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CIN No: U10200WB1906GOI001713, IRDA Regn. No: 58 Authorised Signatory

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CIN No: U10200WB1906GOI001713, IRDA Regn. No: 58 Authorised Signatory POLICY SCHEDULE National Insurance Company Limited 737548 3, Middleton Street, Post Box No. 9229, Kolkata - 700 071 Dept : Misc - Traditional Business Special Contingency Insurance Policy Number : 451105/46/16/9500000045 Agent code: 90001108 Agent name: RAJNISH KUMAR PANDEY Agent Contact No: 9369385972 Insured's Name: INDIAN INSTITUTE OF INFORMATION TECHNOLOGY Issuing Office Code : 451105 Address : LUCKNOW CAMPUS , Address: 5 C, Sardar Patel Marg, Allahabad, Dist. : LUCKNOW, Uttar Pradesh Allahabad, Uttar Pradesh, Pin : Pin Code: 226001 211001 Tel: 0532 2608712 (G) , 2603923 Fax :0532242233 Dev Officer : 26379 PaidUp Cap: Upto Rs. 15 Crores Dt Of Prop & Decl: 16/08/2016 Client Type: Corporate Pol Period:00:00 Hrs On 17/08/2016 To:Midnight of 16/08/2017 Rept Dt & No. :17/09/2016 451105/81/16/0000005734 Net Premium : 41791 RUPEES FORTY ONE THOUSAND SEVEN HUNDRED NINETY ONE ONLY NIC 451105 : 100% Sum Insured Srl.No | Description | ( ) 1 | COVERAGE OF 89 STUDENTS FOR MEDICAL HOSPITALISTION | 66,75,000 2 | COVERAGE OF 89 STUDENTS FOR ACCIDENTAL DEATH & PTD | 4,45,00,000 3 | ACCIDENTAL DEATH OF FEE PAYING PARENT / GAURDIAN @ | 2,67,00,000 4 | CARRIAGE OF DEAD BODY FOR STUDENTS ( WITHIN INDIA | 6,67,500 5 | EDUCATION EXPENSES TO DEPENDENT CHILDREN OF MARRIE | 44,50,000 Total Sum Insured : ( ) 8,29,92,500 Total Sum Insured (In Words): RUPEES EIGHT CRORE TWENTY NINE LAKH NINETY TWO THOUSAND FIVE HUNDRED ONLY Risks Covered : COVERAGE UNDER SCP ( STUDENTS MEDICLAIM CUM ACCIDENTAL RISKS ) WITH DETAILS AS PER ANNESURE I & II Location : IIIT LUCKNOW Special Conditions: TERMS, CONDITIONS, & EXCLUSIONS ARE AS PER ANNEXURE II, SUM INSURED AS PER ANNEXURE I FOR STUDENTS ( PER STUDENT LIMIT ) AND DETAILS OF STUDENTS COVERED ARE AS PER LIST PROVIDED BY INSTITUTE ANNEXURE III. Premium Computation : Net PremPremium : : 41,791 Stamp Duty : 0 Chargeable : No Service Tax (14.00%): 5,851 Swachh Bharat Cess (0.5%): 209 Krishi Kalyan Cess (0.5%): 209 Total : 48,060 Visit us at www.nationalinsuranceindia.com for information on Products, Services and Grievance Redressal. In witness whereof this policy has been signed at ALLAHABAD on this 17th day of September, 2016. For And On Behalf Of National Insurance Company Limited CIN No: U10200WB1906GOI001713, IRDA Regn. No: 58 Authorised Signatory HSP-HSP-17/09/2016 16:30:41-10-1 45110510000003 - 6.9.0.0 Page 1 Of 2 Customer Care Toll Free Number : 18002007710; Grievance Cell Toll Free Number : 18003454033 POLICY SCHEDULE National Insurance Company Limited 737549 3, Middleton Street, Post Box No. 9229, Kolkata - 700 071 Dept : Misc - Traditional Business Special Contingency Insurance Policy Number : 451105/46/16/9500000045 Address & Contact Details of Ombudsmen Centres Office of The Governing Body of Insurance Council (Monitoring Body for Offices of Insurance Ombudsman) 3rd Floor, Jeevan Seva Annexe, Santacruz(West), Mumbai:-400054. Tel no: 26106671/6889. Email id: [email protected] website: www.gbic.co.in ================================================================================================================ If you have a grievance, approach the grievance cell of Insurance Company first. If complaint is not resolved/ not satisfied/not responded for 30 days then you can approach The Office of the Insurance Ombudsman(Bimalokpal) Please visit our website for details to lodge complaint with Ombudsman. Office of the Insurance Ombudsman, Office of the Insurance Ombudsman, 2nd Floor, Ambica House, Ashram Rd, 2nd Floor, Janak Vihar Complex, 6, Malviya Nagar, AHMEDABAD:-380 014 BHOPAL:-462 003. Tel.:- 079-27545441/27546840 Fax : 079-27546142 Tel.:- 0755-2769201/9202 Fax : 0755-2769203 Email: [email protected] Email: [email protected] Office of the Insurance Ombudsman, Office of the Insurance Ombudsman, 62, Forest Park, SCO No.101-103,2nd Floor, Batra Building, Sector 17-D, BHUBANESHWAR:-751 009. CHANDIGARH:-160 017. Tel.:- 0674-2596455/2596003 Fax : 0674-2596429 Tel:- 0172-2706468/2772101 Fax : 0172-2708274 Email: [email protected] Email: [email protected] Office of the Insurance Ombudsman, Office of the Insurance Ombudsman, Fathima Akhtar Court, 4th Floor, 453 (old 312), 2/2 A, Universal Insurance Bldg.,Asaf Ali Road, Anna Salai, Teynampet, NEW DELHI:-110 002. CHENNAI:-600 018. Tel.:- 011-23234057/23232037 Fax : 011-23230858 Tel.:- 044-24333668 /24335284 Fax : 044-24333664 Email: [email protected] Email: [email protected] Office of the Insurance Ombudsman, Office of the Insurance Ombudsman, Jeevan Nivesh, 5th Floor, S.S. Road, 6-2-46, 1st Floor, Moin Court, A.C. Guards, GUWAHATI:-781 001 . Lakdi-Ka-Pool, Tel.:- 0361-2132204/5 Fax : 0361-2732937 HYDERABAD:-500 004. Email: [email protected] Tel : 040-65504123/23312122 Fax: 040-23376599 Email: [email protected] Office of the Insurance Ombudsman, Office of the Insurance Ombudsman, 2nd Floor, CC 27/2603, Pulinat Bldg., M.G. Road, Hindustan Building. Annexe, 4th Floor, C.R.Avenue, ERNAKULAM:-682 015. KOLKATA:-700072 Tel : 0484-2358759/2359338 Fax : 0484-2359336 Tel No: 033-22124339/22124346 Fax: 22124341 Email: [email protected] Email: [email protected] Office of the Insurance Ombudsman, Office of the Insurance Ombudsman, Jeevan Bhawan, Phase-2, 3rd Floor, Jeevan Seva Annexe,S.V. Road, Santacruz(W), 6th Floor, Nawal Kishore Road,Hazaratganj, MUMBAI:-400 054. LUCKNOW:-226 001.Tel : 0522 -2231331/2231330 Fax : 0522- Tel : 022-26106960/26106552 Fax : 022-26106052 2231310 Email: [email protected] Email: [email protected] Office of the Insurance Ombudsman, Office of the Insurance Ombudsman, Ground Floor, Jeevan Nidhi II, Bhawani Singh Road, 3rd Floor, Jeevan Darshan, N.C. Kelkar Road, Narayanpet JAIPUR:-302005. PUNE:-411030. Tel: 0141-2740363 Tel: 020-32341320 Email: [email protected] Email: [email protected] Office of the Insurance Ombudsman, Office of the Insurance Ombudsman, 24th Main Road, Jeevan Soudha Bldg, 4th Floor, Bhagwan Sahai Palace, JP Nagar, 1st Phase, Ground Floor Main Road, Naya Bans, Sector-15, BENGALURU:-560025. NOIDA:-201301. Tel No: 080-26652049/26652048 Tel: 0120-2514250/51/53 Email: [email protected] Email: [email protected] Office of the Insurance Ombudsman, 1st Floor, Kalpana Arcade Building, Bazar Samiti Road, Bahadurpur, PATNA:-800006 Tel No: 0612-2680952 Email id : [email protected]. In witness whereof this policy has been signed at ALLAHABAD on this 17th day of September, 2016. For And On Behalf Of National Insurance Company Limited CIN No: U10200WB1906GOI001713, IRDA Regn. No: 58 Authorised Signatory HSP-HSP-17/09/2016 16:30:41-10-1 45110510000003 - 6.9.0.0 Page 2 Of 2 Customer Care Toll Free Number : 18002007710; Grievance Cell Toll Free Number : 18003454033 POLICY SCHEDULE National Insurance Company Limited 737550 3, Middleton Street, Post Box No. 9229, Kolkata - 700 071 Dept : Misc - Traditional Business Special Contingency Insurance Policy Number : 451105/46/16/9500000046 Agent code: 90001108 Agent name: RAJNISH KUMAR PANDEY Agent Contact No: 9369385972 Insured's Name: INDIAN INSTITUTE OF INFORMATION TECHNOLOGY Issuing Office Code : 451105 Address : DEOGHAT JHALWA , Address: 5 C, Sardar Patel Marg, Allahabad, Dist. : ALLAHABAD, Uttar Pradesh Allahabad, Uttar Pradesh, Pin : Pin Code: 211011 211001 Tel: 0532 2608712 (G) , 2603923 Fax :0532242233 Dev Officer : 26379 PaidUp Cap: Upto Rs. 15 Crores Dt Of Prop & Decl: 16/08/2016 Client Type: Corporate Pol Period:00:00 Hrs On 17/08/2016 To:Midnight of 16/08/2017 Rept Dt & No. :17/09/2016 451105/81/16/0000005734 Net Premium : 472382 RUPEES FOUR LAKH SEVENTY TWO THOUSAND THREE HUNDRED EIGHTY TWO ONLY NIC 451105 : 100% Sum Insured Srl.No | Description | ( ) 1 | COVERAG OF 1006 STUDENTS FOR MEDICAL HOSPITALISATI | 7,44,50,000 2 | COVERAG OF 1006 STUDENTS FOR ACCIDENTAL DEATH & PT | 50,30,00,000 3 | ACCIDENTAL DEATH FOR FEE PAYING PARENT / GAURDIAN | 30,18,00,000 4 | CARRIAGE OF DEAD BODY FOR STUDENTS ( WITHIN INDIA | 74,45,000 5 | EDUCATION EXPENSES TO DEPENDENT CHILDREN OF MARRIE | 5,03,00,000 Total Sum Insured : ( ) 93,69,95,000 Total Sum Insured (In Words): RUPEES NINETY THREE CRORE SIXTY NINE LAKH NINETY FIVE THOUSAND ONLY Risks Covered : COVERAGE UNDER SCP ( STUDENTS MEDICLAIM CUM ACCIDENTAL POLICY ) WITH DETAILS AS PER ANNEXURE I & II Location : IIIT , ALLAHABAD & RGIIT , AMETHI Special Conditions: TERMS , CONDITIONS & EXCLUSIONS ARE AS PER ANNEXURE II AND SUM INSURED AS PER ANNEXURE I FOR STUDENTS ( PER STUDENT LIMIT ) AND DETAILS OF STUDENTS COVERED ARE AS PER LIST PROVIDED BY INSTITUTE ANNEXURE III Premium Computation : Net PremPremium : : 4,72,382 Stamp Duty : 1 Chargeable : Yes Service Tax (14.00%): 66,133 Swachh Bharat Cess (0.5%): 2,362 Krishi Kalyan Cess (0.5%): 2,362 Total : 5,43,240 Visit us at www.nationalinsuranceindia.com for information on Products, Services and Grievance Redressal. In witness whereof this policy has been signed at ALLAHABAD on this 17th day of September, 2016. For And On Behalf Of National Insurance Company Limited CIN No: U10200WB1906GOI001713, IRDA Regn. No: 58 Authorised Signatory HSP-HSP-17/09/2016 16:30:47-10-1 45110510000008 - 6.9.0.0 Page 1 Of 2 Customer Care Toll Free Number : 18002007710; Grievance Cell Toll Free Number : 18003454033 POLICY SCHEDULE National Insurance Company Limited 737551 3, Middleton Street, Post Box No. 9229, Kolkata - 700 071 Dept : Misc - Traditional Business Special Contingency Insurance Policy Number : 451105/46/16/9500000046 Address & Contact Details of Ombudsmen Centres Office of The Governing Body of Insurance Council (Monitoring Body for Offices of Insurance Ombudsman) 3rd Floor, Jeevan Seva Annexe, Santacruz(West), Mumbai:-400054. Tel no: 26106671/6889. Email id: [email protected] website: www.gbic.co.in ================================================================================================================ If you have a grievance, approach the grievance cell of Insurance Company first. If complaint is not resolved/ not satisfied/not responded for 30 days then you can approach The Office of the Insurance Ombudsman(Bimalokpal) Please visit our website for details to lodge complaint with Ombudsman.
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