The New India Assurance Company Limited

Head Office: 87, M G Road, Fort, Mumbai-400001

PROPOSAL FOR DIRECTORS & OFFICERS LIABILITY INSURANCE

SIGNING THIS PROPOSAL DOES NOT BIND TO COMPLETE THIS INSURANCE.

1. Name of Company 2. Addre of Head Off!"e

#. Co$n%ry of Re&! %ra%!on '. A. Ho( Lon& )a %)e Company "on%!n$a**y "arr!ed on +$ !ne B. B$ !ne A"%!-!%!e of %)e Company and !% $+ !d!ar!e , ,

.. D$r!n& %)e *a % f!-e year )a / A. B. C. D. T)e name of %)e paren% "ompany +een ")an&ed , Any a"0$! !%!on or mer&er %a1en p*a"e , Any $+ !d!ary Company +een o*d or "ea ed %rad!n& , T)e "ap!%a* %r$"%$re of %)e paren% Company ")an&ed ,

If o p*ea e &!-e de%a!* 2. A. Ha %)e "ompany any a"0$! !%!on3 %ender offer or mer&er pend!n& or $nder "on !dera%!on , B. I %)e Company a(are of any propo a* re*a%!n& %o !% a"0$! !%!on +y ano%)er Company, C. I %)e Company !n%end!n& a ne( p$+*!" offer!n& of e"$r!%!e (!%)!n %)e ne4% year !n Ind!a or e* e()ere,

5. I %)e Company A. B. C. D. E. Pr!-a%e , P$+*!" , L! %ed on any Ind!an S%o"1 E4")an&e , L! %ed on 6ore!&n S%o"1 E4")an&e, P*ea e pe"!fy Traded !n any o%)er (ay, P*ea e pe"!fy

7. P*ea e L! % / A. To%a* N$m+er of S)are)o*der B. To%a* N$m+er of S)are ! $ed C. To%a* N$m+er of )are )e*d +y D!re"%or and Off!"er 8+o%) d!re"% and +enef!"!a*9 D. A** )o*d!n& repre en%!n& 1.: or more of %)e Ord!nary S)are Cap!%a* of %)e Company &!-!n& %)e )o*der and %)e per"en%a&e )e*d +y ea").

;. A. P*ea e &!-e a *! % of D!re"%or and Off!"er of %)e Company B. P*ea e &!-e de%a!* of any ")an&e %o %)e *! % of D!re"%or and Off!"er &!-en !n %)e Company< *a % repor% and a""o$n% .

1=. G!-e "omp*e%e *! % of a** S$+ !d!ary Compan!e !n"*$d!n& "o$n%ry of re&! %ra%!on and per"en%a&e o(ned +y paren% Company o%)er %)an )o(n !n %)e *a % repor% and a""o$n% .

11. Doe %)e Company or any D!re"%or or Off!"er )a-e D!re"%or and Off!"er L!a+!*!%y In $ran"e "$rren%*y !n for"e, >ES ? NO If >ES3 S%a%e A. In $rer B. Indemn!%y L!m!% C. E4p!ry Da%e 12. Ha %)e Company e-er )ad any In $rer de"*!ne a propo a* or "an"e* or ref$ e %o rene( a D!re"%or and Off!"er L!a+!*!%y In $ran"e , >ES ? NO If >ES3 P*ea e &!-e de%a!* T)e fo**o(!n& 0$e %!on are %o +e "omp*e%ed +y a** propo er 1#. Ha-e "*a!m e-er +een made a&a!n % any pa % or pre en% D!re"%or or Off!"er of %)e Company or !% S$+ !d!ar!e , >ES ? NO If >ES3 P*ea e &!-e de%a!*

1'. I %)e Propo er a(are3 af%er en0$!ry3 of any "!r"$m %an"e of !n"!den% ()!") may &!-e r! e %o a "*a!m , >ES ? NO If >ES3 P*ea e &!-e de%a!* 1.. @$r! d!"%!on for Co-era&e re0$!red for A Ind!a ? Bor*d (!de 8!n"*$d!n& ? e4"*$d!n& Nor%) Amer!"a 9? O%)er CCCCCCCCCCCCCC 12. Any o%)er ma%er!a* Informa%!on ? Re0$!remen%

15. Amo$n% of Indemn!%y re0$!red

/ 6or One A""!den% 8AOA9 R . / 6or One >ear 8AO>9 R . DECLARATION / I de"*are %)a% %)e %a%emen% and par%!"$*ar !n %)! propo a* are %r$e and %)a% no ma%er!a* fa"% )a-e +een m! %a%ed or $ppre ed af%er en0$!ry. I a&ree %)a% %)! propo a*3 %o&e%)er (!%) any o%)er !nforma%!on $pp*!ed )a** form %)e +a ! of any Con%ra"% of In $ran"e effe"%ed %)ereon. I $nder%a1e %o !nform In $rer of any ma%er!a* a*%era%!on %o %)o e fa"% o""$rr!n& +efore "omp*e%!on of %)e Con%ra"% of In $ran"e. Da%eD S!&ned EEEEEEEEEEEEEEEEEEEE To +e !&ned +y C)a!rman ? C)!ef E4e"$%!-e P*ea e en"*o e (!%) %)! Propo a* 6orm / a9 T)e La % %(o Ann$a* Repor% and A""o$n% for %)e Company +9 T)e *a % %(o In%er!m S%a%emen% 8If app*!"a+*e9 "9 Any offer Do"$men%?L! %!n& Par%!"$*ar p$+*! )ed !n %)e *a % 12 mon%) .
No%e 1.T)e *!a+!*!%y of %)e "ompany doe no% "ommen"e $n%!* %)e propo a* )a +een a""ep%ed +y %)e Company and f$** prem!$m pa!d. 2. If pa"e ! fo$nd !n $ff!"!en%3 p*ea e a%%a") epara%e )ee% for de%a!* . #. Prem!$m (!** +e 0$o%ed $pon app*!"a%!on. '. In $ran"e ! %)e $+Fe"% ma%%er of o*!"!%a%!on. PROHIBITION OF REBATE -- Section 41 of the Ins !"nce Act 1#$% No per on )a** a**o( or offer %o a**o(3 e!%)er d!re"%*y or !nd!re"%*y3 a an !nd$"emen% %o any per on %o %a1e o$% or rene( or "on%!n$e an !n $ran"e !n re pe"% of any 1!nd of r! 1 re*a%!n& %o *!-e or proper%y !n Ind!a3 any re+a%e of %)e ()o*e par% of %)e "omm! !on paya+*e or any re+a%e of %)e prem!$m )o(n on %)e po*!"y nor )a** any per on %a1!n& o$% or rene(!n& or "on%!n$!n& a po*!"y a""ep% any re+a%e3 e4"ep% $") re+a%e a may +e a**o(ed !n a""ordan"e (!%) %)e p$+*! )ed pro pe"%$ e or %a+*e of %)e In $rer. Any per on ma1!n& defa$*% !n "omp*y!n& (!%) %)e pro-! !on of %)! e"%!on )a** +e p$n! )a+*e (!%) f!ne ()!") may e4%end %o 6!-e H$ndred R$pee .

FOR OFFICE USE -

MARKETING / DEVELOPMENT OFFICER'S REPORT

The Proposer is known to me/my agent / Broker for___years and I recommend acceptance of this proposal. Name and Code No. Signature of Dev. Officer / A/AO-D