GPA - NAMED POLICY SCHEDULE IRDA/NL-HLT/OIC/P-P/V.1/457/13-14 Policy No. : 433702/48/2021/1319 Prev.Policy No. : - Cover Note No. : 20200002 Cover Note Date : 26/09/2020 Insured's Code : AB0000048692 Issue Office code : 433702 Insured's Name : INDIAN INSTITUTE OF INSURANCE Issue Office Name : DAB HYDERABAD (GSTIN: SURVEYORS & LOSS ASSESSORS 36AAACT0627R3ZY) (GSTIN: 36AABCI5700M1ZK) Address : 6-1-73, SAEED PLAZA, Address : # 16-11-16/V/18, 1ST FLOOR, M G LAKDIKAPOOL, HYDERABAD- PLAZA, 500004. NEAR RTA EAST ZONE, MOOSARAM BAGH, MALAKPET, HYDERABAD 500004 HYDERABAD TELANGANA 500036 Tel. /Fax /Email : 04023261073 / / 0 / NA Tel. /Fax /Email : 040 24553095 / 24550862 / 040 24553458 / [email protected] / [email protected] Agent/Broker Details Dev.Off.Code : Agent/Broker : LB0000000078 PROVIDENCE INDIA INSURANCE BROKING PVT LTD Address : 301,SRI SAI SUDHA SADAN BB PLOT NO 215,MADHAPUR,IRDA/CB615/15 Registration no 542,HYDERABAD,TELANGANA,500082 Tel/Fax/Email : 8008819090/8106602266// Period of Insurance : FROM 00:00 ON 27/09/2020 TO MIDNIGHT OF 26/09/2021 Collection No & Dt : CD A/C AB0000048692 GST INVOICE NO :3619198955 UIN :0 Gross Premium : 3,54,050 GST : 63730 Stamp Duty : 0 Total : 4,17,780 Co-insurance Details : NIL Number of persons covered : 13194 Total Sum Insured : 2751000000 AOA Limit : 3000000 Details of Insured Persons : Sr. Emp No./ Name Age Sex Section/Cover Sum Insured Additional Covers No. ID No. 1 1004246 Pritpal Singh 50 M Table of benefits II NIL Table of benefits III Place : HYDERABAD For and on behalf of Date : 05/11/2020 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 1186 IRDA Regn. No. 556 - Now you can buy and renew selected policies online at www.orientalinsurance.org.in Attached to and forming part of policy number 433702/48/2021/1319 2 1004248 Mukesh Kumar 68 M Table of benefits II NIL Rastogi Table of benefits III 3 1004250 Manoj Kumar Das 56 M Table of benefits II NIL Table of benefits III 4 1004251 B.I.Anshad 55 M Table of benefits II NIL Table of benefits III 5 1004252 Aseem Srivastava 53 M Table of benefits II NIL Table of benefits III 6 1004253 Arun Agarwal 56 M Table of benefits II NIL Table of benefits III 7 1004256 Ejaz Ahmed 44 M Table of benefits II NIL Table of benefits III 8 1004257 Kuladeep Seelam 55 M Table of benefits II NIL Table of benefits III 9 1004259 Gyan Swaroop 60 M Table of benefits II NIL Mauraya Table of benefits III 10 1005933 Kishan Chand 52 M Table of benefits II NIL Table of benefits III 11 1005934 Raj Kumar Arora 54 M Table of benefits II NIL Table of benefits III 12 1005936 Pushkar Kumar Sinha 46 M Table of benefits II NIL Table of benefits III 13 1005937 Ram Prakash Pandey 51 M Table of benefits II NIL Table of benefits III 14 1005938 Rudra Pratap Singh 63 M Table of benefits II NIL Table of benefits III 15 1005939 Sunny Goel 35 M Table of benefits II NIL Table of benefits III 16 1005940 Jeewan Deep Batta 63 M Table of benefits II NIL Table of benefits III 17 1005947 Ranjeev Dougall 54 M Table of benefits II NIL Place : HYDERABAD For and on behalf of Date : 05/11/2020 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 1186 IRDA Regn. No. 556 - Now you can buy and renew selected policies online at www.orientalinsurance.org.in Attached to and forming part of policy number 433702/48/2021/1319 17 Table of benefits III 18 1005948 Sandeep Sharma 48 M Table of benefits II NIL Table of benefits III 19 1005950 Rajnish Bhardwaj 54 M Table of benefits II NIL Table of benefits III 20 1005951 Rakesh Pal Singh 65 M Table of benefits II NIL Table of benefits III 21 1005952 Hemender Kumar 47 M Table of benefits II NIL Garg Table of benefits III 22 1005955 Sunil Kumar 40 M Table of benefits II NIL Table of benefits III 23 1005956 Madan Mohan Lal 84 M Table of benefits II NIL Dhami Table of benefits III 24 1005957 Sanjeev Sethi 53 M Table of benefits II NIL Table of benefits III 25 1005958 Nitin Batra 43 M Table of benefits II NIL Table of benefits III 26 1005959 Vikalp Jain 32 M Table of benefits II NIL Table of benefits III 27 1005960 Jitendra kumar joshi 39 M Table of benefits II NIL Table of benefits III 28 1007744 Shailender Sen 48 M Table of benefits II NIL Table of benefits III 29 1007745 Dr K K Agrawal 41 M Table of benefits II NIL Table of benefits III 30 1007748 Satya Narayan 33 M Table of benefits II NIL Maurya Table of benefits III 31 1007750 Prageet Kumar Verma 42 M Table of benefits II NIL Table of benefits III 32 1007752 Mahesh Patil 44 M Table of benefits II NIL Table of benefits III Place : HYDERABAD For and on behalf of Date : 05/11/2020 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 3 of 1186 IRDA Regn. No. 556 - Now you can buy and renew selected policies online at www.orientalinsurance.org.in Attached to and forming part of policy number 433702/48/2021/1319 32 33 1007755 N. Satish 40 M Table of benefits II NIL Table of benefits III 34 1007756 Ashok Chawla 49 M Table of benefits II NIL Table of benefits III 35 1007757 Rajneesh Sharma 46 M Table of benefits II NIL Table of benefits III 36 1007761 Balaji Wattamwar 40 M Table of benefits II NIL Table of benefits III 37 1007762 M. Veerappan 46 M Table of benefits II NIL Table of benefits III 38 1007763 Suresh Babu Boyapati 75 M Table of benefits II NIL Table of benefits III 39 1007766 Deepankar Gupta 34 M Table of benefits II NIL Table of benefits III 40 1007767 Debangshu Chatterjee 76 M Table of benefits II NIL Table of benefits III 41 1007768 Pranav Arvind 39 M Table of benefits II NIL Lakhdive Table of benefits III 42 1007769 Manohar Singh 36 M Table of benefits II NIL Adhikari Table of benefits III 43 1007770 Sudhir Kumar Shahi 63 M Table of benefits II NIL Table of benefits III 44 1007772 Tapan Mukherjee 78 M Table of benefits II NIL Table of benefits III 45 1007776 Manivannan.P 32 M Table of benefits III NIL Table of benefits II 46 1007777 Sanjay Dattatray 54 M Table of benefits II NIL Karnik Table of benefits III 47 1007778 Chandra Mohan Ahuja 67 M Table of benefits II NIL Table of benefits III Place : HYDERABAD For and on behalf of Date : 05/11/2020 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 4 of 1186 IRDA Regn. No. 556 - Now you can buy and renew selected policies online at www.orientalinsurance.org.in Attached to and forming part of policy number 433702/48/2021/1319 48 1007780 Xavier Mariantony 67 M Table of benefits II NIL Table of benefits III 49 1007783 Radha Shyam Bhadra 65 M Table of benefits II NIL Table of benefits III 50 1007784 Harschal Bamb 53 M Table of benefits II NIL Table of benefits III 51 1007785 Bharat Poptani 33 M Table of benefits II NIL Table of benefits III 52 1007788 Sudhir Chintaman 72 M Table of benefits II NIL Bhide Table of benefits III 53 1007789 S.Niranjana Shastry 56 M Table of benefits III NIL Table of benefits II 54 1006064 Brij Bihari Lal 49 M Table of benefits II NIL Table of benefits III 55 1006070 Anuj Agarwal 52 M Table of benefits II NIL Table of benefits III 56 1006071 Jaipal Tanwar 53 M Table of benefits II NIL Table of benefits III 57 1006072 Sanjeev Sharma 47 M Table of benefits II NIL Table of benefits III 58 1007890 Saurabh Murarka 35 M Table of benefits II NIL Table of benefits III 59 1007891 Amit Katiyar 39 M Table of benefits II NIL Table of benefits III 60 1007892 Pranab Kumar Seth 67 M Table of benefits II NIL Table of benefits III 61 1007895 Akshay Devjibhai 33 M Table of benefits II NIL Bhadra Table of benefits III 62 1007897 Vadamalai.M 47 M Table of benefits II NIL Table of benefits III 63 1007904 Mohammad Ilyass 58 M Table of benefits II NIL Suharwardi Place : HYDERABAD For and on behalf of Date : 05/11/2020 The Oriental Insurance Company Limited This is an electronically generated document (Policy Schedule).The Policy document duly stamped will be sent by post.