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Quoteslip Details:

Name of the Proposer:


Registered Address:
Website address:
Who is the Proposer - Principal/ contractor/ subcontractor :
If contractor/ subcontractor then who is the Principal.
Nature of operation: [Project based/ Annual]
What is the contract period:
What is the policy period:
Since when is this client in operation:
Past claims since then:
Last Year
1 year past
2 years past
Total business from the client:
Have we offered similar type of policy to the client? If yes what has
been the claims experience !
Risk details
How many Risk locations:
List down the risk location address (s):
Exact Scope of work ? [Pls describe the work]
If construction - Pls specify CIVIL or STEEL FRAME work.
At what height will the work be:
At what depth will the work be:
Work involves blasting ?
Work involves tunnelling ?
Work involves Loading/ unloading ?
is this an Engineering risk ? If yes please detail the nature of work
invoveld.
In case of an Engineering risk. what is the final product
manufactured.
Are these Shop floor employees ?
If not "shop floor employees" what is the geographical area of
work ?
Is this an Off shore/ underwater risk ? Pls describe.
Rate:
Endorsement No:
Classification No:
Is Medical Extension required:
Per person Limit for Medical Extension:

Calculator:
DESCRIPTIO SALARY PER
N
MONTH
woker

10000

TOTAL NO.

NUMBER OF TOTAL SUM


MONTHS
INSURED

18

UPTO 8000

540000

432000

TOTAL N

Premium after cd

SER.TAX INCL. EDU

Premi

Medical Extension Rates


SI per employee(Rs)
25,000
50,000
100000
150000
200000
500000

Rate to be charged per employee


Applicable WC Tariff rate x 7.5
Applicable WC Tariff rate x 10
Applicable WC Tariff rate x 12.5
Applicable WC Tariff rate x 15
Applicable WC Tariff rate x 17.
Applicable WC Tariff rate x 20

Mi

Medical Extension Rates for policy less


Policy Period
0 to 3 months
Above 3month upto 6 months
Above 6months

50%
75%

Quote is subject to nil claims for the past three years


This Policy excludes any interest and/or penalty imposed on the Insured on account
with the requirements laid down under the W.C. Act, 1923.
Excluding Blasting and Tunneling
Subject to Clauses : 1) Workmen Compensation Act, 2) Fatal Accident Act 3) Comm
Coverage, Exclusions, terms and conditions as per the standard WC policy.
Warranted that the coverage is only in due course of employement.
Me
excluded
All workers
to be on wage rolls
of the insured
Selection of workers not allowed
workers of sub contractor excluded.

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eslip Details:
AAR AAR TRADERS

157

Calculator:
ABOVE 8000

RATE
%o

RATE ABOVE
8000

NET PREMIUM

108000

27.25

2.0

11,988

27.25

2.0

0.00

2.0

0.00

2.0

0.00

2.0

0.00

2.0

0.00

2.0

TOTAL NET PREMIUM


discount

11,988
52%

Premium after cd

6,194.09
5,794

Add Me
Net premium

5,794

SER.TAX INCL. EDU. CESS @ 14%

869.09

Premium Payable

6,663

Extension Rates:
Minimum Premium Per Employee (Rs)
100
125
150
200
250
300

for policy less than 12months:


Premium
50% of *Annual ME premium
75% of *Annual ME premium
100% premium

nsured on account of his/their failure to comply

dent Act 3) Common Law as per the wordings.


WC policy.