Group Accident Guard Policy
QUOTATION AND PROPOSAL FORM
We have quoted following risk on the basis of information as available / shared with us, it should be same at the time of finalisation of the proposal.
Please do inform us in case of any changes in claim information or any other risk factor, as it has implications on appropriate pricing of the risk
PROPOSER DETAILS
Reference / Quote Number: Q200042253000 Quote Date: 10/03/2025
Name Of The Insured: Shivchem Agro limited Expiring TAGIC Policy Number:
Risk Inception Date: 10/03/2025 Policy Status: Fresh
Insured Location: Delhi Category: SME
Intermediary Name: AKASH SHAW Producer Code: 2532080000
Policy Details:
Number Of Lives: 50
Type of Policy: Named
Group Category: Employer-Employee
Business Description: Manufacturing
Description of Insured: Only Permanent Employees of the company are covered.
Age Bracket: 18 Yrs To 70 Yrs; Only Capital Benefit For Age Above 65 Yrs
Past claim details /Loss Ratio: 0%
Branch: KOLKATA
Sum Insured Category(For Employees only) No of Lives Per Person SI Total Sum Insured
Category 1 50 1000000 50000000
Total 50 1000000 50000000
Coverage Benefits
Benifits Offered Sum Insured
Number of Insured 50
Accidental Death Rs.1000000
Accidental Dismemberment and Paralysis Rs.1000000
Permanent Total Disability Rs.1000000
Permanent Partial Disability Rs.1000000
Temporary Total Disability(Per Week SI) 1% of AD SI or INR 5000 or actual weekly salary for 104 Weeks
whichever is less
No of weeks 104 Weeks
Accidental Medical Expenses Fixed INR 60000 for IPD with Sublimt of INR 30000 for OPD or actual
claims, whichever is lower.
Terrorism Covered
Accident Medical Expenses_IPD Rs.60000
Accident Medical Expenses_OPD Rs.30000
Ambulance Services Rs.2000
Maximum Aggregate Limit Rs.12500000
Per Mille Rate Pre Tax 0.6966160300
Insurance is the subject matter of the solicitation. For more details on risk factors, terms and conditions , please read sales brochure carefully, before concluding a sale.
TATA AIG General Insurance Company Limited
Registered office: Peninsula Business Park, Tower A, 15th Floor, G.K Marg, Lower Parel , Mumbai - 400013
24*7 Toll free Number: 1800 266 7780 or 1800 229966 (For Senior Citizens) Email:
[email protected] Website: www.tataaig.com
IRDA of India Registration No : 108, CIN : U85110MH2000PLC128425, UIN : TATPAGP23093V032223
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Group Accident Guard Policy
Scope Of Coverage: 24 Hours Worldwide
Total Lives Covered: 50
Total Death Capital Sum Insured: 50000000
Sum Insured Basis: Flat
Aggregate Limit: Required
Maximum Individual SI(INR): 1000000
Minimum Individual SI(INR): 1000000
Premium Pre Tax(INR): 34830.8015
Premium Post Tax(INR): 41100
Payment In Favour Of: TATA AIG GENERAL INSURANCE COMPANY LIMITED
Payment Mode:
Document Requested: EMPLOYEE DETAILS AS PER FORMAT ATTACHED
Unique Benefits of TATA AIG Insurance cover:
Claims can be intimated by calling on The Company's 24/7 Toll Free Helpline Number - 1800 266-7780 or by writing to The Company at
[email protected]
Exclusive GPA claims team facilitate undivided attention to the insured.
You are dealing with an Insurance company that is a Specialist in Personal Accident Covers
Risk Class: Risk Class 2
Terms & Conditions(For detailed T&C,Please refer the GAG Policy Wordings)
Sum Insured should not exceed 10 times of Gross Annual Salary of the employees.
Snake Bite/Animal bite are covered under Accidental Death except Mosquito bite
Data for Addition/ Deletion endorsements should be provided to the Tata AIG General within 45 days of the date of joining of the member.
Premium shall not be refunded in case of any claims being paid under the policy.
No Group should be formed of size less than 7 lives,so as to adhere to the Group guidelines given by IRDA.
Named Policy - Name wise declaration from the company needs to be submitted while binding this policy.
Unnamed Policy - Category wise declaration from the company needs to be submitted while binding this policy.
For the weekly benefit to be given to the contractual employees the client has to give us the declaration on its letter head that all the contractual
employees are working exclusively for the client only and are not part time/full time employed with any other company/ organization.
Attested copy of this Quote Letter, Pan Card & Salary component details will be required for binding this policy.
Major Exclusions:
This entire Policy does not provide benefits for any loss resulting in whole or in part from , or expenses incurred, in respect of:
Any Pre-existing disease, any complication arising from it.
The attending Physician who will be (a) Insured Person himself / herself or (b) Close Member of the Family who is covered in this Policy.
Suicide, attempted suicide (whether sane or insane) or intentionally self-inflicted Injury or illness.
Being under the influence of drugs, alcohol, or other intoxicants or hallucinogens unless properly prescribed by a Physician and taken as prescribed.
Participation in an actual or attempted felony, riot, crime, misdemeanor(excluding traffic violations) or civil commotion.
Operating or learning to operate any aircraft, or performing duties as a member of the crew on any aircraft or Scheduled Aircraft.
War or any act of war, invasion, act of foreign enemy, civil war, public defence, rebellion, revolution, insurrection, military or usurped acts, nuclear
weapons / materials, chemical and biological weapons, ionising radiation.
Any loss, damage cost or expense of whatsoever nature caused by, resulting from or in connection with any Act of Terrorism regardless of any other
cause or event contributing concurrently or in any other sequence to the loss unless and otherwise terrorism cover is provided in the policy.
Ionising radiation or contamination by radioactivity from any nuclear fuel or from any nuclear waste from burning nuclear fuel.
The radioactive, toxic, explosive or other dangerous properties of any explosive nuclear equipment or any part of that equipment.
Any Insured Person’s participation in Professional Sports or Adventure sports other than mentioned in Specific Exclusions- i.1, or participation
without expert supervision of trained professional.
Arising or resulting from the Insured Person(s) committing any breach of law with criminal intent.
Any loss caused by osteoporosis (porosity and brittleness of the bones due to loss of protein form the bones matrix) or pathological fracture (any
fracture in an area where Pre-existing disease has caused the weakening of the bone) if osteoporosis or bone Disease diagnosed prior to the Policy.
Insurance is the subject matter of the solicitation. For more details on risk factors, terms and conditions , please read sales brochure carefully, before concluding a sale.
TATA AIG General Insurance Company Limited
Registered office: Peninsula Business Park, Tower A, 15th Floor, G.K Marg, Lower Parel , Mumbai - 400013
24*7 Toll free Number: 1800 266 7780 or 1800 229966 (For Senior Citizens) Email:
[email protected] Website: www.tataaig.com
IRDA of India Registration No : 108, CIN : U85110MH2000PLC128425, UIN : TATPAGP23093V032223
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Group Accident Guard Policy
For any loss of which a contributing cause was Insured Person’s actual or wilful participation in, an illegal act or any violation or attempted violation of
the law or Insured Person’s resistance to arrest.
Confinement in a Hospital which is not Medically Necessary.
Mosquito bite and resultant diseases are excluded under the Policy.
Any loss resulting contributed or aggravated or prolonged by childbirth or from pregnancy.
Declaration:
I/We do hereby declare that all information provided by us under the present Offer, are true and correct and also complete in all respects and there
is nothing material, which is concealed by us in any manner whatsoever.
I/We understand that as per applicable regulations for Group Insurance minimum 7 lives are required to be insured under the Group Policy.
Accordingly we confirm that we will insure atleast 7 lives during the course of the policy and in this context we are paying premium of 7 lives upfront.
In the event we fail to insure minimum 7 lives then the Insurance Company shall book the entire premium of 7 lives and no refund shall be due to us.
In the event of any change in information pertaining to any aspect of the quotation at a later date, TATA AIG General Insurance Company Ltd reserves
the right to revise the premium and recover the same from customer or invoke cancellation of the policy, as may be deemed fit, with short term
premium recovered.
I/We have also carefully read and understood the entire terms, coverage and exclusions agreed in the Offer, and further accept the same, which shall
be binding on both of us as a contract between us and TATA AIG General Insurance Company Ltd.
I/We request you to issue unnamed policy for lives as mentioned above with understanding that if at any point of time actual strength is found more
that no. Of lives insured under this GPA policy then insurer will decline the claim on account of underinsurance
I/We do hereby authorize TATA AIG General Insurance Company Ltd to open a CD account in the name of our Company.
We understand that as per Master Guidelines on Anti-Money Laundering/ Counter Financing of Terrorism (AML/CFT), 2022 (Ref:
IRDAI/IID/GDL/MISC/160/8/2022) issued by IRDAI, the Master Policyholders under the group insurance shall maintain the details of all the individual
members covered, which shall also be made available to the insurer as and when required.
Prohibition of Rebates:
Section 41 of the Insurance Act, 1938 as amended by Insurance Laws (Amendment) Act 20151. No person shall allow or offer to allow, either directly or
indirectly, as an inducement to any person to take out or renew or continue an insurance in respect of any kind of risk relating to lives or property in
India, any rebate of the whole or part of the commission payable or any rebate of premium shown on the policy, nor shall any person taking out or
renewing or continuing a policy accept any rebate, except such rebate as may be allowed in accordance with the prospectus or tables of the insurer.2.
Any person making default in complying with the provision of this section shall be liable for penalty which may extend to ten lakh rupees.
AML guidelines:
1. I/We hereby confirm that all premiums have been/will be paid from bonafide sources and no premiums have been/will be paid out of proceeds of
crime related to any of the offence listed in prevention of Money Laundering Act, 2002.
2. I/We understand that the Company has the right to call for documents to establish sources of funds.
3. The insurance company has right to cancel the insurance contract in case I/We have been found guilty by any competent court of law under any of
the statutes, directly or indirectly governing the prevention of money laundering in India. Insurance is the subject matter of the solicitation. For more
details on risk factors, terms and conditions, please read sales brochure/policy wordings carefully, before concluding a sale. Tata AIG General Insurance
Company Limited. Registered Office: Peninsula Business Park, Tower A, 15th Floor, G. K. Marg, Off Senapati Bapat Road, Lower Parel, Mumbai- 400013,
Maharashtra, India. 24X7 Toll Free No: 1800 266 7780 or 1800 22 9966 Email:[email protected] Website: www.tataaig.com IRDA of India
Registration No: 108 CIN: U85110MH2000PLC128425.
Subject otherwise to the terms , conditions and exclusions of Group Accident Guard Policy
This quote is valid untill: 9/04/2025
Thanking You
Yours sincerely,
TATA-AIG GENERAL INSURANCE COMPANY LIMITED
This is not an acceptance of risk. Details are subject to change. Full details of the cover are as per Tata AIG General insurance company Limited's GAG
policy wordings.
We are pleased to accept your proposal & the above said terms & conditions
Shivchem Agro limited
Place: Delhi Date: 10/03/2025
Insurance is the subject matter of the solicitation. For more details on risk factors, terms and conditions , please read sales brochure carefully, before concluding a sale.
TATA AIG General Insurance Company Limited
Registered office: Peninsula Business Park, Tower A, 15th Floor, G.K Marg, Lower Parel , Mumbai - 400013
24*7 Toll free Number: 1800 266 7780 or 1800 229966 (For Senior Citizens) Email:
[email protected] Website: www.tataaig.com
IRDA of India Registration No : 108, CIN : U85110MH2000PLC128425, UIN : TATPAGP23093V032223
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