PREMIUM COMPUTATION SHEET

Department : MISCELLANEOUS Insured's Name : MUKESH YASHWANT PADWAL

Document No : R/124600/48/2018/8270 Document Date : 15/09/2018

Policy Start Date : 30/09/2018 Policy End Date : 29/09/2019

Product Description : HAPPY FAMILY FLOATER-2015 Document Type : Proposal

Policy Type : HAPPY FAMILY FLOATER-2015

SCHEDULE OF PREMIUM
Cover Description Sum Insured Premium

Basic Cover 10,00,000.00 77,261.00

LESS :NCB DISCOUNT 0.00 11,589.00
TOTAL PREMIUM 65,672.00
ADD :CGST 5,910.00
STAMP DUTY 0.50
ADD :SGST 5,910.00
TOTAL AMOUNT 77,492.00

RISK DETAILS

Section : Happy Family Floater-2015

Individual : MUKESH YESHWANT PADWAL / 1000000 / 1

Cover Name Sum Insured Rate Premium

Basic Cover 10,00,000.00 77,261.00

Total 77,261.00

Insured Person : 1 / MUKESH YESHWANT PADWAL /

Cover Name Sum Insured Rate Premium

GROUP MEDICLAIM - BUILT IN - AGE 10,00,000.00 10176/1 4,070.00

Total 4,070.00

Insured Person : 2 / SADHANA MUKESH PADWAL /

Cover Name Sum Insured Rate Premium

GROUP MEDICLAIM - BUILT IN - AGE 10,00,000.00 10176/1 5,088.00

Total 5,088.00

Insured Person : 3 / ANANYA MUKESH PADWAL /

Cover Name Sum Insured Rate Premium

GROUP MEDICLAIM - BUILT IN - AGE 10,00,000.00 6180/1 2,472.00

Total 2,472.00

Insured Person : 4 / YESHWANT SONU PADWAL / EXCLUDING CLAIM ARISING OUT OF HYPERTENTION AND BENIGN
PROSTATE ENLARGEMENT
 -2-

Cover Name Sum Insured Rate Premium

GROUP MEDICLAIM - BUILT IN - AGE 10,00,000.00 34376/1 34,376.00

Total 34,376.00

Insured Person : 5 / SHARDA YESHWANT PADWAL / EXCLUDING CLAIM ARISING OUT OF HYPERTENSION AND
OSTEOARTHRITIS OF KNEE JOINT

Cover Name Sum Insured Rate Premium

GROUP MEDICLAIM - BUILT IN - AGE 10,00,000.00 31255/1 31,255.00

Total 31,255.00