UNDERTAKING
  To,
  M/s.Bajaj Allian General Insurance Company Ltd.

  Name of InsuredayPakas Skg  Vehicle Regd No.DL1SAD 9o/3
  Date of Accident18-09-2020          Time of Accident:1:00 PM
   above named Insured do hereby state, declare and undertake as follows and firmly
  bound my self unto you (The Bajaj Allianz General Insurance Company Ltd.), and state
  to indemnify you in the whole sum amount in consideration of you having paid the said
  amount to me in the following circumstances:

  was owned by me and insured with your Company vide above policy for the period from
7-6-2020 to66.202ffor a sum insured of Rs.S1000/
  That the said vehicle met with an accident on date and time mentioned above. Based on
  my request the quantum of loss to the vehicle has been evaluated by the designated
  surveyor for Rs.00oas full and final as per the terms and condition of the policy
  and the same is agreeable to me.
  Further I do hereby undertake that: -
      1. I wi ully utilize the claim amount paid in advance by you to get the vehicle
         repaired within 7 days from the date of payment and bring back the vehicle to the
         shape and condition prevailing before the accident.
     2. I will produce the vehicle after repair along with the bills and other documents to
         prove that vehicle have been repaired and restored to the original shape and
         condition prevailing prior to the accident.
     3. I will not make any claim again for the damages already claimed against above
         claim in any form what so ever in the remaining period of the policy.
      4.I will not make any profit out of the claim settled in any form what so ever.
      5.i here by authorize M/S Bajaj Alianz to cancel the policyadjust the premium
         against claim expanses and recover the amount paid against the above mention
         claim in case of violation of the undertaking as mention hereinabove.
      6.I will not raise any legal issue with regards to the settlement agreed upon.
          Signature of the Insyred           Date:29-9-2oPlace:De/L
                          Vinay

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