UIN : IRDA/NL-HLT/BAGI/P-H/V.I/***/**-**
SANKAT MOCHAN- POLICY SCHEDULE
Invoice No:
Period of Insurance
Policy Number
Policy Issued on Policy Status
Policy Details
GSTIN / UIN
Company GST No:
Expiry Date
Place of Supply/State
Code/Name
Company PAN
12-6402-0000323643-00 Endorsement No
12/07/2025
11/07/2026
NA
ACTIVE
From 12/07/2025 00:00 Hrs To
11/07/2026 Midnight
272507I003129371
27 - MAHARASHTRA
AABCB5730G
Unregistered
27AABCB5730G1ZX
Member Name Customer ID Gender Date of Birth Age Relation Nominee Name &
Relation
First Policy
Inception Date
Vikas Anil Ujgare PI34894719 Male 06/06/1997 28 Self 1. Seema Vikas
Ujgare - Spouse
12/07/2025
SWARBABA NAGAR, BEHIND MUTHA HOS, GAUTAM NAGAR, NASHIK,, SATPUR, NASHIK, MAHARASHTRA, 422007, INDIA
Insured Address
Insured Member Details
Member Name Occupation Premium Plan Basic(SI)
Wider
(SI)
Comprehensive(SI)
Accidental
Hospitalization
(SI)
Hospital
Confinement
Allowance(Per Day)
Vikas Anil Ujgare Other Class 2 319 Plan 1 200***-*-*-****** 0 Cover Details
Amount
Three Hundred Eighteen Rupees State GST(9%)
Description
270 270
318
Amount
Gross Premium
Central GST(9%)
Gross Premium:
Base Premium
Description
Premium Details
IGST
UTGST
CESS
0
0
0
Net Premium
24
24
Customer ID
Proposer Details
Email ID
PI34894719
Proposer Address
Proposer Name
Phone No ***********@*****.***
NASIK-Bajaj Allianz General Insurance Co Ltd,3rd Floor, Sumangal Business Court,Plot No.39, Yeolekar Mala,Near Shraddha Petrol Pump, Beside 3m Car Mall,Nashik,Maharashtra,422005,INDIA Previous Policy No
Policy issuing office and Correspondence address for communication by policyholder for claim, service request, notice, summons, etc. Vikas Anil Ujgare
SWARBABA NAGAR, BEHIND MUTHA HOS, GAUTAM NAGAR, NASHIK,, SATPUR, NASHIK, MAHARASHTRA, 422007, INDIA
NA Previous Policy Expiry Date NA
UIN : IRDA/NL-HLT/BAGI/P-H/V.I/147/13-14
SANKAT MOCHAN- POLICY SCHEDULE
"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."
“I/We hereby declare that though our aggregate turnover in any preceding financial year from 2017-18 onwards is more than the aggregate turnover notified under sub-rule (4) of rule 48, we are not required to prepare an invoice in terms of the provisions of the said sub-rule.” It is mandatory to keep your policy with updated contact (Mobile No., Email ID and PAN Card) and bank account details, to process any of your service requests faster and hassle-free in future. You can update the same through Caringly yours App – {https://play.google.com/store/apps/details?id=com.ba.cp.controller&hl=en_IN}, WhatsApp Service { Say ‘Hi’ on WhatsApp - +91-750**-*****}, Contact our 24-Hour Call Center at 1-800-***-****, 180*-***-****, Give a Missed Call on – 808*******, SMS “WORRY” to 575758, Email – {*********@************.**.**}, website – {www.bajajallianz.com}, contact your agent or nearest branch.
AGENCY NAME EMAIL ID
AGENCY CODE 10025404 CONTACT NO
Vicky Kanyalal Valecha
***********@*****.***
Assignment Details NA
Type of Assignment NA
Assignment Wording NA
Special Exclusion at Policy
Level NA
Additional Remarks NA
Premium Payment Details
Receipt Number: SYS-25-000********* Date: 12/07/2025 Premium Payer ID: PI34894719 Float: NA; Payment Frequency: Single Premium ** If Premium paid through Cheque, the Policy is void ab-initio in case of dishonour of Cheque
Financial Institution Ref. No. NA
Member Name Exclusion
Vikas Anil Ujgare NA
Exclusions
This document is digitally signed,hence counter signature / stamp is not required Principal Location : Bajaj Allianz House,Airport Road,Yerwada,Pune-411006 PH- 66026666 Services Accounting Code : 997133 Accident and health insurance services. No reverse charge is payable on these services
Consolidated stamp duty Rs.10 paid for insurance policy stamps Challan No. MH015538899202425M DEFACED NO 0008972915202425 Order No. CSD/19/2025/816 Order Dated 20-FEB-25 Defaced Dated 20-FEB-25 having validity from 01-MAR-25 to 28- FEB-27 of General Stamp Office, Mumbai, India.
Bajaj Allianz General Insurance Company Ltd.
For & on the behalf
Authorized Signatory
Rs.10/-
Stamp Duty
SUB 10025404 / NA
UIN : IRDA/NL-HLT/BAGI/P-H/V.I/147/13-14
SANKAT MOCHAN- POLICY SCHEDULE
Policy Verification
http://twitter.com/BajajAllianz
SMS 'WORRY' to
Contact our 24-Hour Call Center at
575758
http://www.linkedin.com/company/bajaj-allianz-general-insurance Give a Missed Call on
www.bajajallianz.com
Bajaj Allianz General Insurance Co.Ltd.
http://www.facebook.com/BajajAllianz
Claim Registration
Bajaj Allianz House,Airport Road,Yerwada,Pune - 411006. Reg.No.:113 CIN:U66010PN2000PLC015329 808*******,
“The amounts present in the document are calculated with INR currency if not mentioned otherwise.”