THE NEW INDIA ASSURANCE CO. LTD.

(Government of India Undertaking)

POLICY SCHEDULE FOR FIDELITY GUARANTEE (Unnamed(Floating)) INSURANCE

UIN NUMBER - IRDAN190P0105100001

Insured's Name METRO TYRES LIMITED AND ITS GROUP COMPANIES INCLUDING ITS SUBSIDIARIES
Insured's Details Issuing Office Details
Customer ID: PO77720097 Office Code CHANDIGARH DO-II (350200)
Insured's Address: B-27, FOCAL POINT, LUDHIANA, Office Address: THE NEW INDIA ASSURANCE
PUNJAB COMPANY LTD. FIRST FLOOR, SCO-
91,92,93 SECTOR - 34A CHANDIGARH -
160022
LUDHIANA ,PUNJAB, 141010
,160022
Phone No Phone No 2601036 / 2604450 / 1722609107
E-mail/Fax raman@kmdastur.com, E-mail/Fax nia.350200@newindia.co.in
PAN No AAACM3394A S.Tax Regn. No AAACN4165CST178
GSTIN/UIN 03AAACM3394A1Z1 / NA GSTIN 04AAACN4165C1ZZ
SAC 997139 (Other non-life insurance services
excl RI)

Policy Details
Policy Number 35020046220900000041 Business Source Code
Period of Insurance From: 01/02/2023 12:00:01 AM To: Dev.Off. level/Broker/Corp. K.M. Dastur Reinsurance Brokers Pvt.
31/01/2024 11:59:59 PM Agent/Web Ltd. - (DM2615660)
Aggregator/CPSC User 850000_Kmdastur Reinsurance Brokers -
(SI00262255),
Date of Proposal 01-Feb-23 Agent/Bancassurance/Spe
cified Person
Prev. Policy no. 35020046210900000049 Phone No 022 66179850, (022)22855855,
9769660727 / NA
Client Type Corporate E-mail/Fax jignesh.patel@kmdastur.com,
sameer.mahyavanshi@kmdastur.com

Premium(`) GST(`) Total(`) Total:(` in words) Receipt No. & Date

135000 24300 159300 RUPEES ONE LAC FIFTY- 35020081220000011273 - 30/01/23
NINE THOUSAND THREE
HUNDRED ONLY

Details of the Insured covered under the policy:

No of Persons Guarantee Limit per person Total Guarantee Amount

Sl. No.
1 650 15000000 30000000

Sl.No Cadre
1 650 Employees as per annexure attached

Excess 50000
Special Conditions All Permanent & Temporary Employees incl. employees on retainer basis/on
deputation/contractual & employees who will be added during the policy period.
Floater Cover
Retired/employees who has left the org.
Discovery Period of 12 Months

Premium and GST Details

Rate of Tax Amount in INR
Premium ` 135000.00
SGST 0 0
CGST 0 0
IGST 18 24300

Signature Not
Verified
Digitally signed
by JAGATJAYEE Policy No. : 35020046220900000041Document generated by 39750 at 30/01/2023 13:14:59 Hours.
PANIGRAHI Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.
Date: 2023.01.30
For redressal
13:15:01 IST of your grievance, if any,you may approach any one of the following offices- 1. Policy issuing office 2. Regional office 3. Head office.In case, you are not satisfied with our own
grievance redressal mechanism; you may also approach Insurance Ombudsman. For details of our office addresses and addresses of office of Insurance Ombudsman, please visit our website
http://newindia.co.in.

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 THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)

The policy shall be subject to FIDELITY GUARANTEE INSURANCE policy clauses attached herewith.
In witness whereof the undersigned being duly authorized by the Insurers and on behalf of the Insurers has (have) hereunder
set his (their) hand(s) on this

For and on behalf of

The New India Assurance Company
Limited

Date of Issue: 30/01/2023

Duly Constituted Attorney(s)

Mudrank_____________Dt.___________consolidated Stamp Fees Paid by Pay Order Number_______________vide receipt

number___________dt.__________.

We hereby declare that though our aggregate turnover in any preceding financial year from
2017-18 onwards is more than the aggregate turnover notified under sub-rule (4) of rule 48,
we are not required to prepare an invoice in terms of the provisions of the said sub-rule.

Tax Invoice No : 35020022E0018644

IRDA Registration Number: 190

NIA PAN NUMBER: AAACN4165C

Policy No. : 35020046220900000041Document generated by 39750 at 30/01/2023 13:14:59 Hours.

Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.
For redressal of your grievance, if any,you may approach any one of the following offices- 1. Policy issuing office 2. Regional office 3. Head office.In case, you are not satisfied with our own
grievance redressal mechanism; you may also approach Insurance Ombudsman. For details of our office addresses and addresses of office of Insurance Ombudsman, please visit our website
http://newindia.co.in.

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