PREMIUM COMPUTATION SHEET

Department : MISCELLANEOUS Insured's Name : Oxi9 Essentials Pvt. Ltd.

Document No : R/141400/48/2021/5762 Document Date : 03/08/2021

Policy Start Date : 01/10/2021 Policy End Date : 30/09/2022

Product Description : BURGLARY Document Type : Proposal

Policy Type : BURGLARY - STANDARD / FIRST
LOSS

SCHEDULE OF PREMIUM
Cover Description Sum Insured Premium

ADD :Basic Cover - Burglary Standard 50,50,000.00 525.00

TOTAL PREMIUM 525.00
ADD :CGST 47.00
ADD :SGST 47.00
STAMP DUTY 0.50
TOTAL AMOUNT 619.00

RISK DETAILS

Section : BURGLARY - STANDARD

Location Details : 5th Floor, 511. 512, 512/A, Shubh Universal, Opp. Vijya Lakshmi Hall, Vesu Main Road, Surat, 395007

Cover Name Sum Insured Rate Premium

Basic Cover - Burglary Standard 50,50,000.00 .0104/100 525.00

Total 525.00