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SCHEDULE
Attached to and forming part of Policy No
Endorsement No
: 520000/44/2014/8
Endorsement Date
: 520000/44/2014/8/004
19/01/2015
Endorsement Effective
Insured's Code
: AB0000030320
Insured's Name
Address
Address
CHENNAI - 18
CHENNAI 600018
Agent/Broker Details
Dev.Off.Code :
Agent/Broker
: LB0000000076 1433
Address
: 2 G, 2ND FLOOR, DEV REGENCY,,(NEW) NO. 11, (OLD) 6, 1, MAIN ROAD,,GANDHI NAGAR,
ADYAR,,CHENNAI,TAMIL NADU,600020
: 044-42117075/MR. V. SIVARAMAN/044-42117743/
Tel/Fax/Email
Total Premium
Type of Endorsement :
160,270
ENDORSEMENT
Notwithstanding anything contained herein to the contrary in the within mentioned policy it is hereby declared and agreed that
at the request of the insured vide mail dt. 21/01/2015 the policy is extended by 6 Months upto 31/07/2015. In consequence
whereof an additional premium amounting to Rs. 1,60,270/- inclusive of S.Tax is hereby collected
The Extension details are as follows.
Sum Insured
: Rs. 42,40,00,000/Extension No. & Period : 1st . 01/02/2015 to 31/07/2015
Premium
: Rs. 1,42,640/- + S.Tax.
Subject otherwise to the terms, conditions, exceptions, exclusions and limitations of the policy.
SCHEDULEOF PREMIUM
Cover Description
Original
Sum Insured
Endorsement
Sum Insured
Revised
Sum Insured
Endorsement
Premium
Basic Cover
42,40,00,000
42,40,00,000
7,42,000.00
42,40,00,000
42,40,00,000
31,800.00
4,24,00,000
4,24,00,000
74,200.00
Place
: CHENNAI
Date
: 19/01/2015
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ADD :Earthquake
Cover
ADD :Terrorism
Cover
TOTAL PREMIUM
42,40,00,000
42,40,00,000
10,600.00
42,90,00,000
42,90,00,000
49,335.00
1,42,640.00
17,630.00
TOTAL AMOUNT
1,60,270.00
: Rs 1,60,270 ( INDIAN RUPEES One lakh sixty thousand two hundred seventy 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
Examined By :
GOPU MOHAN
LATHA POORANI C
Authorised Signatory
Place
: CHENNAI
Date
: 19/01/2015
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