FIDELITY GUARANTEE - POLICY SCHEDULE

NAMED - FLOATER - POLICY LEVEL

Policy No. : 124700/48/2018/6300 Prev. Policy No. : -

Cover Note No. : - Cover Note Date : -
Insured's Code : 50886938 Issuing Office Code : 124700
Insured's Name : 50886938 - M/S HAREKRISHNA (GSTIN: Issuing Office : 124700 - MCDO 19 (GSTIN:
21AACFH1780L1ZJ) 27AAACT0627R4ZW)

Address : 1058, Nayapalli, Opp. Iscon Temple, Address : MAGNET HOUSE, GROUND FLOOR
Bhubaneshwar, Orissa NAROTTAM MORARJI MARG
BALLARD ESTATE
BHUBANESWAR 751001 MUMBAI MAHARASHTRA 400023

Tel. /Fax /Email : / / 0 / NA Tel. /Fax /Email : 22691455 / 22626230 / 022-22626071 /

laiju.marar@orientalinsurance.co.in
Agent/Broker Details
Dev.Off.Code : NA0000000376 DIRECT 332200
Agent/Broker : BA0000116890 MRS RESHMA KATARIA
Address : 39, TAD WADI, SONAPUR STREET,,NEAR HOTEL ANANDASHRAM, CHIRA BAZAR,,MUMBAI-
400002,MUMBAI,MAHARASHTRA,400002
Tel/Fax/Email
: 022-22080835/022-22080835//info@katariainsurance.com
Period of Insurance : FROM 00:00 ON 10/08/2017 TO MIDNIGHT OF 09/08/2018
Collection No. & Dt. : DC_I_IND 9140004360 - 10/08/2017
Gross Premium : 9,290 GST : 1,672 Stamp Duty : .5 Total : 10,962
Co-insurance Details: Nil
Retroactive Date :
Per Event Limit :

Amount of Indemnity on Floater Basis : Rs. 3000000

EMPLOYEE DETAILS

Sr.
Name/s of Employee/s Place of employment Category Duties
No.

1 Anil Ram
2 Sandeep kumar Routry
3 Giridhari Prasad Mohanty
4 Debasish Pattnaik Shop Various
5 Debi Prasad Pattanaik
6 Srimant Mohpatra
7 Rajesh Kumar Razak
8 Purna Chandra Nayak
9 Bhagirathi Jena
10 T Satyanarayan Achari

Place : MUMBAI For and on behalf of

Date : The Oriental Insurance Company Limited
10/08/2017

Atul Sahai
General Manager
In case of any query regarding the Policy please call Toll
Free No. 1800 11 8485 and 011 33208485. Authorised Signatory

CIN: U66010DL1947GOI007158 All the Amounts mentioned in this policy are in Indian Rupees Page 1 of 3
IRDA Regn. No. 556 - Now you can buy and renew selected policies online at www.orientalinsurance.org.in
Attached to and forming part of policy number 124700/48/2018/6300

11 Basant Nayak
12 Manash Ranjan Sahoo
13 Prasanta Nanda
14 Ajay Kumar Nayak
15 Susanta Nayak
16 Ashok Kumar Das
17 Manash Ranjan Pattnaik
18 Rudra Prasad Mohanty
19 Soumya Ranjan Barik
20 Rasmiranjan Swain
21 Sagar Dash
22 Manoj Pradhan
23 Prabhakar Gouda
24 Hemant Kumar Nayak
25 Sipini Kumar Senapati
26 Kuna Behera
27 Santosh Kumar Nayak
28 Kailas Chandra Mohapatra
29 K Tarini Achary

Total Premium in words : Indian Rupees Ten Thousand Nine Hundred Sixty-Two Only

The Insurance under this policy is extended to cover risks of : Nil

The Insurance under this policy is subject to Warranties & Clauses :

Per Event Limit Rs.30 lacs, AOA Limit Rs.30 lacs, AOY Limit Rs.30 lacs.
The basis of valuation is market value for gold and silver jewellery. and invoice value +10% for diamond jewellery.

Excess : Excess - 5% of each and every claim. - 0

Hypothecation /Lease//Hire Names are as per the List Attached: None

Place : MUMBAI For and on behalf of

Date : The Oriental Insurance Company Limited
10/08/2017

Atul Sahai
General Manager
In case of any query regarding the Policy please call Toll
Free No. 1800 11 8485 and 011 33208485. Authorised Signatory

CIN: U66010DL1947GOI007158 All the Amounts mentioned in this policy are in Indian Rupees Page 2 of 3
IRDA Regn. No. 556 - Now you can buy and renew selected policies online at www.orientalinsurance.org.in
Attached to and forming part of policy number 124700/48/2018/6300

Warranted that in case of dishonour of premium cheque(s) the Company shall not be liable under the policy and the policy shall be void abinitio (from
inception).

In witness whereof the undersigned being authorised by and on behalf of the Company has/have herein to set his/their hands at MCDO 19 (GSTIN:
27AAACT0627R4ZW) on 10TH DAY OF AUGUST 2017.

Entered By : MS.A.M.SONAWANE For and on behalf of

The Oriental Insurance Company Limited
Examined By : GEETA VIJAYAN

Atul Sahai
Policy Printed By 172880 IP 10.11.14.55 General Manager
Authorised Signatory
Policy Printed On : AUG-21-17 13:29:21

Place : MUMBAI For and on behalf of

Date : The Oriental Insurance Company Limited
10/08/2017

Atul Sahai
General Manager
In case of any query regarding the Policy please call Toll
Free No. 1800 11 8485 and 011 33208485. Authorised Signatory

CIN: U66010DL1947GOI007158 All the Amounts mentioned in this policy are in Indian Rupees Page 3 of 3
IRDA Regn. No. 556 - Now you can buy and renew selected policies online at www.orientalinsurance.org.in