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    GPA Endo 2

    Uploaded by

    DebDutta Dutta

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    GPA Endo 2

    Uploaded by

    DebDutta Dutta
    8 views2 pages

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    © © All Rights Reserved

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    8 views2 pages

    GPA Endo 2

    Uploaded by

    DebDutta Dutta

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    5/21/24, 4:36 PM gccore.uiic.in/Configurator/UnderwrittingMasters/reports/frmNonNilEndorsementSchedule.aspx?

    Reference_Num=2024052188299…

    UNITED INDIA INSURANCE COMPANY LIMITED


    ENDORSEMENT SCHEDULE
    GROUP PERSONAL ACCIDENT POLICY

    Policy Number 0305004224P100631994 Department Personal Accident

    Previous Policy
    Number

    Type of Policy Group Personal Accident Policy Business Channel code AGN0004142

    Policy Start Date 09/04/2024 Policy End Date 08/04/2025

    Endorsement No 2 Endorsement Effective Date 09/04/2024

    M/s BUREAU VERITAS


    Insured's Name INDUSTRIAL SERVICES Issuing Office 030500
    (INDIA)PVT.LTD.

    Address ECO CENTRE,16TH FLOOR, UNIT- Office Address 25, THAPAR HOUSE
    1601 &1602 EM-04, SALT LAKE, B T MAHARAJ ROAD, BURRABAZAR
    SECTOR-V, KOLKATA-700091(WB) KOLKATA, KOLKATA, WEST BENGAL
    KOLKATA
    NORTH TWENTY FOUR PARGANAS 700001
    700091 WEST BENGAL
    WEST BENGAL

    SAC Code: 997133


    Customer GST/UIN No.: 19AAACB1999E2ZJ
    Office GST No.: 19AAACU5552C1ZG
    Debit Note No. & Date: 24102763013D01 & 21/05/2024
    Original Invoice No. & Date: 4224I100631994 & 10/04/2024
    Amount Subject to Reverse Charges-NIL

    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.
    Insured Request No. & Date 202405218829941 & 09/04/2024

    Endorsement Type Addition of Insured person

    Endorsement Premium : 1,300.00


    Endorsement CGST(9%) : 117.00
    Endorsement SGST(9%) : 117.00
    Endorsement Stamp Duty : 0.00
    Total Endorsement Premium : 1,534.00

    gccore.uiic.in/Configurator/UnderwrittingMasters/reports/frmNonNilEndorsementSchedule.aspx?Reference_Num=202405218829941&Reference_Dat… 1/2
    5/21/24, 4:36 PM gccore.uiic.in/Configurator/UnderwrittingMasters/reports/frmNonNilEndorsementSchedule.aspx?Reference_Num=2024052188299…

    REASON FOR ADDITION OF MEMBERS AS PER LIST PROVIDED BY INSURED.


    ENDORSEMENT:

    ENDORSEMENT Notwithstanding anything contained herein to the contrary it is hereby declared and agreed that at the request of the
    WORDING: insured the following member/s has/have been included under the within mentioned policy with effect from
    09/04/2024.

    Srl. Employee Name Of Assignee Assignee Risk Sum Date of


    Age Gender Occupation
    No. ID Insured Name RelationShip Category Insured Joining
    BUREAU
    Indrani VERITAS RiskCategory
    29 29 26 Male Service Employer 1,000,000.00 09/04/2024
    Chatterjee INDUSTRIAL I
    SER
    BUREAU
    Prithwish VERITAS RiskCategory
    30 30 31 Male Service Employer 1,000,000.00 09/04/2024
    Mukherjee INDUSTRIAL I
    SER

    SI(Tbl-I) SI(Tbl-II) SI(Tbl-III) SI(Tbl-IV) SI(Tbl-Va) SI(Tbl-Vb) SI(Tbl-Vc)


    0.00 1,000,000.00 0.00 0.00 0.00 0.00 0.00
    0.00 1,000,000.00 0.00 0.00 0.00 0.00 0.00

    In consequence whereof an amount of 1534 is hereby charged to the insured.


    The Total Sum Insured under the policy now stands increased to 30000000 and the Total No. of members covered
    now are 30.

    Subject otherwise to the terms, exceptions, conditions and limitations of this policy.

    For and on behalf of


    United India Insurance Company Limited

    Authorised Signatory

    *Note: Wherever SI for Table of benefit is reflecting "0.00", it indicates that particular cover has not been opted.

    Printed By - ANU29350 @ 21/05/2024


    Underwritten By - ANU29350 ( DO UW CUM CASHIER )

    gccore.uiic.in/Configurator/UnderwrittingMasters/reports/frmNonNilEndorsementSchedule.aspx?Reference_Num=202405218829941&Reference_Dat… 2/2

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