SBI General Insurance Company Limited

9th Floor, A&B Wing, Fulcrum Building, Sahar Road, Andheri East,
Mumbai – 400099

QUOTATION - EMPLOYEE COMPENSATION INSURANCE

Date : 13 January 2025
Quote Ref. no. 10012025
Intermediary Name: SBI

Thank you for your submission on this risk.

Our indication of Employee Compensation insurance is subject to the submission of fully completed and signed Proposal Form and compliance of conditions set out
below. Please note that it is not possible for us to bind cover until conditions herewith have been complied.

Name of the Insured: IMTB Engineers Pvt Ltd

Address of the Insured:

Ground floor flat no 6 tower t4 nirala estate gh4 techzone 4 noida extn gautam buddh nagar noida u p 201301
Business Activity: Engineers not otherwise classified --Incl. work away from shop or yard exceeding 9 mts high

Particulars of Work Engineers not otherwise classified --Incl. work away from shop or yard exceeding 9 mts high

Risk Location: Ground floor flat no 6 tower t4 nirala estate gh4 techzone 4 noida extn gautam buddh nagar noida u p 201301

Period of Insurance: 12 months RSD 15-Jan-25

Policy Territory & Jurisdiction: India

Scope of cover Indemnity against legal liability for accidents to employees under Employees Compensation Act, 1923 and subsequent
amendments thereof prior to the date of inception of this policy, the Fatal Accidents Act 1855 and at Common Law

Policy Wording As per SBI General standard Employees Compensation Insurance Policy Wordings

INR 40,80,000
Split as:
Category of Worker Number of Estimated Wages declared
Employees
Project Head 1 INR 10,20,000
Service Engineer 1 INR 5,40,000
Service Engineer 1 INR 3,00,000
Declared Wages
Service Engineer 1 INR 3,00,000
Service Engineer 1 INR 3,00,000
Sales 1 INR 5,40,000
Sales 1 INR 3,00,000
Sales 1 INR 3,00,000
Driver 1 INR 2,40,000
Housekeeping 1 INR 2,40,000
Total 10 INR 40,80,000
Net Premium INR 12,453
GST - 18% INR 2,242

Total Amount payable INR 14,695

1. Proper register recording the attendance and wage disbursement must be maintained and to be produced as and
when required.
2. Any interest and/ or penalty imposed on the Insured on account of his/ their failure to comply with the requirements
laid down under WC Act 1923, is excluded.

3. Occupational diseases listed in part C of the schedule III of the Act unless specifically covered by an endorsement to
the policy is excluded.
4. Compressed Air Diseases listed in Part A of the Schedule III of the Act unless specifically covered by an endorsement
Coverage Conditions to the policy is excluded.

5. Coverage Extensions:
Cover for Contractor's employees Yes
Joint Policy cover No
Indemnity cover to Principals No
Cover for occasional domestic labour No
Cover for Ocupational diseases No
Medical expenses limit per insured person
during the period of insurance. INR 3,00,000
1. Any employment compensation in excess of the actual limit for employee compensation ordinance (not to apply in
respect of Common law awards)
2. Blasting activity and use/handling of explosives

3. Losses in connection with asbestos and/or asbestos products/asbestos containing products

Key Exclusions
4. Underground and / or Underwater mines and /or underground services thereof

5. Subaqueous work

6. As exclusions as per SBIG Employees Compensation Insurance Policy wording

1. Submission of completed, stamped & dated SBIG proposal form signed by the Authorised Signatory, to us before
inception of the policy with us

2. Confirmation of no Known or Reported Losses or Circumstances Leading to Losses other than those already declared,
Subjectivities prior to binding.

3. Copy of PAN Card

4. GSTIN Details
*Warranted that no cover for worker involved in any sort of live wire works.
*No material change to the information provided including but not limited to the Loss history declared herein, prior to
attachment of cover.
* Jurisdiction-INDIA *
Other Additional Conditionalities Warranted that workers are using adequate safety measures while working at the unit.
* Warranted workers working above 9metres are properly harnessed and wearing safety belt & helmet

Premium Payment: Prior to our binding on this risk

Validity of this Quote: 15 days from the date of the quote.

For SBI General Insurance Company Ltd.

Authorised Signatory
Casualty & Liability Underwriting