB5730G
Scrutiny No NA

Geographical Area INDIA Policy Status ACTIVE POLICY

Zone A Bank Reference No 1

Vehicle Details:
Registration Number Vehicle Make Vehicle Model Vehicel Sub Type CC KW GVW Mfg Year

AP-09-TVA-1301 TATA SUMO VICTA DI GX (6+1) 2956 2009

Place of Registration Carrying Capacity Chassis No Engine Number Fuel Type No of Trailer

AP09-HYDERABAD 6 MAT44636199F15417 497SPTC42FQZ617977 DIESEL(D) 0

Electrical/ Electronical Value of CNG/LPG (Extra

Vehicle IDV (Rs) Non-Electrical accessories IDV (Rs) Fitted) IDV (Rs) Total IDV (Rs)
Accessories IDV (Rs)

0 0 0

SCHEDULE OF PREMIUM
Own Damage Premium(Rs.) Liability Premium(Rs.)
Total Own Damage NA Basic Third Party Liability 17225
null null Attached Trailer Premium 0
null null Compulsory Personal Accident -SI- 331
1500000 Period: From 20/05/2024 To
Final Premium 20787
19/05/2025
Twenty Thousand Seven PA Paid Drivers IMT 17 60
Final Premium (In Words)
Hundred Eighty-Seven Only
***All premium Figures are in Rupees IGST (18%) 3171
CGST ( )

“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 E. &
O.E.”
“In case no GSTIN or incorrect GSTIN is provided by the Proposer at Proposal stage, Bajaj Allianz General Insurance Company Ltd shall not be responsible for any
Input Tax Credit losses and no subsequent revision of invoice will be undertaken.”
 Agency Details

Agency Code 43080002 Phone Number 18001033999

Agency Name POLICYBAZAAR INSURANCE Email ID [email protected]
Sub IMD Code
SP Code SP Name
POSP Code NA SP/POSP Contact No
SP/POSP Aadhar No SP/POSP PAN No

Cover Details & Limitations of Use

The Policy covers use only under a permit within the meaning of the Motor Vehicle Act, 1988 or such a
Limitation as to Use carriage falling under Subsection 3 of Section 66 of the Motor Vehicle's Act 1988. The Policy does not cover
use for : Organised racing, Pace Making, Reliability Trials, Speed Testing

Any person including the insured 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. Provided also that the person
Driver 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.
Under section II-I(i) of the policy -> Death of or bodily injury : Such amount is necessary to meet there
Limits of Liability requirements of the Motor Vehicles Act,1988. Under section II-I(ii) of the policy ->Damage to Third Party
Property : Rs. 750000

No Claim Bonus NA

Existing Damage Details NA

Nominee Details Nominee Name: Relationship:

Subject to Warranties/
IMT-Endorsements/
17

Additional Details Coinsurance Details: - .Transaction Id: -NA.

54-24-000000178559/1,Date 18/05/2024** If Premium paid through Cheque, the Policy is

Premium Details
void ab-initio in case of dishonour of Cheque.
Excess Details Compulsory Excess: Rs. Additional Excess: Rs. NA Voluntary Excess: Rs. NA

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.

Signature Not Verified

Digitally signed by DS BAJAJ ALLIANZ
GENERAL INSURANCE COMPANY LIMITED
Date: 2024.05.18 15:54:52 IST
Authorized Signatory Stamp Duty Rs .5
Printed, Signed and Executed at Pune

This document is digitally signed, hence counter signature / stamp is not required.
Consolidated Stamp Duty of Rs. .5/- paid towards Insurance Stamps vide Challan No. MH009975032202324M Defaced No. 0005568654202324
Order No.CSD/17/2023/4571 Order Dated 10/11/2023 DEFACED DATE dated 10/11/2023 timing 15:32:10 PM of General Stamp Office, Mumbai,
India
Principal Location: Bajaj Allianz House, Airport Road, Yerwada, Pune - 411006 PH:66026666 |Service Accounting Code: 997134 Motor vehicle
insurance services. No reverse charge is payable on these services.

Latest Schedule – 18-05-2024 03:54:50 PM - - Module- PARTNERPORTAL

Policy Details Caringly Yours App Claim Registration Online Grievance Whatsapp Service

Bajaj Allianz General Insurance Co.Ltd. Bajaj Allianz House, Airport Road, Yerawada, Pune -411 006.IRDA Reg. No.:113 CIN:U66010PN2000PLC015329

Give a Missed Call on 8080945060, SMS ‘WORRY’ to 575758 http://www.facebook.com/BajajAllianz

Contact our 24-Hour Call Center at 1800-209-5858 http://twitter.com/BajajAllianz

www.bajajallianz.com www.bit.do/bjazgi

[email protected] Demystify Insurance http://support.bajajallianz.com

Signature Not Verified

Digitally signed by DS BAJAJ ALLIANZ
GENERAL INSURANCE COMPANY LIMITED
Date: 2024.05.18 15:54:52 IST
 RECEIPT

WEB SALES-Bajaj Finserv Building,1st Floor,Behind

Policy Issuing Office and correspondence address for communication
Weikfield It-Park,Viman
by policy holder for claim, service request, notice, summons etc.
Nagar,Pune,Maharashtra,INDIA,411014
Proposer Name Manyam Ganesh Manyam Policy Number 12-1831-0005237259-00

Receipt Number : 54-24-000000178559/1

Receipt Date : 18/05/2024
Business Channel : Websales

Received with thanks from :Manyam Ganesh Manyam

(Customer ID: PI30527831) a total sum of Rupees TWENTY THOUSAND SEVEN HUNDRED EIGHTY-SEVEN ONLY by,

Instrument Type Inst./Ref. No. Instrument Date Bank Name Branch Name Amount (Rs.)
Online Payment 104512188 18-May-2024 BN00000158 BN00000158 20,787.00

Total Amount: 20787

Note: Issuance of this receipt does not amount of 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.
* Cheque/DD/PO receipt is valid subject to realisation of the instrument

For & on the behalf

Bajaj Allianz General Insurance Company Ltd.

Authorized Signatory

Bajaj Allianz General Insurance Co.Ltd. Bajaj Allianz House, Airport Road, Yerawada, Pune -411 006.IRDA Reg. No.:113 CIN:U66010PN2000PLC015329

Give a Missed Call on 8080945060, SMS ‘WORRY’ to 575758 http://www.facebook.com/BajajAllianz

Contact our 24-Hour Call Center at 1800-209-5858 http://twitter.com/BajajAllianz

www.bajajallianz.com www.bit.do/bjazgi

[email protected] Demystify Insurance http://support.bajajallianz.com

Signature Not Verified

Digitally signed by DS BAJAJ ALLIANZ
GENERAL INSURANCE COMPANY LIMITED
Date: 2024.05.18 15:54:52 IST
TAX INVOICE
(Customer Copy)

Invoice Number 372405I000147850 Customer ID PI30527831

Invoice Date 18/05/2024 Policy No. 12-1831-0005237259-00

Recipient/ Details of Insured Supplier/ Details of Insurer

GSTIN Unregistered GSTIN 27AABCB5730G1ZX

PAN NA PAN AABCB5730G

Name (Proposer) MANYAM GANESH MANYAM Name Bajaj Allianz General Insurance Company Ltd.
4-71 Marlabanda Bhoomireddipalle Kasirala
Address-1 Address-1 Bajaj Finserv Building
Yadamari Chittoor
Address-2 Address-2 1st Floor

Address-3 Address-3 Behind Weikfield It-Park,Viman Nagar

Pin Code 517422 Pin Code 411014

City CHITTOOR City PUNE

State ANDHRA PRADESH State MAHARASHTRA

Place of
Client Category NON HNI 37 - ANDHRA PRADESH
Supply

Premium

Description Amount(INR) Description Amount(INR)

Net Premium 17616 CGST(6%) 0

Receipt Number: 54-24-000000178559 Date: 18/05/2024 SGST/UTGST(6%) 0

Premium Payer ID: PI30527831 Float: NA; ** If Premium paid
through Cheque, the Policy is void ab-initio in case of dishonour CGST(9%) 0
of Cheque
SGST/UTGST(9%) 0

IGST(12%) 0

IGST(18%) 3171

Gross Premium 20787

Total Invoice Value (In figures) : 20787

Total Invoice Value (In Words) : Rupees Twenty Thousand Seven Hundred Eighty-Seven Only

Amount of Tax Subject to Reverse Charge: No reverse charge is payable on these services.
Services Accounting Code: 997134 Motor vehicle insurance services.
Principal Location: Bajaj Allianz House, Airport Road, Yerwada, Pune- 411006 PH-66026666

For & on the behalf

Bajaj Allianz General Insurance Company Ltd.

Authorized Signatory

Important Notes:
* The invoice is issued as per Section 31 of the CGST Act
* Signature
In case no Not Verified
GSTIN or incorrect GSTIN is provided by the Proposer at Proposal stage, Bajaj Allianz General Insurance Company Ltd shall not be responsible for any Input
Tax Credit
Digitally losses
signed by and no subsequent
DS BAJAJ ALLIANZ revision of invoice will be undertaken
* GENERAL
As per theINSURANCE
GST regulations, the amount
COMPANY of GST will not be refunded if the policy / endorsement is cancelled after 30th September of the next financial year
LIMITED
Date: 2024.05.18 15:54:52 IST
This is a digitally signed document and hence no physical signature is required
Bajaj Allianz General Insurance Co.Ltd. Bajaj Allianz House,Airport Road,Yerwada,Pune -411006.IRDA Reg.No:113 CIN:U66010PN2000PLC015329

Give a Missed Call 80809450 SMS 'WORRY' to 57575 http://www.facebook.com/BajajAllianz

Contact our 24-Hour Call 1800-209-5858 http://twitter.com/BajajAllianz

www.bajajallianz.com www.bit.do/bjazgi

[email protected] Demystify Insurance http://support.bajajallianz.com