EMPLOYEE COMPENSATION INSURANCE
Insurance is the subject matter of the Solicitation UIN No. IRDAN150RP0032V02201213
POLICY SCHEDULE
In consideration of the policyholder named herein paying to the Liberty General Insurance Limited (hereinafter called the Insurer) the premium as stated in the Schedule and in reliance upon the
statements made by the Policyholder in the proposal including its attachments or otherwise, and the material incorporated therein, the Insurer agrees to provide insurance against loss, damage,
liability or expense to the extent and in the manner herein provided subject to all terms, conditions, exceptions and warranties hereinafter set forth.
Policy Servicing Office: B-302, 3rd Floor ITC Centre, Majura Gate SURAT 395002 GUJARAT PH: +91 Policy Issuing Office: Unit 1501&1502, 15th Floor, Tower 2, One International Center,
8655914100 FAX: +91 0 0 Senapati Bapat Marg, Prabhadevi, Mumbai 400013 Maharashtra Phone: +91 22 6700
1313
Policy Issue Date: 11/04/2025
*361140020225100000100000* Period Of Insurance: From 11/04/2025 Midnight of 10/06/2025
Policy number: 3611-400202-25-1000001-00-000
Insured Name: PARTH TEXTILES
Address: PLOT NO 4516 PLASTIC ZONE GIDC,
SARIGAM,,
sarigam,valsad,VALSAD,VALSAD,
GUJARAT,396155
Mobile No : 9712650050
Email: gic@[Link]
UIN Number : IRDAN150RP0032V02201213
Customer UIN: -
GSTIN No/State Name: 24AFTPD4989B1Z9/GUJARAT
Intermediary Name Intermediary Code Intermediary Contact Details
HETAL MANOJKUMARMEHTA IMD1267429 9426680080
Co-Insurance details
Name Of The Insurer Share % Unique Reference Code
Liberty General Insurance 100% -
Policy Covered Under The Policy cover the Liability of the Insurered Under the following Law(s):
a. Employees' Compensation Act ,1923 and Subsequent amendments thereto prior to the
date of issue of this Policy.
b. Common Law
Risk Details
Business Description Electrical Fittings, Machine Maintainace
Risk Location Address Any where in india
Employee Details As per Annexure
Premium Details
Net Premium Taxable Value ₹9996.0
CGST(9.0% - GUJARAT) ₹899.64
SGST (9.0% - GUJARAT) ₹899.64
Stam Duty ₹5.0
Premium Including Tax ₹11800.0
% DSUnknown
q
1G
1g
0.1 0 0 0.1 9 0 cm
0 J 0 j 4 M []0 d
1i
0g
313 292 m
313 404 325 453 432 529 c
478 561 504 597 504 645 c
504 736 440 760 391 760 c
286 760 271 681 265 626 c
265 625 l
100 625 l
100 828 253 898 381 898 c
451 898 679 878 679 650 c
679 555 628 499 538 435 c
488 399 467 376 467 292 c
313 292 l
h
308 214 170 -164 re
f
0.44 G
1.2 w
1 1 0.4 rg
287 318 m
287 430 299 479 406 555 c
451 587 478 623 478 671 c
478 762 414 786 365 786 c
260 786 245 707 239 652 c
239 651 l
74 651 l
74 854 227 924 355 924 c
425 924 653 904 653 676 c
653 581 602 525 512 461 c
462 425 441 402 441 318 c
287 318 l
h
282 240 170 -164 re
B
Q
Digitally signed by:
SACHIN JOSHI
Date: 2025-04-11
[Link] IST
Page 2/4
Employee Details
Salary Upto ₹15,000 Per Month Salary above ₹15,000 Per Month
Sl No. Employee Category
No of Workers Total Wages (₹) No of Workers Total Wages (₹)
Operator/Skilled/SemiSkilled/Unskilled
1 0 ₹0 15 ₹540000
workers
Operator Cum Commercial
2 Traveller/Skilled/SemiSkilled/Unskille 0 ₹0 3 ₹108000
d workers/Commercial Traveller/Peon
3 Helper/Loading/Unloading workers 8 ₹240000 0 ₹0
Helper Cum Commercial
4 Traveller/Skilled/SemiSkilled/Unskille 2 ₹60000 0 ₹0
d workers
Supervisor Cum Commercial
5 0 ₹0 2 ₹100000
Traveller/Supervisors
Maintainace Cum Commercial
6 0 ₹0 2 ₹200000
Traveller/Engineers
7 Fitter/Engineers 0 ₹0 3 ₹180000
Fitter Cum Commercial
8 0 ₹0 1 ₹60000
Traveller/Engineers
9 Packaging/Skilled workers 4 ₹120000 0 ₹0
10 Accountant/Officer & Directors 0 ₹0 3 ₹210000
11 Watchman/Other Labour workers 2 ₹60000 0 ₹0
12 Housekeeping/Un-skilled workers 4 ₹104000 0 ₹0
13 Peon/Un-skilled workers 2 ₹60000 0 ₹0
Total 22 ₹644000 29 ₹1398000
Add-on Details
[Link] Description Sum Insured
1 Medical Expenses : Limit per Employee ₹500000
Annexure 'A'-
[Link]. Premises Address
1 PLOT NO 4706, PLASTIC ZONE, GIDC, SARIGAM,SARIGAM,396155
You may visit our website [Link] to view/download the complete policy wordings
% DSUnknown
q
1G
1g
0.1 0 0 0.1 9 0 cm
0 J 0 j 4 M []0 d
1i
0g
313 292 m
313 404 325 453 432 529 c
478 561 504 597 504 645 c
504 736 440 760 391 760 c
286 760 271 681 265 626 c
265 625 l
100 625 l
100 828 253 898 381 898 c
451 898 679 878 679 650 c
679 555 628 499 538 435 c
488 399 467 376 467 292 c
313 292 l
h
308 214 170 -164 re
f
0.44 G
1.2 w
1 1 0.4 rg
287 318 m
287 430 299 479 406 555 c
451 587 478 623 478 671 c
478 762 414 786 365 786 c
260 786 245 707 239 652 c
239 651 l
74 651 l
74 854 227 924 355 924 c
425 924 653 904 653 676 c
653 581 602 525 512 461 c
462 425 441 402 441 318 c
287 318 l
h
282 240 170 -164 re
B
Q
Digitally signed by:
SACHIN JOSHI
Date: 2025-04-11
[Link] IST
Page 4/4
