PACKAGE POLICY - ENDORSEMENT SCHEDULE

Attached to and forming part of Policy No Endorsement No : 10003/31/12/253277 Endorsement Date : 24/01/2012 : 10003/31/12/253277-001

Endorsement Effective Insured's Code Insured's Name Address

From 15:01 On 24/01/2012 To Midnight Of 09/09/2012 Issue Office Code : 10003 Issue Office Name : Head Office - III Address : E - 8, RIICO INDUSTRIAL AREA SITA PURA JAIPUR RAJASTHAN 302022 Broker Details : LC0000000002 M/S.R S I B P Ltd. Contact No: Transfer of Interest with recovery of NCB.

: 4043843 : Mr.ILLIYASKUTTYA : ADD SALU HOUSE VELICHIKALA POST KANNANALLOOR

KERALA Dev.Officer Total Premium : NA0000000770 : 3,117

Type of Endorsement :

Collection No & Dt : BG Co Insurance Details :

ENDORSEMENT It is hereby declared and agreed that as from 30/01/2012 the interest in the policy is transferred to and vested in ILLIYASKUTTYA of ________ carrying on or engaged in the business or profession of ____ who shall be deemed to be the Insured and whose proposal and declaration dt.30/01/2012 shall be deemed to be incorporated in and to be the basis of this contract. This policy is now subject to IMT 3 of All India Motor Tariff. All other terms , exceptions and conditions remain unaltered. SCHEDULEOF PREMIUM Cover Description Original Sum Insured Endorsement Sum Insured Revised Sum Insured Endorsement Premium -2,775.28 13,00,000 13,00,000 2,775.28 2,775.00 50.00 6.00 286.00 3,117.00 : Rs 3,117 ( INDIAN RUPEES Three thousand one hundred seventeen only )

LESS :NO CLAIM BONUS-GR27 OD TOTAL TOTAL PREMIUM ADD :Transfer Fee ADD :Service Tax for Transfer Fee ADD :SERVICE TAX TOTAL AMOUNT Total Amount in figures and words

Place : Date

: JAIPUR : 30/01/2012

For and on behalf of SHRIRAM GENERAL INSURANCE COMPANY LTD.

All the Amounts mentioned in this policy are in INDIAN RUPEES

Authorised Signatory
Service Tax Reg. No. AAKCS2509KST001 Page 1 of 2

Attached to and forming part of policy number 10003/31/12/253277 The Insurance under this policy / endorsement is subject to following terms,conditions,waranties & clauses specified in the policy / endorsement: Condition(s) / Waranties / Clauses Included : 1 . IMT-3 All other terms/conditions/waranties/clauses in the policy remain unaltered Waranted that in case of dishounour of premium cheque(s) the company shall not be liable under the endorsement and the endorsement shall be void ab initio In witness whereof the undersigned begin authorised by and on behalf of the company has herein to set his hands.

Entered By

SVS0H026 SVS0H026

Examined By :

Place : Date

: JAIPUR : 30/01/2012

For and on behalf of SHRIRAM GENERAL INSURANCE COMPANY LTD.

All the Amounts mentioned in this policy are in INDIAN RUPEES

Authorised Signatory
Service Tax Reg. No. AAKCS2509KST001 Page 2 of 2