Signed

by:Reliance
General Insurance
Company Limited
Date:2024.11.21

GROUP PERSONAL ACCIDENT SCHEDULE

Corporate Office/Policy Issuing Office: Policy Servicing Branch: Reliance General Insurance Co. Ltd., Reliance House, 6th
Reliance General Insurance Company Limited 6th Floor, Oberoi Floor, Haddows Road, ChennaiTAMIL NADU
Commerz, International Business Park, Oberoi Garden City, Off
Western Express Highway, Goregaon (East), Mumbai - 400 063.
Policy Branch Office Code: 1216 Agent/Broker Code:14BRG524
Policy No: 121632429140000046
Date of proposal:21/11/2024 Details of previous policy (in case of renewal)
ProposalNo:P112024100007 Previous policy No:121632329140000049
Date of expiry: 15/11/2024
TaxInvoice No & Date :P112024100007 & 21/11/2024
INSURED NAME : M/S EWAC ALLOYS LIMITED
GSTIN /UN of the insured 27AAACE2470R1Z9
Policy Holder Address / Place Of Supply :
VAMAN TECHNO CENTER 6TH FLOOR AWFIS MAROL, ANDHERI-E
MAHARASHTRA
MUMBAI
400059
Period of Insurance: From 16/11/2024 to mid night on 15/11/2025
Total No of Employees Covered 211
Total No of Lives Covered 211
Type of Policy Named
Total Sum Insured(Rs) 968000000.00
Description of Group Employees
Nature of Business
Coverage Details and List of members covered as per Schedule attached.

Premium (Rs) 222640.00

IGST (@18.00%) 40075.20

TOTAL PREMIUM PAYABLE(Rs) 262715.00

Branch GSTIN :33AABCR6747B1ZN;HSN Code :997133;Description Of Services :Accident and Health Insurance Service;

Consolidated Stamp duty Paid vide Letter of Authorisation “NO LOA/ENF-1/CSD/62/2024-25/(Validity Period Dt. 01/10/2024 to Dt. 01/12/2025)/4634 Date 25-09-2024” at General Stamp Office, Mumbai. **
Not Applicable for the State of Jammu & Kashmir.

Reliance General Insurance Company Limited. IRDAI Registration No. 103 An ISO 9001:2015 Certified Company
Registered Office & Corporate Office/Policy Issuing Office: Reliance General Insurance Company Limited 6th Floor, Oberoi Commerz, International Business Park, Oberoi Garden City, Off Western Express Highway,
Goregaon (East), Mumbai - 400 063.
Corporate Identity No: U66603MH2000PLC128300. PERSONAL ACCIDENT - GROUP. UIN : RELPAGP01001V010001
*Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License.
RGI/MCOM/CO/ 2914 /PS/Ver.1.0/151020

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Notice of communication to be given in respect of claim to :

Name:
Address:
City:
Website Address:
Customer care No
Email id:
In the event of dishonor of Cheque, this policy automatically stands cancelled from inception irrespective of whether a separate
communication is sent or not.

The policy wording with detailed terms, conditions and exclusions are available on our website [Link]
The Customer Information Sheet (CIS) for this product is available on our website
[Link]
In witness whereof this policy has been signed at Mumbai on 21/11/2024
In case of a renewal, the benefits provided under the policy and/or terms and conditions of the policy including premium rate may be subject to change.

Grievance Clause: For resolution of any query or grievance, Insured may contact the respective branch office of the Company or may call at 02248903009 or may write an email at
[Link]@[Link]. In case the insured is not satisfied with the response of the office, insured may contact the Nodal Grievance Officer of the Company at [Link]@[Link]. In
the event of unsatisfactory response from the Nodal Grievance Officer, insured may email to Head Grievance Officer at [Link]@[Link]. In the event of unsatisfactory response from
the Head Grievance Officer, he/she may, subject to vested jurisdiction, approach the Insurance Ombudsman for the redressal of grievance. Details of the offices of the Insurance Ombudsman are available
at IRDAI website [Link] or on company website [Link] or on [Link]. The insured may also contact the following office of the Insurance Ombudsman within whose
territorial jurisdiction the branch or office of the Company is [Link] of the Insurance Ombudsman,Fatima Akhtar Court,4th Floor,453, Anna Salai,Teynampet,CHENNAI– 600 018. Tel.: 044 -
24333668 / 24335284 Fax: 044 - 24333664 Email: [Link]@[Link]

For and on behalf of

Reliance General Insurance Company Limited.

Agent Code 14BRG524

Agent Contact No Authorised Signatory

User ID: 50034767 Policy Generation Date :21/11/2024

Reliance General Insurance Company Limited. IRDAI Registration No. 103 An ISO 9001:2015 Certified Company
Registered Office & Corporate Office/Policy Issuing Office: Reliance General Insurance Company Limited 6th Floor, Oberoi Commerz, International Business Park, Oberoi Garden City, Off Western Express Highway,
Goregaon (East), Mumbai - 400 063.
Corporate Identity No: U66603MH2000PLC128300. PERSONAL ACCIDENT - GROUP. UIN : RELPAGP01001V010001
*Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License.
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 Schedule attached to and forming part of Policy No.121632429140000046

Cover Name Sum insured Co-pay Special Conditions

Table D-Death +Permanent Total Disability Table D covers, Death+Permanent Total

+Permanent Partial Disability + Temporary Disablement+Permanent Partial
Total Disablement Disablement+Temporary Total Disablement
due to accidental external means
Medical expenses Medical expenses - 10% of sum insured or
40% of admissible claim amount or actual
whichever is lower, only when claim is
admissible under benefit table A,B,C or D
Education Grant Children Education Welfare Fund for
Dependent Children in case of a Death of
an employee 10%of SI Subject to max
Rs.200,000/- per child restricted to 2
children up to 25 years.
General Conditions: 1)TTD benefit will be 1% of the SI OR 24 times monthly salary of employee OR Rs: 5,000/- whichever is lower on weekly basis for
maximum of 100 weeks
2)AOA Limit - 10 cr
3)Maximum any one life limit -- 1,25,00,000
4)Subject to condition that Table D sum insured does not exceed 24 times monthly salary of any person
5)Policy will be on named basis
6)Individual sum insured can not be more than 100 times of the monthly salary or sum insured specified which ever is less.
7)This quote is subject to condition that no employee is involved in any hazardous activity or manual labour
8)Insured to submit salary certificate of month prior to date of accident at the time of claim
9)Mid term Sum insured changes not allowed. Addition-deletion will be done on pro-rata premium basis for employees once in a month only, subject to all
relevant details being forwarded to insurer before 7th day of succeeding month.
10)Minimum age of beneficiary 18 years and maximum 70 years
11)Terrorism is covered, however, terrorism activity arising out of Nuclear, Biological and/or Chemical means is excluded from the scope of this policy
12)Ambulance Hiring Charges: - The policy will be reimbursed up to Rs.1,000 for ambulance hiring charges in the event of an accident.
13)24*7 worldwide cover.
14)Risk Group 1 & 2 only
Special Conditions:
Below mentioned activity shall be outside the scope of the policy:-
Professional sports team in respect of specific benefit for inability to perform
Participation in any kind of motor speed contest
While engaged in aviation, or whilst mounting or dismounting from or traveling in any aircraft. ( Not applicable for fare Paying Passengers)
Underground mining & contractor specializing in tunnelling and Offshore activities
Naval, military or air force personnel
Radioactivity, Nuclear risks, ionizing radiation
Animal bite / Snake Bite covered. Insect bite not covered
Perils of the sea are excluded from the scope of the policy.
Persons working in mines, explosives, Electrical installations on high tension lines, Racing, Circus People, skiing, mountaineering, big game hunting,
ballooning, hang gliding, river rafting, winter sports, skiing, ice hockey ,polo, offshore employees & such other persons engaged in occupation of similar
hazard are not covered under this policy.
Exclusions:-
Suicide, attempt to Suicide or intentionally self- inflicted injury, sexually transmitted conditions, mental disorder, anxiety, stress or depression.
Being under influence of drugs, alcohol, or other intoxication or hallucinogens
Participation in actual or attempted felony, riot, civil commotion, crime misdemeanour
Committing any breach of law of land with criminal intent.
Death or disablement resulting from Pregnancy or childbirth
Risk Category III people are out of the scope of the policy
Offshore workers are Specifically excluded
Workers involved in High Tension LIVE Wires are specifically excluded

Reliance General Insurance Company Limited. IRDAI Registration No. 103 An ISO 9001:2015 Certified Company
Registered Office & Corporate Office/Policy Issuing Office: Reliance General Insurance Company Limited 6th Floor, Oberoi Commerz, International Business Park, Oberoi Garden City, Off Western Express Highway,
Goregaon (East), Mumbai - 400 063.
Corporate Identity No: U66603MH2000PLC128300. PERSONAL ACCIDENT - GROUP. UIN : RELPAGP01001V010001
*Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License.
RGI/MCOM/CO/ 2914 /PS/Ver.1.0/151020

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Reliance General Insurance Company Limited. IRDAI Registration No. 103 An ISO 9001:2015 Certified Company
Registered Office & Corporate Office/Policy Issuing Office: Reliance General Insurance Company Limited 6th Floor, Oberoi Commerz, International Business Park, Oberoi Garden City, Off Western Express Highway,
Goregaon (East), Mumbai - 400 063.
Corporate Identity No: U66603MH2000PLC128300. PERSONAL ACCIDENT - GROUP. UIN : RELPAGP01001V010001
*Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License.
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SCHEDULE ATTACHED TO AND FORMING PART OF POLICY NO.: 121632429140000046 ' '
MEDICAL EXPENSES EXTENSION (Group Insurance)
Endorsement extending Insurance under Policy No. '121632429140000046 ' in the name of 'M/S EWAC ALLOYS LIMITED ' In consideration of the
payment of an additional premium paid under the policy it is hereby agreed and declared that notwithstanding anything in the within written policy
contained to the contrary, this insurance is extended to cover the medical expenses necessarily incurred and expended in connection with any accident
as specified in the Policy, for which a claim is made by the Insured and admitted by the Company. The Company shall reimburse to the insured person
an amount up to but not exceeding ___% of the Admissible Claim or ___% of claim amount or actual whichever is less. Further, it is a condition
precedent to the payment of such medical expenses that the medical attendant’s detailed account shall, if the Company so requires be submitted to and
is approved by the Company.

PROVIDED ALWAYS THAT:

1. The insurance shall not apply, in so far as it applies to a female to expenses incurred in respect of any condition arising from the traceable to any
disease of the organs of generation, malignant diseases of mammary glands, pregnancy, childbirth, abortion or miscarriage or any complications and or
sequels arising from the foregoing, unless otherwise provided hereafter.
2. The Company shall not be liable to may any payment under this Policy in respect of :-
i. Disease, Injury, Death or Disablement directly or indirectly due to war, Invasion, Act of Foreign Enemy Hostilities or Warlike Operations (whether war be
declared or not) or Civil War or Rebellion, Revolution, Insurrection Mutiny, Military, Naval or Air Service or Breach of Law of Hunting Steeple chasing or
engaging in aviation or Ballooning other than as a passenger (fare paying or otherwise) in any licensed Standard Type of Aircraft.
ii. Circumcision or Strictures of Vaccination or Inoculation or change of life or beauty treatment of any description of dental or eye treatment other than
treatment for the diseases etc. or Intentional self injury or insanity or dissipation or Nervous Breakdown (which expression shall cover also general
debility "run down" conditions and General "overhaul") or Venereal Disease or intemperance or the use of intoxicating drugs or liquors or any diseases,
injury, death or disablement directly or indirectly due to any one or more of them.

Subject otherwise to the terms, exceptions, conditions and limitations of the Policy.

Reliance General Insurance Company Limited. IRDAI Registration No. 103 An ISO 9001:2015 Certified Company
Registered Office & Corporate Office/Policy Issuing Office: Reliance General Insurance Company Limited 6th Floor, Oberoi Commerz, International Business Park, Oberoi Garden City, Off Western Express Highway,
Goregaon (East), Mumbai - 400 063.
Corporate Identity No: U66603MH2000PLC128300. PERSONAL ACCIDENT - GROUP. UIN : RELPAGP01001V010001
*Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License.
RGI/MCOM/CO/ 2914 /PS/Ver.1.0/151020

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Schedule of Members covered attached to and forming part of Policy No 121632429140000046

SNo Emp Name Nominee Grade Age Gen Table A Table B Table C Table D Total DateofJoi Location Remarks
Cod der Sum ning
e Insured
1 1229 BHARATH REDDY P NA NA 40 Yr M 0 0 4500000 500000 5000000 11/16/2024
05 00 M [Link]
AM
2 2000 SANDEEP M UCHIL NA NA 49 Yr M 0 0 4500000 500000 5000000 11/16/2024
0367 00 M [Link]
AM
3 2000 VIKASH KUMAR NA NA 42 Yr M 0 0 9500000 500000 10000000 11/16/2024
0542 00 M [Link]
AM
4 2000 SIDDHARTH DAS NA NA 40 Yr M 0 0 9500000 500000 10000000 11/16/2024
0667 00 M [Link]
AM
5 2000 AVADUT PRABHU NA NA 48 Yr M 0 0 3500000 500000 4000000 11/16/2024
3535 00 M [Link]
AM
6 2000 NIKHIL A N NA NA 37 Yr M 0 0 4500000 500000 5000000 11/16/2024
3584 00 M [Link]
AM
7 2001 AMOL MAGANLAL NA NA 38 Yr M 0 0 4500000 500000 5000000 11/16/2024
3696 GAJERA 00 M [Link]
AM
8 2001 UTTAM SHIVAJI NA NA 50 Yr M 0 0 4500000 500000 5000000 11/16/2024
7935 MULIK 00 M [Link]
AM
9 2002 DHARMENDRA R NA NA 59 Yr M 0 0 1200000 500000 12500000 11/16/2024
18 VARMA 00 M 0 [Link]
AM
10 2003 DURGADUTT RAI NA NA 37 Yr M 0 0 4500000 500000 5000000 11/16/2024
2377 00 M [Link]
AM
11 2003 SOMDEV NA NA 41 Yr M 0 0 4500000 500000 5000000 11/16/2024
3329 BYABARTTA 00 M [Link]
AM
12 2003 BHAVIN PATEL NA NA 33 Yr M 0 0 4500000 500000 5000000 11/16/2024
6455 00 M [Link]
AM
13 2003 PRASHANT KUMAR NA NA 38 Yr M 0 0 4500000 500000 5000000 11/16/2024
6459 00 M [Link]
AM
14 2004 SELVAN KANNAN NA NA 36 Yr M 0 0 4500000 500000 5000000 11/16/2024
0211 00 M [Link]
AM
15 2004 SHAILESH NA NA 38 Yr M 0 0 4500000 500000 5000000 11/16/2024
0387 SAURABH 00 M [Link]
AM
16 2004 AMIT DEB NA NA 34 Yr M 0 0 4500000 500000 5000000 11/16/2024
4463 00 M [Link]
AM
17 2004 NISHITH BHAVSAR NA NA 33 Yr M 0 0 4500000 500000 5000000 11/16/2024
4464 00 M [Link]
AM

Reliance General Insurance Company Limited. IRDAI Registration No. 103 An ISO 9001:2015 Certified Company
Registered Office & Corporate Office/Policy Issuing Office: Reliance General Insurance Company Limited 6th Floor, Oberoi Commerz, International Business Park, Oberoi Garden City, Off Western Express Highway,
Goregaon (East), Mumbai - 400 063.
Corporate Identity No: U66603MH2000PLC128300. PERSONAL ACCIDENT - GROUP. UIN : RELPAGP01001V010001
*Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License.
RGI/MCOM/CO/ 2914 /PS/Ver.1.0/151020

6 of 18
Schedule of Members covered attached to and forming part of Policy No 121632429140000046

SNo Emp Name Nominee Grade Age Gen Table A Table B Table C Table D Total DateofJoi Location Remarks
Cod der Sum ning
e Insured
18 2004 HIREN PATEL NA NA 34 Yr M 0 0 4500000 500000 5000000 11/16/2024
4466 00 M [Link]
AM
19 2004 BHAUTIK KHUNT NA NA 33 Yr M 0 0 4500000 500000 5000000 11/16/2024
4471 00 M [Link]
AM
20 2004 MILAN KEVADIYA NA NA 34 Yr M 0 0 4500000 500000 5000000 11/16/2024
4477 00 M [Link]
AM
21 2004 SOMNATH NA NA 56 Yr M 0 0 9500000 500000 10000000 11/16/2024
45 GOSWAMI 00 M [Link]
AM
22 2004 UMESH NIJAGUNI NA NA 55 Yr M 0 0 1200000 500000 12500000 11/16/2024
46 MARIGERI 00 M 0 [Link]
AM
23 2004 LOKESH NARAYAN NA NA 54 Yr M 0 0 4500000 500000 5000000 11/16/2024
59 PADMASHALI 00 M [Link]
AM
24 2004 MADHUKAR D NA NA 38 Yr M 0 0 4500000 500000 5000000 11/16/2024
9486 KUSUMALE 00 M [Link]
AM
25 2005 AMIT JAIN NA NA 35 Yr M 0 0 4500000 500000 5000000 11/16/2024
4657 00 M [Link]
AM
26 2006 PAWAN KUMAR NA NA 36 Yr M 0 0 4500000 500000 5000000 11/16/2024
8005 GUPTA 00 M [Link]
AM
27 2007 SACHIN MUNDHE NA NA 43 Yr M 0 0 2000000 500000 2500000 11/16/2024
3000 00 M [Link]
AM
28 2007 KETAN NA NA 53 Yr M 0 0 9500000 500000 10000000 11/16/2024
33 RAMESHCHANDRA 00 M [Link]
PANDYA AM
29 2007 SAIKAT NA NA 33 Yr M 0 0 4500000 500000 5000000 11/16/2024
4689 CHAKRABORTY 00 M [Link]
AM
30 2007 VIVEK S GANDHI NA NA 31 Yr M 0 0 3500000 500000 4000000 11/16/2024
5902 00 M [Link]
AM
31 2007 TAMIZHSELVAN A C NA NA 33 Yr M 0 0 4500000 500000 5000000 11/16/2024
7444 00 M [Link]
AM
32 2008 NIRMAL SAHA NA NA 44 Yr M 0 0 4500000 500000 5000000 11/16/2024
0303 00 M [Link]
AM
33 2009 VINEET KUMAR NA NA 49 Yr M 0 0 2000000 500000 2500000 11/16/2024
4466 MISHRA 00 M [Link]
AM
34 2010 SANTANU NA NA 43 Yr M 0 0 4500000 500000 5000000 11/16/2024
7188 BHATTACHARJEE 00 M [Link]
AM

Reliance General Insurance Company Limited. IRDAI Registration No. 103 An ISO 9001:2015 Certified Company
Registered Office & Corporate Office/Policy Issuing Office: Reliance General Insurance Company Limited 6th Floor, Oberoi Commerz, International Business Park, Oberoi Garden City, Off Western Express Highway,
Goregaon (East), Mumbai - 400 063.
Corporate Identity No: U66603MH2000PLC128300. PERSONAL ACCIDENT - GROUP. UIN : RELPAGP01001V010001
*Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License.
RGI/MCOM/CO/ 2914 /PS/Ver.1.0/151020

7 of 18
Schedule of Members covered attached to and forming part of Policy No 121632429140000046

SNo Emp Name Nominee Grade Age Gen Table A Table B Table C Table D Total DateofJoi Location Remarks
Cod der Sum ning
e Insured
35 2010 KAUSIK BRATA DAN NA NA 50 Yr M 0 0 9500000 500000 10000000 11/16/2024
90 00 M [Link]
AM
36 2010 ARGHOJYOTI DEY NA NA 34 Yr M 0 0 4500000 500000 5000000 11/16/2024
9889 00 M [Link]
AM
37 20110 SHATRUGHAN NA NA 40 Yr M 0 0 4500000 500000 5000000 11/16/2024
362 MAHATO 00 M [Link]
AM
38 20113 KRUPANANDA BABU NA NA 53 Yr M 0 0 9500000 500000 10000000 11/16/2024
049 PONNADA 00 M [Link]
AM
39 20116 PRATEEK GOYAL NA NA 30 Yr M 0 0 3500000 500000 4000000 11/16/2024
345 00 M [Link]
AM
40 2013 DEVADUTT NA NA 32 Yr M 0 0 3500000 500000 4000000 11/16/2024
2586 BADHADRA 00 M [Link]
AM
41 2014 VINOD NA NA 25 Yr M 0 0 2000000 500000 2500000 11/16/2024
1056 BHAGWANSAHAY 00 M [Link]
KUMAVAT AM
42 2014 DEEPAK KUMAR NA NA 40 Yr M 0 0 2000000 500000 2500000 11/16/2024
1260 00 M [Link]
AM
43 2014 ARTI MANISH NA NA 48 Yr F 0 0 9500000 500000 10000000 11/16/2024
8249 TAMHANKAR 00 M [Link]
AM
44 2014 CHINTAN DILIPBHAI NA NA 32 Yr M 0 0 3500000 500000 4000000 11/16/2024
8349 PANCHAL 00 M [Link]
AM
45 2015 HIMANSHU VIPIN NA NA 28 Yr M 0 0 4500000 500000 5000000 11/16/2024
3324 DWIVEDI 00 M [Link]
AM
46 3354 SIVA P NA NA 54 Yr M 0 0 1200000 500000 12500000 11/16/2024
7 00 M 0 [Link]
AM
47 3355 SHOBHA SHETTY NA NA 52 Yr F 0 0 4500000 500000 5000000 11/16/2024
2 00 M [Link]
AM
48 3355 SANTOSH NA NA 48 Yr M 0 0 9500000 500000 10000000 11/16/2024
5 KOOTINGAL 00 M [Link]
AM
49 3359 PUNIT FAISAL NA NA 45 Yr F 0 0 4500000 500000 5000000 11/16/2024
8 MADRE 00 M [Link]
AM
50 3361 SATISH JOYASHI NA NA 48 Yr M 0 0 4500000 500000 5000000 11/16/2024
3 00 M [Link]
AM
51 3361 SHAKEEL AHMAD NA NA 52 Yr M 0 0 4500000 500000 5000000 11/16/2024
8 00 M [Link]
AM

Reliance General Insurance Company Limited. IRDAI Registration No. 103 An ISO 9001:2015 Certified Company
Registered Office & Corporate Office/Policy Issuing Office: Reliance General Insurance Company Limited 6th Floor, Oberoi Commerz, International Business Park, Oberoi Garden City, Off Western Express Highway,
Goregaon (East), Mumbai - 400 063.
Corporate Identity No: U66603MH2000PLC128300. PERSONAL ACCIDENT - GROUP. UIN : RELPAGP01001V010001
*Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License.
RGI/MCOM/CO/ 2914 /PS/Ver.1.0/151020

8 of 18
Schedule of Members covered attached to and forming part of Policy No 121632429140000046

SNo Emp Name Nominee Grade Age Gen Table A Table B Table C Table D Total DateofJoi Location Remarks
Cod der Sum ning
e Insured
52 3363 GIRISH LELE NA NA 50 Yr M 0 0 4500000 500000 5000000 11/16/2024
7 00 M [Link]
AM
53 5410 HARSHADKUMAR NA NA 49 Yr M 0 0 2000000 500000 2500000 11/16/2024
59 ISHWARBHAI PATEL 00 M [Link]
AM
54 5410 YOGESH R MISTRY NA NA 44 Yr M 0 0 2000000 500000 2500000 11/16/2024
61 00 M [Link]
AM
55 5410 BHAVESH SHAH NA NA 42 Yr M 0 0 4500000 500000 5000000 11/16/2024
64 00 M [Link]
AM
56 5410 BHAVIK GANDHI NA NA 42 Yr M 0 0 2000000 500000 2500000 11/16/2024
68 00 M [Link]
AM
57 5415 YASIN IBRAHIM NA NA 58 Yr M 0 0 2000000 500000 2500000 11/16/2024
19 PATEL 00 M [Link]
AM
58 7248 SRIDEVI NA NA 52 Yr F 0 0 3500000 500000 4000000 11/16/2024
1 RAGHUNATHAN 00 M [Link]
AM
59 8003 DARSHAN PATEL NA NA 33 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
60 8006 ACHYUT KRISHNA NA NA 40 Yr M 0 0 3500000 500000 4000000 11/16/2024
DAS 00 M [Link]
AM
61 8019 SHREY MISHRA NA NA 36 Yr M 0 0 4500000 500000 5000000 11/16/2024
00 M [Link]
AM
62 8028 RUPESH NARESH NA NA 34 Yr M 0 0 3500000 500000 4000000 11/16/2024
KADU 00 M [Link]
AM
63 8037 KANAGASABABATHY NA NA 48 Yr M 0 0 3500000 500000 4000000 11/16/2024
S 00 M [Link]
AM
64 8038 SRITHARAN J NA NA 55 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
65 8040 BHARATHAN K NA NA 30 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
66 8049 SAQEEB AHMED NA NA 36 Yr M 0 0 4500000 500000 5000000 11/16/2024
00 M [Link]
AM
67 8050 MANSI TYAGI NA NA 39 Yr F 0 0 2000000 500000 2500000 11/16/2024
00 M [Link]
AM
68 8053 GOBALAKRISHNAN NA NA 30 Yr M 0 0 3500000 500000 4000000 11/16/2024
M 00 M [Link]
AM

Reliance General Insurance Company Limited. IRDAI Registration No. 103 An ISO 9001:2015 Certified Company
Registered Office & Corporate Office/Policy Issuing Office: Reliance General Insurance Company Limited 6th Floor, Oberoi Commerz, International Business Park, Oberoi Garden City, Off Western Express Highway,
Goregaon (East), Mumbai - 400 063.
Corporate Identity No: U66603MH2000PLC128300. PERSONAL ACCIDENT - GROUP. UIN : RELPAGP01001V010001
*Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License.
RGI/MCOM/CO/ 2914 /PS/Ver.1.0/151020

9 of 18
Schedule of Members covered attached to and forming part of Policy No 121632429140000046

SNo Emp Name Nominee Grade Age Gen Table A Table B Table C Table D Total DateofJoi Location Remarks
Cod der Sum ning
e Insured
69 8056 RUBY PANDIT NA NA 31 Yr F 0 0 2000000 500000 2500000 11/16/2024
00 M [Link]
AM
70 8057 ABHISHEK NA NA 32 Yr M 0 0 3500000 500000 4000000 11/16/2024
TOSHNIWAL 00 M [Link]
AM
71 8067 DINESHKUMAR K NA NA 33 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
72 8076 RAFI SHAIK NA NA 29 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
73 8079 AMAN KASHYAP NA NA 30 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
74 8081 JAYAWANT JHA NA NA 37 Yr M 0 0 4500000 500000 5000000 11/16/2024
00 M [Link]
AM
75 8088 VAIBHAV DINKAR NA NA 41 Yr M 0 0 4500000 500000 5000000 11/16/2024
GHATE 00 M [Link]
AM
76 8091 KAUSHLENDRA NA NA 40 Yr M 0 0 4500000 500000 5000000 11/16/2024
CHAUHAN 00 M [Link]
AM
77 8092 DISHA ALPESH NA NA 35 Yr F 0 0 2000000 500000 2500000 11/16/2024
PATHARI 00 M [Link]
AM
78 8093 PRAKASH JAGTAP NA NA 38 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
79 8094 MEGHA BHARATI NA NA 33 Yr F 0 0 2000000 500000 2500000 11/16/2024
00 M [Link]
AM
80 8097 SANKALP NA NA 36 Yr M 0 0 4500000 500000 5000000 11/16/2024
SRIVASTAVA 00 M [Link]
AM
81 8100 HARISH KUMAR NA NA 40 Yr M 0 0 2000000 500000 2500000 11/16/2024
SAHU 00 M [Link]
AM
82 8101 SHIVRAJ A NA NA 42 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
83 8102 ASLAM B PATEL NA NA 28 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
84 8109 KAUSHIK SARDAR NA NA 26 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
85 8118 ISHWAR LAL NA NA 36 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM

Reliance General Insurance Company Limited. IRDAI Registration No. 103 An ISO 9001:2015 Certified Company
Registered Office & Corporate Office/Policy Issuing Office: Reliance General Insurance Company Limited 6th Floor, Oberoi Commerz, International Business Park, Oberoi Garden City, Off Western Express Highway,
Goregaon (East), Mumbai - 400 063.
Corporate Identity No: U66603MH2000PLC128300. PERSONAL ACCIDENT - GROUP. UIN : RELPAGP01001V010001
*Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License.
RGI/MCOM/CO/ 2914 /PS/Ver.1.0/151020

10 of 18
Schedule of Members covered attached to and forming part of Policy No 121632429140000046

SNo Emp Name Nominee Grade Age Gen Table A Table B Table C Table D Total DateofJoi Location Remarks
Cod der Sum ning
e Insured
86 8127 KARTHIC R NA NA 29 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
87 8128 JISHNU P NA NA 28 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
88 8129 KARTHIC B NA NA 28 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
89 8132 RIBHU NA NA 33 Yr M 0 0 3500000 500000 4000000 11/16/2024
CHATTERJEE 00 M [Link]
AM
90 8133 RAMANJINEYULU NA NA 32 Yr M 0 0 3500000 500000 4000000 11/16/2024
BENNE 00 M [Link]
AM
91 8135 TUSHAR NAMDEO NA NA 32 Yr M 0 0 3500000 500000 4000000 11/16/2024
KADU 00 M [Link]
AM
92 8138 MITHUN KUMAR NA NA 30 Yr M 0 0 3500000 500000 4000000 11/16/2024
ASHOK PINKY JHA 00 M [Link]
AM
93 8140 JASMINE NA NA 40 Yr F 0 0 4500000 500000 5000000 11/16/2024
SEBASTIAN 00 M [Link]
AM
94 8144 DEBASIS NAYAK NA NA 40 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
95 8146 MADHAV PANDYA NA NA 27 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
96 8147 KUNDAN SAH NA NA 34 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
97 8149 RAVI PENTA NA NA 40 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
98 8151 VAIBHAV SIRMOUR NA NA 26 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
99 8154 AVIJAN PATTANAYAK NA NA 32 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
100 8158 RAKHEE SOHI NA NA 48 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
101 8163 MITESH PATEL NA NA 34 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
102 8164 KEERTHIVASAN NA NA 28 Yr M 0 0 3500000 500000 4000000 11/16/2024
GANAPATHY 00 M [Link]
AM

Reliance General Insurance Company Limited. IRDAI Registration No. 103 An ISO 9001:2015 Certified Company
Registered Office & Corporate Office/Policy Issuing Office: Reliance General Insurance Company Limited 6th Floor, Oberoi Commerz, International Business Park, Oberoi Garden City, Off Western Express Highway,
Goregaon (East), Mumbai - 400 063.
Corporate Identity No: U66603MH2000PLC128300. PERSONAL ACCIDENT - GROUP. UIN : RELPAGP01001V010001
*Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License.
RGI/MCOM/CO/ 2914 /PS/Ver.1.0/151020

11 of 18
Schedule of Members covered attached to and forming part of Policy No 121632429140000046

SNo Emp Name Nominee Grade Age Gen Table A Table B Table C Table D Total DateofJoi Location Remarks
Cod der Sum ning
e Insured
103 8167 CHYAWAN KUMAR NA NA 37 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
104 8170 RAHUL KUMAR JHA NA NA 27 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
105 8171 DIPAK MAKWANA NA NA 31 Yr M 0 0 2000000 500000 2500000 11/16/2024
00 M [Link]
AM
106 8179 RISHIKESH NA NA 29 Yr M 0 0 2000000 500000 2500000 11/16/2024
JAISWAL 00 M [Link]
AM
107 8181 SUJIT KUMAR NA NA 30 Yr M 0 0 2000000 500000 2500000 11/16/2024
SHARMA 00 M [Link]
AM
108 8185 BHARATH NA NA 30 Yr M 0 0 3500000 500000 4000000 11/16/2024
SAHYADRI 00 M [Link]
AM
109 8189 BIMLESH PANDEY NA NA 33 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
110 8190 AKSHAY PATIL NA NA 29 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
111 8196 ANSHUL AGARWAL NA NA 28 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
112 8199 DEEPU KUMAR RAI NA NA 31 Yr M 0 0 2000000 500000 2500000 11/16/2024
00 M [Link]
AM
113 8201 ARITRA SAHA NA NA 39 Yr M 0 0 4500000 500000 5000000 11/16/2024
00 M [Link]
AM
114 8204 TUSHAR SONI NA NA 29 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
115 8205 SRIKANTH K NA NA 27 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
116 8206 NAVEEN GURJAR NA NA 29 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
117 8208 VAIJAINTHBABULING NA NA 32 Yr M 0 0 3500000 500000 4000000 11/16/2024
AM P 00 M [Link]
AM
118 8209 PRIYA SHAH NA NA 28 Yr F 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
119 8210 PRADEEP PATIL NA NA 38 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM

Reliance General Insurance Company Limited. IRDAI Registration No. 103 An ISO 9001:2015 Certified Company
Registered Office & Corporate Office/Policy Issuing Office: Reliance General Insurance Company Limited 6th Floor, Oberoi Commerz, International Business Park, Oberoi Garden City, Off Western Express Highway,
Goregaon (East), Mumbai - 400 063.
Corporate Identity No: U66603MH2000PLC128300. PERSONAL ACCIDENT - GROUP. UIN : RELPAGP01001V010001
*Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License.
RGI/MCOM/CO/ 2914 /PS/Ver.1.0/151020

12 of 18
Schedule of Members covered attached to and forming part of Policy No 121632429140000046

SNo Emp Name Nominee Grade Age Gen Table A Table B Table C Table D Total DateofJoi Location Remarks
Cod der Sum ning
e Insured
120 8211 VICKY KUMAR NA NA 30 Yr M 0 0 3500000 500000 4000000 11/16/2024
YADAV 00 M [Link]
AM
121 8212 AKASH DHANE NA NA 28 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
122 8213 PRADEEP KUMAR NA NA 30 Yr M 0 0 2000000 500000 2500000 11/16/2024
00 M [Link]
AM
123 8214 ASHISH SAINI NA NA 32 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
124 8215 DEEPANSHU GUPTA NA NA 29 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
125 8216 CHINMOY DAS NA NA 54 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
126 8218 NARENDRA PATEL NA NA 35 Yr M 0 0 4500000 500000 5000000 11/16/2024
00 M [Link]
AM
127 8221 PRAKASH K NA NA 28 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
128 8222 ASHUTOSH KUMAR NA NA 24 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
129 8226 SWAYAM SIDDHA NA NA 24 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
130 8229 ABHISHEK PATRA NA NA 23 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
131 8230 RITIK KUMAR NA NA 24 Yr M 0 0 3500000 500000 4000000 11/16/2024
AMANTA 00 M [Link]
AM
132 8231 PABITRA KUMAR NA NA 26 Yr M 0 0 3500000 500000 4000000 11/16/2024
DASH 00 M [Link]
AM
133 8232 PRAJESH KUMAR NA NA 23 Yr M 0 0 3500000 500000 4000000 11/16/2024
DEHURY 00 M [Link]
AM
134 8233 SIDDHARTH KUMAR NA NA 30 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
135 8234 KRISHNA KUMAR NA NA 26 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
136 8235 MOHD AMMAR KHAN NA NA 23 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM

Reliance General Insurance Company Limited. IRDAI Registration No. 103 An ISO 9001:2015 Certified Company
Registered Office & Corporate Office/Policy Issuing Office: Reliance General Insurance Company Limited 6th Floor, Oberoi Commerz, International Business Park, Oberoi Garden City, Off Western Express Highway,
Goregaon (East), Mumbai - 400 063.
Corporate Identity No: U66603MH2000PLC128300. PERSONAL ACCIDENT - GROUP. UIN : RELPAGP01001V010001
*Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License.
RGI/MCOM/CO/ 2914 /PS/Ver.1.0/151020

13 of 18
Schedule of Members covered attached to and forming part of Policy No 121632429140000046

SNo Emp Name Nominee Grade Age Gen Table A Table B Table C Table D Total DateofJoi Location Remarks
Cod der Sum ning
e Insured
137 8236 SHIVAM SHARMA NA NA 22 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
138 8238 SUVAM DAS NA NA 26 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
139 8239 THULASIPRASAD NA NA 31 Yr M 0 0 3500000 500000 4000000 11/16/2024
RADHAKRISHNAN 00 M [Link]
AM
140 8240 VIKAS SHARMA NA NA 32 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
141 8242 HARSHAL KULKARNI NA NA 27 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
142 8243 ABHISHEK DUBEY NA NA 29 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
143 8244 SIRJAN AFZAL NA NA 29 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
144 8245 G RAMESH KUMAR NA NA 49 Yr M 0 0 4500000 500000 5000000 11/16/2024
00 M [Link]
AM
145 8246 KOLLI JOSH REDDY NA NA 23 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
146 8250 AAKARSH GAYALA NA NA 22 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
147 8251 ANJALI DODIA NA NA 28 Yr F 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
148 8252 ROHIT MISHRA NA NA 30 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
149 8257 SHABANAM SHEIKH NA NA 24 Yr F 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
150 8258 ADITYA SHEKHAR NA NA 22 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
151 8259 SHASHANK NA NA 23 Yr M 0 0 3500000 500000 4000000 11/16/2024
JAISWAR 00 M [Link]
AM
152 8262 PARTH BALAI NA NA 29 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
153 8263 KAUSHAL DALWADI NA NA 26 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM

Reliance General Insurance Company Limited. IRDAI Registration No. 103 An ISO 9001:2015 Certified Company
Registered Office & Corporate Office/Policy Issuing Office: Reliance General Insurance Company Limited 6th Floor, Oberoi Commerz, International Business Park, Oberoi Garden City, Off Western Express Highway,
Goregaon (East), Mumbai - 400 063.
Corporate Identity No: U66603MH2000PLC128300. PERSONAL ACCIDENT - GROUP. UIN : RELPAGP01001V010001
*Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License.
RGI/MCOM/CO/ 2914 /PS/Ver.1.0/151020

14 of 18
Schedule of Members covered attached to and forming part of Policy No 121632429140000046

SNo Emp Name Nominee Grade Age Gen Table A Table B Table C Table D Total DateofJoi Location Remarks
Cod der Sum ning
e Insured
154 8264 UTKARSH NA NA 28 Yr M 0 0 3500000 500000 4000000 11/16/2024
SRIVASTAVA 00 M [Link]
AM
155 8265 TULENDRA KUMAR NA NA 35 Yr M 0 0 4500000 500000 5000000 11/16/2024
VERMA 00 M [Link]
AM
156 8266 RISHABH NA NA 28 Yr M 0 0 3500000 500000 4000000 11/16/2024
DEWANGAN 00 M [Link]
AM
157 8267 SUBRATA DAS NA NA 54 Yr M 0 0 4500000 500000 5000000 11/16/2024
00 M [Link]
AM
158 8268 MUKESH SINGH NA NA 32 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
159 8269 SANDEEP SINGH NA NA 29 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
160 8270 ANKUR GUPTA NA NA 28 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
161 8271 SHILPA BHOSALE NA NA 38 Yr F 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
162 8272 MEHUL SAINI NA NA 29 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
163 8274 ANIL SHUKLA NA NA 28 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
164 8275 ARJUN KUMAR NA NA 26 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
165 8276 SOHIT SANKHLA NA NA 31 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
166 8277 BHARGAV ABOTI NA NA 35 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
167 8278 TANMOY NA NA 26 Yr M 0 0 3500000 500000 4000000 11/16/2024
MAJUMDAR 00 M [Link]
AM
168 8279 SARAN SRIHARI NA NA 23 Yr M 0 0 2000000 500000 2500000 11/16/2024
00 M [Link]
AM
169 8280 ARAVIND BABU L NA NA 22 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
170 8283 GOPINATH G NA NA 22 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM

Reliance General Insurance Company Limited. IRDAI Registration No. 103 An ISO 9001:2015 Certified Company
Registered Office & Corporate Office/Policy Issuing Office: Reliance General Insurance Company Limited 6th Floor, Oberoi Commerz, International Business Park, Oberoi Garden City, Off Western Express Highway,
Goregaon (East), Mumbai - 400 063.
Corporate Identity No: U66603MH2000PLC128300. PERSONAL ACCIDENT - GROUP. UIN : RELPAGP01001V010001
*Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License.
RGI/MCOM/CO/ 2914 /PS/Ver.1.0/151020

15 of 18
Schedule of Members covered attached to and forming part of Policy No 121632429140000046

SNo Emp Name Nominee Grade Age Gen Table A Table B Table C Table D Total DateofJoi Location Remarks
Cod der Sum ning
e Insured
171 8284 NAMBIRAJAN NA NA 32 Yr M 0 0 3500000 500000 4000000 11/16/2024
MUPPIDATHI 00 M [Link]
AM
172 8285 SANTANU HAZRA NA NA 27 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
173 8286 MIDHUN M NA NA 24 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
174 8287 ASHPAK MANSURI NA NA 32 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
175 8288 NEELABH NA NA 30 Yr M 0 0 3500000 500000 4000000 11/16/2024
SRIVASTAVA 00 M [Link]
AM
176 8289 AYUSH MISHRA NA NA 23 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
177 8290 DARPAN BHARDWAJ NA NA 22 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
178 8292 ADITYA MISHRA NA NA 22 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
179 8293 ANIRUDH PRATAP NA NA 23 Yr M 0 0 3500000 500000 4000000 11/16/2024
SINGH 00 M [Link]
AM
180 8295 PRATAP SINGH NA NA 25 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
181 8296 VINAY NA NA 22 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
182 8297 RITESH KUMAR NA NA 22 Yr M 0 0 3500000 500000 4000000 11/16/2024
YADAV 00 M [Link]
AM
183 8298 ASHISH ANAND NA NA 21 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
184 8299 KAPIL PATIL NA NA 33 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
185 8300 ROHIT JADHAV NA NA 29 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
186 8301 NIKUNJ BUHA NA NA 30 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
187 8302 JAYSUKH KHASIYA NA NA 27 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM

Reliance General Insurance Company Limited. IRDAI Registration No. 103 An ISO 9001:2015 Certified Company
Registered Office & Corporate Office/Policy Issuing Office: Reliance General Insurance Company Limited 6th Floor, Oberoi Commerz, International Business Park, Oberoi Garden City, Off Western Express Highway,
Goregaon (East), Mumbai - 400 063.
Corporate Identity No: U66603MH2000PLC128300. PERSONAL ACCIDENT - GROUP. UIN : RELPAGP01001V010001
*Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License.
RGI/MCOM/CO/ 2914 /PS/Ver.1.0/151020

16 of 18
Schedule of Members covered attached to and forming part of Policy No 121632429140000046

SNo Emp Name Nominee Grade Age Gen Table A Table B Table C Table D Total DateofJoi Location Remarks
Cod der Sum ning
e Insured
188 8303 DARSHAN JOSHI NA NA 24 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
189 8304 DISHANK MISTRY NA NA 24 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
190 8306 CHETAN THAKARE NA NA 34 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
191 8307 TANMOY KUNDU NA NA 29 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
192 8308 ARGHADEEP NA NA 26 Yr M 0 0 2000000 500000 2500000 11/16/2024
GHOSH 00 M [Link]
AM
193 8309 ASHISH BHORE NA NA 29 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
194 8310 MANISH KARMUR NA NA 27 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
195 8311 SANDEEP PAWAR NA NA 28 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
196 8312 TAMENDRA PARMAR NA NA 25 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
197 8313 VISHAL RAUT NA NA 30 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
198 8314 GAGAN PRADHAN NA NA 26 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
199 8316 APOORV SAXENA NA NA 28 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
200 8317 HEMANTH IJJADA NA NA 22 Yr M 0 0 3500000 500000 4000000 11/16/2024
00 M [Link]
AM
201 8318 ANKIT SHARMA NA NA 36 Yr M 0 0 2000000 500000 2500000 11/16/2024
00 M [Link]
AM
202 8319 UTKARSH KUMAR NA NA 25 Yr M 0 0 3500000 500000 4000000 11/16/2024
SINGH 00 M [Link]
AM
203 8320 DHAVAL NA NA 35 Yr M 0 0 4500000 500000 5000000 11/16/2024
SURYAVANSHI 00 M [Link]
AM
204 9509 SUNDARARAMAN NA NA 47 Yr M 0 0 9500000 500000 10000000 11/16/2024
25 BALACHANDRAN 00 M [Link]
AM

Reliance General Insurance Company Limited. IRDAI Registration No. 103 An ISO 9001:2015 Certified Company
Registered Office & Corporate Office/Policy Issuing Office: Reliance General Insurance Company Limited 6th Floor, Oberoi Commerz, International Business Park, Oberoi Garden City, Off Western Express Highway,
Goregaon (East), Mumbai - 400 063.
Corporate Identity No: U66603MH2000PLC128300. PERSONAL ACCIDENT - GROUP. UIN : RELPAGP01001V010001
*Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License.
RGI/MCOM/CO/ 2914 /PS/Ver.1.0/151020

17 of 18
Schedule of Members covered attached to and forming part of Policy No 121632429140000046

SNo Emp Name Nominee Grade Age Gen Table A Table B Table C Table D Total DateofJoi Location Remarks
Cod der Sum ning
e Insured
205 9509 DEEPAK KUMAR NA NA 47 Yr M 0 0 9500000 500000 10000000 11/16/2024
40 00 M [Link]
AM
206 9512 ADWAITA PRASAD NA NA 56 Yr M 0 0 3500000 500000 4000000 11/16/2024
57 TEWARY 00 M [Link]
AM
207 9512 DEBABRATA SAHOO NA NA 48 Yr M 0 0 3500000 500000 4000000 11/16/2024
78 00 M [Link]
AM
208 9529 VENUGOPALA M NA NA 49 Yr M 0 0 9500000 500000 10000000 11/16/2024
06 BHAT 00 M [Link]
AM
209 9541 KULDEEP NA NA 41 Yr M 0 0 9500000 500000 10000000 11/16/2024
35 NANJIBHAI 00 M [Link]
JULASANA AM
210 9541 SACHIN ANILKUMAR NA NA 43 Yr M 0 0 9500000 500000 10000000 11/16/2024
77 CHOWDHARY 00 M [Link]
AM
211 9543 ADITYA N GUPTA NA NA 42 Yr M 0 0 9500000 500000 10000000 11/16/2024
96 00 M [Link]
AM
Grand Total 0 0 8625000 1055000 968000000
00 00

Reliance General Insurance Company Limited. IRDAI Registration No. 103 An ISO 9001:2015 Certified Company
Registered Office & Corporate Office/Policy Issuing Office: Reliance General Insurance Company Limited 6th Floor, Oberoi Commerz, International Business Park, Oberoi Garden City, Off Western Express Highway,
Goregaon (East), Mumbai - 400 063.
Corporate Identity No: U66603MH2000PLC128300. PERSONAL ACCIDENT - GROUP. UIN : RELPAGP01001V010001
*Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License.
RGI/MCOM/CO/ 2914 /PS/Ver.1.0/151020

18 of 18