BUNDLED POLICY - ENDORSEMENT SCHEDULE

Attached to and forming part of Policy No : 212203/31/2020/848

Endorsement No : 212203/31/2020/848-001 Endorsement Date : 29/05/2019
Endorsement Effective From 11:23 On 29/05/2019 To Midnight Of 27/05/2020
Insured's Code : 95323822 Issue Office Code : 212203
Insured's Name : AMANDEEP SINGH (GSTIN: 0) Issue Office Name : CBO 13 N-34 C.PLACE (GSTIN:
07AAACT0627R1Z1)
Address : H.NO 535, STREET NO 4, GURU Address : L-5, FIRST FLOOR,
RAM DASS NAGAR, LAXMI NAGAR, LAJPAT NAGAR - II
DELHI-110092
NEW DELHI-110024
NEW DELHI DELHI 110024
DELHI 110092

Agent/Broker Details
Dev.Off.Code : NZ0000000336 AGENCY MANAGER CBO-13 N.D (ASHOK DUNG)
Agent/Broker : BA0000023614 MR MUKESH SHARMA
Address : G-6/254, FF, BLOCK-G, PKT.-6, ROHINI, SECTOR-16,
DELHI,DELHI,DELHI,110085
Tel/Fax/Email
: 25515533/25515533/bhardwajmukesh1965@gmail.com

Total Premium : 0 Type of Endorsement : Change in Risk & inclusion / exclusion

of Covers
Collection No & Dt : GST INVOICE NO :071810136967 UIN :0
Co Insurance Details :

ENDORSEMENT

HP DELETION

SCHEDULEOF PREMIUM

Cover Description Original Endorsement Revised Endorsement

Sum Insured Sum Insured Sum Insured Premium

Total Amount in figures and words : Rs 0 ( INDIAN RUPEES only )

The Insurance under this policy / endorsement is subject to following terms,conditions,waranties & clauses specified in the
policy / endorsement:

All other terms/conditions/waranties/clauses in the policy remain unaltered

Bank Names are as per the list attached:

Sl No Bank Name/Financier Bank Branch and Adress Status

Place : NEW DELHI For and on behalf of

The Oriental Insurance Company Limited
Date : 29/05/2019

Authorised Signatory

All the Amounts mentioned in this policy are in INDIAN RUPEES Page 1 of 2

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Attached to and forming part of policy number 212203/31/2020/848

1 HDFC BANK LTD N.D Deleted

Waranted that in case of dishounour of premium cheque(s) the company shall not be liable under the endorsement and
the endorsement shall be void ab initio
In witness whereof the undersigned begin authorised by and on behalf of the company has herein to set his hands.

Entered By : MS. CHARANJIT KAUR For and on behalf of

The Oriental Insurance Company Limited
Examined By : Mr. SUBHASH

Authorised Signatory

Place : NEW DELHI For and on behalf of

The Oriental Insurance Company Limited
Date : 29/05/2019

Authorised Signatory

All the Amounts mentioned in this policy are in INDIAN RUPEES Page 2 of 2

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