Digitally signed by

Raman Arora
Date: 2019.11.29

0 SID112919022391

QUOTATION cum PROPOSAL FORM FOR EMPLOYEES COMPENSATION

INSURANCE

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Dear Customer,

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At the outset, we would like to thank you for giving us an opportunity to quote. Based on the information furnished to us , please find our
terms as mentioned below.

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Quote No : 1315219Q27110046686V01 Quote Valid Till : 14/12/2019

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Date of Approval : 29/11/2019 Date of Request : 29/11/2019

Proposed Risk Start Date : 29/11/2019 Proposed Risk End Date : 28/12/2019

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Name of the Insured: M/S INDUS FLOORS INDIA PVT. LTD.

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Communication Address 406, 4TH FLOOR, BLOCK-A, UNITECH ARCADIA, SOUTH CITY-2 ,GURUGRAM, GURGAON, GURGAON,
& Place of Supply: HARYANA, 122018,
GSTIN/UIN of the Insured: 06AADCI4881P1ZZ

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Risk Locations : AARUSH LOGISTICS PARK PRIVATE LTD,Vadekkal,,,SRIPERUMBUDUR,TAMIL NADU,631604

Nature of Business : Flooring Service e Type of Proposal : New Business

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Sr. Employee Category Salary Declared no. Declared Classificatio Endorseme

No Per of wages( Rs.) n No. nt No.
month employees /
Occupation Designation worker
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1 Builders -All employees SKILLED WORKERS 10000 50 493151.00 46

engaged in shop or yard or 0
in construction/ demolition of
buildings and other civil
construction like dams,
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bridges etc. incl. excavation

Excl. blasting and tunneling
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Medical Expense Extension -
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Option Per Person Limit (Rs) Annual Aggregate Limit (Rs)

1 25000.00
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Premium (including ME Premium) : - 0 1

Option Net Premium (Rs) GST (Rs) Tax Percentage Total Premium (Rs)
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1 2000.00 360.00 18% 2360.00

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Laws: The Policy covers Liability of the Insured under the following Law(s) shown as covered, subject to claim being otherwise admissible as
per terms, conditions and exclusions of the Policy and subject to Limit of Indemnity as stipulated against each Law:
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LAW LIMIT OF INDEMNITY COVERAGE

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Employee’s Compensation Act, 1923 and Subject otherwise, to the terms, conditions & Exclusions of the
subsequent amendments thereof prior to the date of Yes
Policy, the amount of liability incurred by the Insured
issue of this Policy

Subject otherwise, to the terms, conditions & Exclusions of the

Common Law Policy, the amount of liability incurred by the Insured, but not Yes
exceeding the payment under WC act

Reliance General Insurance Company Limited.

Reliance Centre, South Wing, 4th Floor,
Off. Western Express Highway,
Santacruz (East), Mumbai - 400 055. Page 1 Of 3
 Subject otherwise, to the terms, conditions & Exclusions of the
Fatal Accident 1855 : Policy, the amount of liability incurred by the Insured, but not Yes

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exceeding the payment under WC act .

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Employees Compensation Endorsement 345 (Erstwhile Tariff)- 1
Coverage for Medical Expenses:

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In consideration of the payment of an additional premium it is hereby understood and agreed that this Policy subject to its terms provisions and
conditions is extended to indemnify the Insured in respect of the reasonable medical surgical and hospital expenses (including cost of
conveyance to hospital) incurred by theInsured for treatment of injury to which the indemnity granted under this policy applies had disablement

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exceeded three days.
Provided always that the liability of the Company under this endorsement shall be limited to Rs 25000.00 /- in respect of each Employee per
person per accident

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Reliance General Insurance Company Limited.

Reliance Centre, South Wing, 4th Floor,
Off. Western Express Highway,
Santacruz (East), Mumbai - 400 055. Page 2 Of 3
Terms & Conditions :
This quote and the subsequent policy if any are based on the following data / assumptions / conditions -
Including Cover for Contractors & sub Contractors workers - subject to submission of details at the time of claim.

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Previous Loss History:NIL

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Warranted that attendance and wage register is maintained at the place of employment by the Insured as per statutory requirements/
compliance and to be submitted when required by insurer.

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The change in place or nature of employment as when if any during the policy period to be informed to the insurer mandatorily and the same
shall be covered at the sole discretion of Insurer and if additional premium is required the same shall be charged
The total number of employees/workers mentioned against each job description and occupation should not exceed at any time and if it is

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exceeding the same should be informed to the insurer and premium should be paid accordingly and in case of any violation claim shall not be
admissible
Warranted that no tunneling work/ underground work and/ or blasting is carried out at the work site.

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Losses / damage due to war , Civil war , Nuclear energy and radio active effects are excluded
Occupational Diseases stand excluded.

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The workman under the influence of liquor or drugs is excluded.
The willful disobedience by the workman of orders and rules expressly given to secure the safety of the workmen is excluded.
Workers to follow all safety measures as per industry standards at all times.

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Onus of proof lies with the insured for employment and coverage under the policy for the person on behalf of whom the claim is made, to furnish
the total number of employees/workers working on site at the time of accident.
Endorsement no :NA
Quote is subject to No past insurance claims history.
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Medical Extension : provided
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Exclusion:
Losses suffered in the course of the construction, maintenance and demolition of towers, steeples, bridges, flyovers and other walkways and
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road bridges not longer than 300 meters and road bridges with unsupported span longer than 100 meters.
Losses suffered in the course of shipbuilding, ship repairing and ship breaking other than pleasure crafts, stevedoring and or harbour / long
shore work and Sub-aqueous work
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Service in any kind of armed forces (including, but not limited to military, police, security services).
Workers engaged in underground and/or underwater mines and underground services.
Subaqueous work.
Quarries where explosives are used.
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Employees stationed outside India.

• For other terms and conditions please refer to Reliance Employees Compensation Policy Wordings.
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I,M/s Indus Floors India Pvt. Ltd. , agree to the coverages and other terms and conditions as mentioned in Quote no. 1315219Q27110046686V01
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above.
Please find enclosed Cheque No. ____________________ dated : ______________ for an amount of Rs. ________________ towards payment
of premium. I understand and agree that Reliance General Insurance Co. Ltd has the sole discretion to accept or reject the proposal without
assigning any reason thereof.
I confirm that all the information as mentioned above is complete in all respects and in case of any deviation the policy will stand cancelled ab-
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Proposal Acceptance Form

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Quote No : 1315219Q27110046686V01 Name of the Insured M/S INDUS FLOORS INDIA PVT. LTD.
Date Of Quote : 29/11/2019
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Period of Insurance :
RSD -
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Signature and Seal : RED -

Name and Signature of the Authorised Signatory of Proposer :

Place : Mumbai

Reliance General Insurance Company Limited.

Reliance Centre, South Wing, 4th Floor,
Off. Western Express Highway,
Santacruz (East), Mumbai - 400 055. Page 3 Of 3