This Document is Digitally Signed

Signer: SUNITA TULI NAGPAL

Date: Mon, May 29, 2023 15:20:10 IST
Location: NOIDA
Reason: Signing Policy for OICL
PA INDIVIDUAL POLICY SCHEDULE
Policy No. : 131201/48/2024/332 Prev. Policy No. : 131201/48/2023/249
Cover Note No. : - Cover Note Date : -
Insured's Code : 34169505 Issue Office Code : 131201
Insured's Name : DIPANKUMAR B MEHTA (GSTIN: 0) Issue Office Name : BO VASAI (GSTIN:
27AAACT0627R4ZW)
Address : F-801 DHEERAJ DARSHAN APPT., Address : 1ST FLR. LAWRENCE TRADE
KONKAN NAGAR, CENTRE
JOGESHWARI (E), MUMBAI NAVGHAR ROAD
VASAI
MUMBAI MAHARASHTRA 400041 MUMBAI MAHARASHTRA 401202

Tel. /Fax /Email : / / 9820691951 / Tel. /Fax /Email : (0912) 2339512/9892290208 / /

dipanmehta@gmail.com rameshwar.hedaoo@orientalinsurance.c
o.in;131201@orientalinsurance.co.in
Agent/Broker Details
Dev.Off.Code : NY0000000450 SUBHASH SAKHARAM NAIK

Agent/Broker : BA0000114348 LOKESH SINGH

Address : B-204, REGAL COMPLEX, SECTOR-6, VASANT NAGARI, VASAI -EAST,
THANE,THANE,MAHARASHTRA,401208
Tel/Fax/Email : 9821044637/0250-6451098//NA

Period of Insurance : FROM 00:00 ON 03/06/2023 TO MIDNIGHT OF 02/06/2024

Collection No. & Dt. : CC 9249000842 - 29/05/2023 GST INVOICE NO :2722131685 UIN :0
Gross Premium : 3,375 GST : 608 Stamp Duty : 225 Total : 3,983
Co-insurance Details : NIL

Details of Insured Persons :

Sr. Name Relationship Age Sex Section Sum Insured Additional Covers
No. with Insured

1 DIPANKUMAR Self 46 M Table of benefits II 1500000

B MEHTA Table of benefits III 500000
Table of benefits I 2500000
Medical Expenses
4500000 LoadingNIL
Cumulative Bonus 2251500

Additional Details of Insured Persons :

Sr. Name Occupation Pre-existing Risk Group Assignee Name Share Assignee
No. Disabilities % Relationship

1 DIPANKUMAR B SERVICE NORMAL RISK DHARNA DIPAN 100 Spouse

MEHTA MEHTA

Total Sum Insured in words : Indian Rupees Forty-Five Lakhs Three Thousand Only
Total Premium in words : Indian Rupees Three Thousand Nine Hundred Eighty-Three Only

Place : MUMBAI For and on behalf of

Date : 29/05/2023 The Oriental Insurance Company Limited

This is an electronically generated document (Policy Schedule).The

Policy document duly stamped will be sent by post.

In case of any query regarding the Policy please call Toll

Free No. 1800 11 8485 and 011 33208485. Authorised Signatory

CIN: U66010DL1947GOI007158 All the Amounts mentioned in this policy are in Indian Rupees Page 1 of 2

IRDA Regn. No. 556 - Now you can buy and renew selected policies online at www.orientalinsurance.org.in
 This Document is Digitally Signed

Signer: SUNITA TULI NAGPAL

Date: Mon, May 29, 2023 15:20:10 IST
Location: NOIDA
Reason: Signing Policy for OICL
Attached to and forming part of policy number 131201/48/2024/332

Term of Insurance: As per the Clauses written hereunder and/or attached herewith .
User Defined

Excess :

Warranted that in case of dishonour of premium cheque(s) the Company shall not be liable under the policy and the policy
shall be void abinitio (from inception).

In witness whereof the undersigned being authorised by and on behalf of the Company has/have herein to set his/their hands
at BO VASAI (GSTIN: 27AAACT0627R4ZW) on 29TH DAY OF MAY 2023.

For and on behalf of

Entered By : 170500 The Oriental Insurance Company Limited

Policy Printed By : OICL IP :

Authorised Signatory
Policy Printed On : 29-MAY-23 15:21:26 MAC :

Place : MUMBAI For and on behalf of

Date : 29/05/2023 The Oriental Insurance Company Limited

This is an electronically generated document (Policy Schedule).The

Policy document duly stamped will be sent by post.

In case of any query regarding the Policy please call Toll

Free No. 1800 11 8485 and 011 33208485. Authorised Signatory

CIN: U66010DL1947GOI007158 All the Amounts mentioned in this policy are in Indian Rupees Page 2 of 2

IRDA Regn. No. 556 - Now you can buy and renew selected policies online at www.orientalinsurance.org.in