IFFCO—TOKIO GENERAL INSURANCE CO. LTD.

APKA SBU Name: Hyderabad SBU82

Name of the client Telangana Engineering Departments Contributory
Occupation: deputy executive engineers
Communication address Erramanzil
Date of quote request 02.05.2019
Intermeidary details ( broker/agency/banca/ direct) broker

Type of Policy: new/ market renewal/ ITGI renewal New

Name of Expirng insurer / expiry policydate Fresh

claims made ( past 1+3 yrs expereince ) (if more than 4 years, you can attach in seperate sheet)
Number of claims and
Year premium claims amount CR % details Risk Category & Table Table C Table B Table B1 Table A
2015-2016 Normal risk 1.40 0.85 0.70 0.40
2016-2017 Heavy risk 2 1.25 1 0.6
2017-2018 Very heavy risk 2.5 1.6 1.25 0.75
2018-2019

Period of Insurance:
Geographical loation (within india / outside India /
on duty cover)
Target premium / Remarks if any about this
account Proposed Flate SI
Coverage Opted-Table A,B,B1,C (Accidental Risk Category & Table Total Nos SI per person Table C SI Table B SI Total SI
Death+PTD+TTD + Medical Expenses) please specify Accidental Death+PTD+PPD
Normal risk - - -
Number of lives proposed 348 heavy risk 312 10,00,000 5,00,000 5,00,000 31,20,00,000
TOTAL Capital Sum Insured 31,20,00,000 very heavy risk - - -
Base Premium 6,24,000 Total 312 31,20,00,000
Medical extension Slab to verify 25%
Premium payable 6,24,000
Discount allowed 85% 5,30,400

Payable premium without add on 93,600

Additional covers SI per person

Terrorism : Required /Not covered Required 0.1 - 31,200

Net Premium 93,600 1,24,800.0
GST @ 18% 16,848 22,464.0
Final premium payable 1,10,448 1,47,264.0
IFFCO-TOKIO General Insurance Co.Ltd

Authorized Signatory

This will be a Named cover only

Mid-term enhancement of SI due to any reason will not be allowed unless specifically approved by the insurance company
Day one cover for new joinee subject to receipt of premium / CD balance and intimation by 15th of every month
Descriptive list of employees with age, nominie details and SI mentioned against each should be submitted for policy preparation
It is warranted that all the proposed employees falls under heavy Risk categories only and not under Heavy Risk or Very Heavy Risk Category (Occupations like
Temporary Total Disablement-with weekly benefits @ 1% of TableC SI per individual or 5000 whichever is less per week upto maximum of 104 weeks.
All conditions, exclusions, except as mentioned /waived above as per ITGI's standard Group Personal Accident Policy.
Quote valid for 15 days only.
Geographical cover - World wide

Additional Benefits opted:

Ambulance charges for transportation of Insured person to Hospital following accident, which results in liability having been admitted by the Company as per
In the event of death of Insured Person outside his/her place of residence, transportation cost for carriage of dead body to the place of his/her residence,
Cost of Clothing damaged : Rs 1000/- per person for any one accident or actuals which is less.
Education Fund: In the event of death, permanent total disablement of Insured Person due to accident, provided the claim under the policy is admissible, we
Loss of Employment: - In the event of Permanent Total Disablement, leading to loss of employment of insured person, we shall compensate Rs. 15000 or 1%
All terms and conditions as per our standard terms and conditions.