Name of Group : M/s GAMMA PROCESS

 
 D.O./BO 2. Fresh/Renewal of 3. Quote/Approval : 4. Policy Number & Period

710200 Fresh Quote required FRESH

5. Family size: EMPLOYEES ONLY 6. Employees No.-200 7. Dependents No.- nil 8. Total Lives- 200

9. TPA Name: 10. Sum Insured(per11. Broker/ Agent Name: 12.Brokerage/Commission:

PERSON)
Zeal Brokers 5%
1 LAKH

13. Other Business of Group and 14.Expiring Premium -- 15.Annualized Claims -- 16. ICR on Earned Premium: ---
ICR: NIL
FRESH

17.Premium : 18. with 8%IBNR: 19. with 4%IBNR: 20. with NIL IBNR:

Rs.7.04 lakhs +GST

21. Premium Recommended by D.O. : RS. 7.04 lakhs +GST 22. DISCOUNT RECOMMENDED
BY DO: ____%

Tailormade Terms Expiring Terms Proposed Terms HO Remark

(If renewal)

23. Waiver 4.1,4.2,4.3 -- YES

24. Maternity Benefit: -- --

a)Baby Day one cover

b)Waiver of 9months
waiting period

25. Corporate Buffer -- --

26.Disease wise Capping -- --

26.RoomRent Restriction -- --

27. Co-pay/Excess -- ---

Other: 

D.O. Recommendation : We recommend premium for Rs.7.04 lakhs /- + GST. with waiver of One Month,
I,2,3/4 years waiting period condition. 

D.O. SIGNATURE.