GROUP MEDICLAIM TAILORMADE - ENDORSEMENT SCHEDULE

Attached to and forming part of Policy No : 311500/48/2017/5435

Endorsement No : 311500/48/2017/5435/026 Endorsement Date : 12/05/2017
Endorsement Effective From 00:00 On 01/05/2017 To Midnight Of 09/09/2017
Insured's Code : AB0000033473 Issue Office Code : 311500
Insured's Name : INDIAN INSTITUTE OF Issue Office Name : DO 5 CALCUTTA
MANAGEMENT CALCUTTA
Address : DIAMOND HARBOUR ROAD, P.O. Address : ROOM NO.-33,STEPHEN HOUSE
JOKA, KOLKATA 700104 4,B.B.D. BAG (EAST), 2ND FLOOR,
KOLKATA -700 001
KOLKATA WEST BENGAL 700001

Agent/Broker Details
Dev.Off.Code :
Agent/Broker : LC0000000373 SLK BIMA BROKERS PVT LTD(1530)
Address : 26/18 EAST PATEL NAGAR,DELHI,DELHI,110008
: 01125864949//
Tel/Fax/Email
Total Premium : 0 Type of Endorsement : Addition / Deletionof Person(s)
Collection No & Dt : CD A/C AB0000033473
Co Insurance Details :

ENDORSEMENT

Notwithstanding anything contained herein to the contrary in the within mentioned policy it is hereby declared and agreed that
the Name of the Spouse of Mr. Gourab Nandy should be read as MADHURIMA NAHA.Subject otherwise to the terms
,conditions ,exceptions,exclusionsand limitations of the policy.

SCHEDULEOF PREMIUM

Cover Description Original Endorsement Revised Endorsement

Sum Insured Sum Insured Sum Insured Premium

Total Amount in figures and words : 0 ( INDIAN RUPEES 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

Place : KOLKATA For and on behalf of

The Oriental Insurance Company Limited
Date : 12/05/2017

Authorised Signatory

All the Amounts mentioned in this policy are in INDIAN RUPEES Page 1 of 2

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Attached to and forming part of policy number 311500/48/2017/5435

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 : SUPRITY ROY For and on behalf of

The Oriental Insurance Company Limited
Examined By : VINAYAK GOLDAR

Authorised Signatory

Place : KOLKATA For and on behalf of

The Oriental Insurance Company Limited
Date : 12/05/2017

Authorised Signatory

All the Amounts mentioned in this policy are in INDIAN RUPEES Page 2 of 2

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