Name of Group : M/s GAMMA PROCESS
D.O./BO 2. Fresh/Renewal of 3. Quote/Approval : 4. Policy Number & Period
710200 Fresh Quote required FRESH
5. Family size: EMPLOYEES ONLY 6. Employees No.-200 7. Dependents No.- nil 8. Total Lives- 200
9. TPA Name: 10. Sum Insured(per11. Broker/ Agent Name: [Link]/Commission:
PERSON)
Zeal Brokers 5%
1 LAKH
13. Other Business of Group and [Link] Premium -- [Link] Claims -- 16. ICR on Earned Premium: ---
ICR: NIL
FRESH
[Link] : 18. with 8%IBNR: 19. with 4%IBNR: 20. with NIL IBNR:
Rs.7.04 lakhs +GST
21. Premium Recommended by D.O. : RS. 7.04 lakhs +GST 22. DISCOUNT RECOMMENDED
BY DO: ____%
Tailormade Terms Expiring Terms Proposed Terms HO Remark
(If renewal)
23. Waiver 4.1,4.2,4.3 -- YES
24. Maternity Benefit: -- --
a)Baby Day one cover
b)Waiver of 9months
waiting period
25. Corporate Buffer -- --
[Link] wise Capping -- --
[Link] Restriction -- --
27. Co-pay/Excess -- ---
Other:
D.O. Recommendation : We recommend premium for Rs.7.04 lakhs /- + GST. with waiver of One Month,
I,2,3/4 years waiting period condition.
D.O. SIGNATURE.