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Issuing Office: Bajaj Finserv,1st Floor , Survey # 208/1-B, Behind Weikfield IT-Park, Viman Nagar, Pune-
411014, Contact No: 1800-209-0144
Date: 15-APR-18 Reference No: ARU19861978
Generated by : ONLINE
plot no 85 ,vgn platina
TIRUVALLUR
TAMIL NADU
Dear ARUN ,
Re.: Your enquiry for premium quotation for vehicle
We thank you for your enquiry for quote on insurance premium for your registered as Private Car. Details of
your requirement are noted below -
Make Model SubType CC Fuel Year of Registered NCB at
Manufacture Seating Renewal
MAHINDRA SCORPIO SLX TURBO 7 2609 Diesel 2007 7 50%
AND SEATER
MAHINDRA
Vehicle IDV Value of Electrical Value of Non-Electrical Value of CNG/LPG Unit Total IDV
Accessories Accessories -extra fitted
266035 0 0 0 266035
Proposed Insurance Policy Expiry Date Date of Vehicle Pin Code of your Vehicle Registration Voluntary Ex-
commencement date Registration normal place of city cess
stay
05-MAY-18 04-MAY-19 15-SEP-07 600077 CHENNAI 15000
Based on the cited details, we are pleased to quote our premium as under: (* All figures in Rupees)
Net OD Premium Net TP Premium Total Premium Integrated GST Final Premium
1880 7990 9870 1777 11647
Thanking You,
Websales Team,
Bajaj Allianz General Insurance Company Limited.
This is an electronically generated quotation and does not require any signature.
Please turn overleaf
Registered & Corporate Office - G E Plaza, Airport Road, Yerwada, PUNE 411 006
Date: 15-APR-18
Reference No: ARUN
Generated by : ONLINE
To,
I/We acknowledge receipt of your Quote-cum-Proposal and accept the terms and intend to insure my/our
vehicle detailed therein with you. I/We agree that this Proposal and the declarations shall be the basis of the
contract between Bajaj Allianz and me/us. I/We confirm that the vehicle is being used for private purposes
only. I/We warrant the truth of the forgoing statements in every respect and agree that if I/We have made
any false statement or provided false information, the claim shall be repudiated and premium forfeited. I/We
also declare that if any additions or alterations are carried out after the submission of this Quote-
cum-Proposal, then the same would be conveyed to Bajaj Allianz immediately.
cash
Please find attached my/our remittance of premium of Rs.11647/- by Cash/Cheque No__________
dated____________ nil
17/04/2018 drawn on______________________________________ towards issuance of the
Policy with the following additional information.
Pin Code : 600077 Vehicle Make : MAHINDRA AND Vehicle Model : SCORPIO
MAHINDRA
Sub Type : SLX TURBO 7 SEATER Fuel : Diesel Registration Date : 15-SEP-07
Please mention your Name, Mobile Number and Reference Number on the reverse of cheque.
17/04/2018
Date : ___________________ Signature of Proposer : ____________________
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