WC-QUOTATION

Ref. No.: W215587451129

Date: 30-Mar, 2023

JAGANNATH, VIJAN BUSINESS CENTRE

JABALPUR 482001 MADHYA PRADESH
JABALPUR MADHYA PRADESH - 482001
Contact No.: 9999999999
Cust ID: 10088249350485435
Subject: Workmen Compensation policy Quotation

Dear Customer,

We value your relationship with ICICI Lombard General Insurance Company Limited and thank you for choosing us as your
preferred service provider.

Quotation for 05 labors for a period of 31-Mar-2023 to 30-Apr-2023 with medical expenses cover upto Rs.25000/-:

Policy Details Premium Details (`)

Sum Insured Nature of Work Gross Premium GST/Sales Tax Total Premium
(`) Payable Including
Tax
Builders - construction incl civil
75000 1242 224 1466
constructions
*Premium value mentioned above is inclusive of taxes applicable.

Important Points:
* Medical Coverage upto Rs.25000/- per labour in the policy period.

cmah5127127001
* If policy is sought to be renewed after renewal date then renewal notice shall be valid till 45 days from policy expiry date subject to no reported claims and
the premium would be calculated and charged as per Company's underwriting guidelines effective as on that day.
* In case of change in the proposal details, we reserve the right to change the terms and conditions of the policy.
* In case a claim is lodged before the commencement of the renewed policy, it will impact the renewal premium & will have to be reimbursed to the Company.
Rest of the terms and conditions are as per your previous policy.

Assuring you of our best services at all times.

Sincerely,
For ICICI Lombard General Insurance Company Ltd.

Authorised Signatory