THE NEW INDIA ASSURANCE CO. LTD. (Government of India Undertaking)

Member Extract for Policy Number : 15020034190500000009

Sl No Family Member Employee Name of Age Sex Designation Relation Date of Sum Details of Number Serial Number Employee Insurance of Insured pre-existing Number /Member First policy (in `) Diseases 1 1 1 1 YASHRAJ 13 Male NM Employee 23/03/2020 150000 0 KADAM 2 10 1 10 NAISHAA 11 Female NM Employee 23/03/2020 150000 0 BHATOYE 3 11 1 11 KRISHA 13 Female NM Employee 23/03/2020 150000 0 SONI 4 12 1 12 TAARINI 13 Female NM Employee 23/03/2020 150000 0 SURI 5 13 1 13 KUNJAL 12 Female NM Employee 23/03/2020 150000 0 MANDLIK 6 14 1 14 PRAJWAL 13 Male NM Employee 23/03/2020 150000 0 SONAWA NE 7 15 1 15 PRATHAM 15 Male NM Employee 23/03/2020 150000 0 WANI 8 16 1 16 TEJAS 14 Male NM Employee 23/03/2020 150000 0 SHINDE 9 17 1 17 TANISHQ 17 Male NM Employee 23/03/2020 150000 0 SAXENA 10 18 1 18 YASH 16 Male NM Employee 23/03/2020 150000 0 SURYAVA NSHI 11 19 1 19 VARUN 17 Male NM Employee 23/03/2020 150000 0 KAPUR 12 2 1 2 AARYAVE 13 Male NM Employee 23/03/2020 150000 0 ER DESHMU KH 13 20 1 20 ARYA 16 Male NM Employee 23/03/2020 150000 0 THAKORE 14 21 1 21 DHRUV 16 Male NM Employee 23/03/2020 150000 0 THAKORE 15 22 1 22 RAVINDR 47 Male NM Employee 23/03/2020 150000 0 A DESHMU KH 16 23 1 23 AKSHAY 31 Male NM Employee 23/03/2020 150000 0 DEWALKA R 17 24 1 24 MAKRAN 53 Male NM Employee 23/03/2020 150000 0 D DEO 18 25 1 25 MADHUMI 13 Female NM Employee 23/03/2020 150000 0 TA NARAYAN 19 26 1 26 HETAL 13 Female NM Employee 23/03/2020 150000 0 VISHWAK ARMA 20 27 1 27 TARA 15 Female NM Employee 23/03/2020 150000 0 SHAH 21 28 1 28 MANYA 14 Female NM Employee 23/03/2020 150000 0 AVLANI 22 29 1 29 NIKKITA 15 Female NM Employee 23/03/2020 150000 0 JOSEPH 23 3 1 3 OM 13 Male NM Employee 23/03/2020 150000 0 GAVANDI 24 30 1 30 AASAVAR 14 Female NM Employee 23/03/2020 150000 0 I KHANDEK AR 25 31 1 31 RHUCHA 15 Female NM Employee 23/03/2020 150000 0 SAWANT

Policy No. : 15020034190500000009Document generated by null at 06/05/2020 01:00:05 Hours. Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415. For redressal of your grievance, if any,you may approach any one of the following offices- 1. Policy issuing office 2. Regional office 3. Head office.In case, you are not satisfied with our own grievance redressal mechanism; you may also approach Insurance Ombudsman. For details of our office addresses and addresses of office of Insurance Ombudsman, please visit our website http://newindia.co.in. THE NEW INDIA ASSURANCE CO. LTD. (Government of India Undertaking)

26 32 1 32 HRISSHA 16 Female NM Employee 23/03/2020 150000 0 DUBEY 27 33 1 33 RIYA 15 Female NM Employee 23/03/2020 150000 0 HABBU 28 34 1 34 JANHAVI 17 Female NM Employee 23/03/2020 150000 0 KANITKA R 29 35 1 35 YASH 19 Male NM Employee 23/03/2020 150000 0 SHAH 30 36 1 36 RAHOUL 18 Male NM Employee 23/03/2020 150000 0 KANNE 31 37 1 37 ROHAN 17 Male NM Employee 23/03/2020 150000 0 THOOL 32 38 1 38 HARSHAL 19 Male NM Employee 23/03/2020 150000 0 JADHAV 33 39 1 39 SASMIT 18 Male NM Employee 23/03/2020 150000 0 PATIL 34 4 1 4 AJINKYA 13 Male NM Employee 23/03/2020 150000 0 GADEKAR 35 40 1 40 SIMRAN 18 Female NM Employee 23/03/2020 150000 0 SINGHI 36 41 1 41 RITIKA 19 Female NM Employee 23/03/2020 150000 0 THAKER 37 42 1 42 RIYA 18 Female NM Employee 23/03/2020 150000 0 KUNJIR 38 43 1 43 SMIT 19 Female NM Employee 23/03/2020 150000 0 TOSHNIW AL 39 44 1 44 SAIE 18 Female NM Employee 23/03/2020 150000 0 NANDUR KAR 40 45 1 45 SIDDHI 17 Female NM Employee 23/03/2020 150000 0 JADHAV 41 46 1 46 KIRAN 50 Male NM Employee 23/03/2020 150000 0 MAKODE 42 47 1 47 MILIND 57 Male NM Employee 23/03/2020 150000 0 DESHMU KH 43 48 1 48 KAUSHAL 24 Male NM Employee 23/03/2020 150000 0 DHARMA MER 44 49 1 49 VIGNESH 23 Male NM Employee 23/03/2020 150000 0 DEVLEKA R 45 5 1 5 DR 43 Male NM Employee 23/03/2020 150000 0 MAHESH WAKRAD KAR 46 50 1 50 DEEP 21 Male NM Employee 23/03/2020 150000 0 RAMBHIY A 47 51 1 51 AKSHAN 20 Male NM Employee 23/03/2020 150000 0 SHETTY 48 52 1 52 ARYA 20 Male NM Employee 23/03/2020 150000 0 BHIVPAT HAKI 49 53 1 53 VAIDEHI 21 Female NM Employee 23/03/2020 150000 0 CHOUDH ARI 50 54 1 54 PURVA 19 Female NM Employee 23/03/2020 150000 0 BARVE 51 55 1 55 RASHI 19 Female NM Employee 23/03/2020 150000 0 LAMBE 52 56 1 56 TANISHK 18 Female NM Employee 23/03/2020 150000 0 A DESHPAN DE

53 57 1 57 ASHISH 63 Male NM Employee 23/03/2020 150000 0 BAJPAI 54 58 1 58 NIKHIL 40 Male NM Employee 23/03/2020 150000 0 KANETKA R 55 59 1 59 NEHA 32 Female NM Employee 23/03/2020 150000 0 PANDIT 56 6 1 6 GURUNAT 65 Male NM Employee 23/03/2020 150000 0 H KHUBBA 57 60 1 60 MRUNMA 22 Female NM Employee 23/03/2020 150000 0 YI SAOJI 58 61 1 61 MANASI 28 Female NM Employee 23/03/2020 150000 0 GADGIL 59 62 1 62 SHRUTI 26 Female NM Employee 23/03/2020 150000 0 MUNDAD A 60 63 1 63 MANGIRI 42 Male NM Employee 23/03/2020 150000 0 SH PALEKAR 61 64 1 64 ABHISHE 25 Male NM Employee 23/03/2020 150000 0 K KULKARN I 62 65 1 65 PRATIK 20 Male NM Employee 23/03/2020 150000 0 RANADE 63 66 1 66 POOJA 19 Female NM Employee 23/03/2020 150000 0 DEVLEKA R 64 7 1 7 SHRAVAN 12 Female NM Employee 23/03/2020 150000 0 I WALEKAR 65 8 1 8 NIRMITEE 13 Female NM Employee 23/03/2020 150000 0 GAJBHIYE 66 9 1 9 RAKSHA 12 Female NM Employee 23/03/2020 150000 0 KANDASA MY

IRDA Registration Number: 190