Tata AIG General Insurance Company Limited

Employees Compensation Insurance

(This document is not a contract of insurance and nor is it a confirmation of insurance)

QUOTATION SLIP

1. Quote No: Q200003321425

2. Quote Date: 30-Mar-2023

3. Insured Name: JAGANNATH

4. Insured Communication Address: VIJAN BUSINESS CENTRE JABALPUR

5. Risk Location Address: Coverage provided is for "All over India".The specific risk locations
(if any) will be as per the mentioned below.

Risk Location 1: VIJAN BUSINESS CENTRE JABALPUR

6. Period of Insurance: From Date to be Advised

Expiry Date: 31 MAR TO 30 APR 2023

7. Nature of Work: LABOUR ENGAGED FOR CONSTRUCTION OF BUILDING OR AS

ADVISED AT SITE BY THE CONTRACTOR

8. Cover: As per TATA AIG's Employees Compensation Insurance Policy

wordings and Medical Coverage upto Rs.25000/-

9. Loss History for last 3 years: no

10. Estimated Wages (INR): 75000

11. No. of Employees: 5

12. Premium Payable: Final Premium (incl. Tax and Stamp Duty) : Rs. 1530/-

Tata AIG General Insurance Company Ltd.

(Regd Offi ce: Peninsula Business Park, Tower A, 15th Floor, G. K. Marg, Lower Parel, Mumbai-400013)
For information and clarification call the Tata AIG Toll-free Helpline at 1-800-2667780 or E-mail us at customersupport@tataaig.com UAT PDF
13. Conditions: * Subject additionally to the following conditions, limitations,
warranties.
* Warranted that workers involved in underground work such as
mines, tunneling, etc. and/or blasting are not covered.
* Jurisdiction - India
* Excluding cover for Contractor and sub contractor workers
* Including Medical expenses upto INR 25,000 per person
* Loss History for last 3 years: - no
* Warranted that workers are using adequate safety measures
while working at the unit
* Warranted there is no work carried on/at live wire.
* Warranted that workers are not working above 9 metres
* Warranted that workers involved in tunnelling and/or any sort of
Wet Risk works and/or any sort of blasting and/or work in depth are
specifically excluded.

14. Important Notice: This Quotation is subject to the following provisions:

* Valid for 30 days from the quote date, viz.
* No material change to the information provided including but not
limited to the Loss history declared herein, prior to attachment of
cover.
* Please note that any requests for any other coverage extensions
mentioned in the RFQ, Submission or in any other document, if not
specifically affi rmed in this QUOTE is not being extended.

UIN IRDAN108CP0011V01202122

CIN U85110MH2000PLC 128425

IRDA Registration No 108

Tata AIG General Insurance Company Ltd.

(Regd Offi ce: Peninsula Business Park, Tower A, 15th Floor, G. K. Marg, Lower Parel, Mumbai-400013)
For information and clarification call the Tata AIG Toll-free Helpline at 1-800-2667780 or E-mail us at customersupport@tataaig.com UAT PDF