THE NEW INDIA ASSURANCE CO. LTD.

(Wholly owned by the Govt. of India)

NIL ENDORSEMENT DOCUMENT

AVIATION - HULL ALL RISK Insurance Policy
Insured Name : M/S SUPREME TRANSPORT Insurer Office Code : KALYAN DO (170500)
ORGANISATION PVT.LTD
Address : (1)208B TRADING COMPANY Address : GURU GOVIND NIWAS,
-LLC, (2)1ST JETPRO OF 2ND FLR.,MURBAD ROAD,
TEXAS, LLC OPP.PURNIMA THEATRE,
5B/34, AKSHAY MITTAL KALYAN,421301
INDUSTRIAL ESTATE
MV ROAD, ANDHERI(E)
MUMBAI
MUMBAI ,MAHARASHTRA,
400059
Telephone : 9999999999 Telephone : 02512324689 / 9819146987
Fax : Fax :
Email : Email : nia.170500@newindia.co.in

Endorsement attached to forming part of Policy Number : 17050043170100000002

Department : Aviation Cover : NA
Period of Insurance : From 16/05/2017 12:00:01 AM To Endorsement No : 17050043170182000003
28/05/2017 11:59:59 PM
NIA S.T.REGN No : AAACN4165CST178 Effective Date : 28 May 2017
Date Signed : 30/05/2017 Sum Insured` : 180,000,000.00
Additional Premium ` : N/A Additional S.T. ` : N/A
Refund Premium ` : N/A Refund S.T. ` : N/A

It is hereby understood and agreed that the endorsement on policy 17050043170100000002 will be in effect
from 28 May 2017.
Reason AS PER THE COMPETENT AUTHORITY APPROVAL IT IS HEREBY DECLARED & AGREED

THAT THE POLICY PERIOD SHOULD BE READ AS 16/05/2017 TO 15/05/2018.

ALSO HAR POLICY IS INCLUSIVE OF FERRY FLIGHT.

ALL OTHER TERMS AND CONDITIONS REMAIN SAME.

IN WITNESS WHEREOF THIS POLICY has been signed at _______________ this 30-May-17.

Extension Details :

Period of extension Modified Expiry date

28-MAY-17

Place :2ND FLR.,MURBAD ROAD,,

OPP.PURNIMA THEATRE, KALYAN,421301
Date :30-May-17

For and on behalf of

The New India Assurance Company Limited
Authorized Signatory

IRDA Registration Number: 190

Signature Not
Verified
Digitally signed
by Srinivasan
Vaideswaran
Date: 2017.05.30
15:39:24 IST
Policy No. : 17050043170100000002Document generated by 37658 at 30/05/2017 15:39:23 Hours.
Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.

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