GROUP MEDICLAIM TAILORMADE - ENDORSEMENT SCHEDULE

Attached to and forming part of Policy No : 254003/48/2020/2410

Endorsement No : 254003/48/2020/2410-002 Endorsement Date : 23/04/2020
Endorsement Effective From 00:00 On 03/04/2020 To Midnight Of 12/03/2021
Insured's Code : AB0000046326 Issue Office Code : 254003
Insured's Name : SHINRYO SUVIDHA ENGINEERS Issue Office Name : DAB GHAZIABAD (GSTIN:
INDIA PRIVATE LIMITED (GSTIN: 09AAACT0627R4ZU)
09AABCS7831B1ZI)
Address : C-37, SECTOR-57, NOIDA, Address : DAB. C - 43 R.D.C.
GAUTAM BUDH NAGAR RAJ NAGAR
GHAZIABAD
GHAZIABAD UTTAR PRADESH
GAUTAM BUDH NAGAR 201306 201001
Agent/Broker Details
Dev.Off.Code :
Agent/Broker : LC0000000179 (1149)UNISON INSURANCE BROKING SERVICES P
Address : 206-213 Glacier,Next To Pizza Inn,Jetalpur Road,Vadodara-
Gujrat,BARODA,GUJARAT,390007
Tel/Fax/Email
: 0265-2357445/0265-2357445/0265-2356033/
Total Premium : 254,854 Type of Endorsement : Addition / Deletionof Person(s)
Collection No & Dt : CD A/C AB0000046326 GST INVOICE NO :091920934 UIN :0
Co Insurance Details :

ENDORSEMENT

Notwithstanding anything contained herein to the contrary in the within mentioned policy it is hereby declared and agreed that
the policy is extended to cover the following additional Persons with effect from 03/04/2020 in consequence whereof an
additional premium as below is hereby charged to the Insured.Subject otherwise to the terms ,conditions
,exceptions,exclusionsand limitations of the policy.

ADDITION OF 11 NEW EMPL. WITH DEPANDENTS & 3 DEPANDENTS OF EXISTING EMPL.. TOTAL 48 PERSONS.

SCHEDULEOF PREMIUM

Cover Description Original Endorsement Revised Endorsement

Sum Insured Sum Insured Sum Insured Premium

Basic Cover 9,00,00,000 33,00,000 9,33,00,000 2,15,978.00

TOTAL PREMIUM 2,15,978.00
ADD :SGST 19,438.00
ADD :CGST 19,438.00
TOTAL AMOUNT 2,54,854.00

Total Amount in figures and words : Rs 2,54,854 ( INDIAN RUPEES Two lakhs fifty-four thousand eight hundred fifty-

Place : GHAZIABAD For and on behalf of

The Oriental Insurance Company Limited
Date : 23/04/2020

Authorised Signatory

All the Amounts mentioned in this policy are in INDIAN RUPEES Page 1 of 2

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 Attached to and forming part of policy number 254003/48/2020/2410

four only )

The Insurance under this policy / endorsement is subject to following terms,conditions,waranties & clauses specified in the
policy / endorsement:

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 : OMIKA KALRA For and on behalf of

The Oriental Insurance Company Limited
Examined By : SUNITA MITTAL

Authorised Signatory

Place : GHAZIABAD For and on behalf of

The Oriental Insurance Company Limited
Date : 23/04/2020

Authorised Signatory

All the Amounts mentioned in this policy are in INDIAN RUPEES Page 2 of 2

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