(OSBIgeneral INSURANCE
BHÁROSA DONO
SURAKSHA AUR
To,
WEX
SurveyTECHNOLOGI
no 244/2, ERaiiy
S PRIVATE
GandhiLIMITED
Date: 29/12/2023
info tech
HiIndia.
njewadi,Pune-411057
Maharashtra park,Hinjewadi
Contact details:+91-9852214777
Subject: Policy Number:
Dear Customer, 0000000036927170
Welcome to SBI
delighted to haveGeneral. Thank you for choosing SBI General's Employees
you as our esteemed Customer. We enclose the Compensation Insurance Policy. We are
following documents pertaining to your Policy:
Policy Schedule
Policy Clauses &
"
Wordings
Grievance Redressal Letter
" Premium Receipt
we have taken care that the
documents
Contirm that the documents are reflect details of
in order. Please ensure risk and cover as proposed by you. VWe request you t
For all your future
you may have with us,safety these documents as they form part of our contract
of verity and
correspondence kindly quote your Customer ID and with yOu.
Your Customer ID Policy Number.
: 0000000070012583
Your Policy Number :
0000000036927170
The Postal Address of your SBI
General Branch that will service you in future is:
SBIGeneral Insurance
289/6-7, Near 7 Loves Company Limited
Hotel, K.D. Plaza (1st
Swargate, Swargate /Bhavanipeth, floor), Nehru Road, Near Swargate,
Maharashtra-411042,
India.
In case of any
queries or suggestions, please do not
hesitate to get in touch with us. You can
Customer.care@sbigeneral.in or call our Customer Care
Number 1800-102-1111, contact us at
1800-22-1111
We look forward to a
continuing and mutually beneficial relationship.
Yours sincerely,
NSMAANCE
EENER4
DPUNE
AuthRedsig
locurance and SBl are separate legal entities and SBl is
working as Corporate Agent of the company for
sourcing of insurance oroducts
nral insurance Company Ltd.,
Registered Office: & Corporate Office: SBI General
Choor ARB Wing, Fulcrum Building, Sahar Road, Andheri East,
Mumbai - 400099 Insurance Company Ltd 9th
aay ldentity Number -
U6600OMHZO09PLC190546, IRDAI Registration No.144 UIN -SBG-WC-P12-43-V01-11-12
OSBI general INSURANCE
SURAKSHA AUR BHAROSADONO
EMPLOYEES COMPENSATION INSURANCE POLICY
UIN -SBG-WC-P12-43-V01-11-12
SCHEDULE
Policy No: 0000000036927170
Servicing Branch Office : SBI General Insurance Company Limited, K.D. Issue Date:
(1st floor), 289/6-7, Near 7 Loves Hotel, Plaza
Nehru Road, Near Swargate, 29/12/2023
Swargate, Swargate / Bhavanipeth - 411042.
Intermediary Details :
Intermediary Name First Policy Insurance Brokers Pvt Ltd
Intermediary Code 0004748
Intermediary Contact Details
Land Line No:+91-20-66073200
Insured Details:
WEX TECHNOLOGIES PRIVATE LIMITED
Name and Address of the Survey no 244/2, Rajiv Gandhi info tech park,,Hinjewadi
Insured
Hinjewadi,Pune
Maharashtra - 411057
India.
Business/Occupation of the Insured Chemical, acid, Cholorine & analysis,dosing, monitoring,
Policy Period Operator Cum helper, Helper and troubleshooting at site
From 28/12/2023 (20:38 Hrs) to Midnight of
Coverage Territory 27/12/2024
India
Risk Location Address
Details of Risk Location covered under the
"A" policy - Annexure
Details of Employees covered
As per Annexure "A"
Coinsurance Details
Own Share(100%)
Law
The Policy coversLiability of the
Insured under the
otherwise admissible as per terms, conditions and following Law(s) shown as covered, subject to claim being
exclusions of the Policy.
Sr. No. Law
Covered
Employees Compensation Act, 1923 and subsequent
1 amendments thereof
Yes
prior to the date of inception of this policy.
2 Common Law
Yes
3. Fatal Accidents Act 1855
Yes
Add On Cover:
Sr. No Particulars Covered
Limit of Indemnity (INR)
1 Coverage of Medical Expenses Yes
ME Per Person:
50000
2 Coverage for Contractors Employees Yes
3 Indemnity cover to Principals No
Principal Name :
Joint Policy Cover No
5 Cover for occasional domestic |labor No
6 Cover for Occupational diseases No
Commany ldentity Number -
Ubb00OMHZ00SPLCIS0S40, IRDAI Registration No.144 UIN - SBG-WC-P12-43-VO1-11.12
OSBIgeneral INSURANCE
BHAROSA DONO
SURAKSHA AUR
EMPLOYEES COMPENSATION INSURANCE POLICY
Attached to and forming part of the Schedule to the
Policy No. 0000000036927170
Clauses Applicable:
Radioactive Exclusion Clause
Political Risk Exclusion Clause
Special Condition Clause
Communicable Disease Exclusion Clause
Coverage For Medical Expenses
Coverage For Contractors
Workers/Employees
Endorsements
attached.
Applicable : All other
endorsement are as per Employees Compensation Insurance Policy Wording as
Warranties Applicable:
It is warranted that any change in actual
wages should be intimated to the company in writing in
insured and it may be covered at the option of the company advance by the
Allother as per Employees subject to payment of additional premium.
Compensation Insurance Policy Wording as attached.
Exclusions:
Blasting Activity and use/handling of explosives
Losses in connection with asbestos and/or asbestos
Known losses, incidents or circumstances likely to giveproducts/ asbestos containing products
rise to a loss prior to inception date of this Policy
exclusion
Any employment compensation in excess of the actual limit for
in respect of Common law awards) employee compensation ordinance (not to apply
Underground and/or Underwater mines and /or underground services thereof
Subaqueous work
All other as per Employees Compensation Insurance Policy
Wording as attached
Communicable Disease Exclusion
Cyber Loss Exclusion
Sanctions Limitation and Exclusion Clause
Political Risks Exclusion Endorsement
Radioactive Exclusion Clause
Information Technology Clarification Clause
Special Conditions (If any):
Proper register recording the attendance and wage disbursement must be
maintained and to be produced as
and when required.
Anv interest and/ or penalty imposed on the Insured on account of his/ their failure to comply with the
reauirements laid down under WC Act 1923 and subsequent amendments there of prior to the date of
Inception of this Policy" is excluded
Occupational diseases listed in part Cof the schedule Ill of the Act unless specifically covered by an
endorsement to the policy is excluded.
Compressed Air Diseases listed in Part Aof the Schedule ll of the Act unless specifically covered by an
endorsement to the policy is excluded.
Premium Computation:
Particulars Amount (Rs)
Gross Premium 5,393.00
Csmnany ldentity Number -U66000M H2009PLC190546, IRDAI Registration No.144 UIN -SBG-WC-P12-43-V01-11-12
OSBI gena
SURAKSHA AUR BHAROSA DONO
|Taxes as Applicable
971.00
Final Premium
6,364.00
Collection Details: System Receipt No.
Receipt Date:
P.S. It premium paid through cheque, the
policy is yoid ab
initio in case of dishonour of cheque.
Consoltdated Stamp Duty paid Rs. 0,5 towards Insuranee Policy Stamps vide Order
erod t.26708/Z023 to Dt.27/08/2024)/3568 Date:.
Office,Mumbai. 28/08/2023 Dated 2023-09-20 No.LOA/CSD/110/2025/(Vallcy
11:38:26.0 of
General Stamps
Signed at: Mumbai
For SBI GeneralInsurance CompanyLimited
Date: 29/12/2023
SURAN
PUN
GSTIN :27AAMCS8857L1ZC
Signatory
tih Number-
U66000MH2009PLC190546, IRDAI Registration No.144 UIN -
SBG-WC-P12-43-V01-11-12
OSBIgeneral
INSURANCE
BHAROSA DONO
SURAKSHA AUR
EMPLOYEES COMPENSATION INSURANCE POLICY
Attached to and forming part of the Schedule to the Policy No.
0000000036927170
Important Note:
ase examine this Policy including its attached Schedules/ Annexure if any. In the event of any discrepancy please coe
eorice of the Company immediately,it being noted that this Policy shallbe otherwise considered as being entirely in oroc
Edse refer the Claims Settlement& Grievance Redressal procedure document attached herein for ready references.
INTIMATING ACLAIM
For Intimating a Claim with us please contact us through the following channels:
Phone : 1800-102-1111/1800-22-1111(Toll Free 8:00 am to 8:00 pmn (Monday to Saturday)
Email -
customer.care@sbigeneral.in
Facsimile - 1800-102-7244/1800-22-7244(Toll Free)
CLAIM SETTLEMENT
The Company willsettle the claim under this policy within 30 days from the date of receipt of necessary documents required
Tor assessing the claim. In the event that the Company decides to reject a claim made under this policy, the Company shall do
So within a period of thirty days of the Survey Report or the additional Survey Report, as the case may be, in accordance with
the provisions of Protection of Policyholders' Interest Regulations 2017.
, identity Number - U66000MH2009PLC190546, IRDAIRegistration No.144 UIN -SBG-WC-P12-43-V01-11-12
(OSBI general INSURANCE
SURAKSHA AUR BHAROSA DONO
EMPLOYEES COMPENSATION INSURANCE POLICY
Attached to and forming part of the Schedule to the Policy No. 0000000036927170
ANNEXURE " A "
Details of Employees covered under the policy
Sr. No of Declared Wages
Description Risk Location Address
No. Employees (In Rs)
1 Site Inchange 1 241824.00
Adani Godda, APJL Jharkhand AND
Anywhere in India
AdaniGodda, APJL Jharkhand AND
2 Chemist &Opertor 1 203292.00
Anywhere in India
Adani Godda, APJL Jharkhand AND
3 Chemist &Opertor 1 189732.00
Anywhere in India
Adani Godda, APJL Jharkhand AND
4 Operator Cum helper 1 141600.00
Anywhere in India
139776.00
Adani Godda, APJL Jharkhand AND
5 Helper 1
Anywhere in India
174000.00
Adani Godda, APJL Jharkhand AND
6 Chemist & Opertor
Anywhere in India
Total : No of Employees and 6 00
Wages
Company ldentity Number -U66000MHZ009PLC190546, IRDAI Registration No.144 UIN -SBG-WC-P12-43-v01-11-12
OSBI general INSURANCE
SURAKSHA AUR BHAROSA DONO
EMPLOYEES COMPENSATION INSURANCE POLICY
Attached to and forming part of the Schedule to the Policy No. 0000000036927170
CLAUSE WORDINGS
Radioactive Exclusion Clause
|Notwithstanding any provision to the contrarv contained within this Policy or any endorsement thereto, it is hereby understood and agreed that
hCyexcludes loss, damage, cost or expense of whatsoever nature directly or indirectly caused by, resulting from or in connection with any of
tne rollowing regardless of any other cause or event contributing concurrently or in any other sequence to the loss:
i)
fuel; lonising radiations from or contamination by radioactivity from any nuclear fuel or from any nuclear waste or from the combustion of nuclear
The radioactive, toxic, explosive or other hazardous or contaminating properties of any nuclear installation, reactor or other nuclear
assembly or nuclear component thereof;
ii) Any weapon or device of war employing atomic or nuclear fission and/or fusion or other like reaction or radioactive force or matter.
Subject otherwise to the terms and conditions of this Policy, except for the specific terms, conditions and exclusions made
applicable herein.
Political Risk Exclusion Clause
|Notwithstanding any provision to the contrarycontained within this Policy or any endorsement thereto, it is hereby understood and agreed that
|this Policy excludes loss, damage, cost or expense of whatsoever nature directly or indirectly
caused by, resulting from or in connectionwith any of
|the following regardless of any other cause or event contributing concurrently or in any
other sequence to the loss:
War, invasion, acts of foreign enemies, hostilities or warlike operations (whether war be
declared or not), civil war,
|dispossession resulting from confiscation, commandeering or requisition by any lawfully constituted authority, Mutiny, civilPermant or temporary
|the proportions of or amounting to a particular rising, tribal rising, military rising, commotion assuming
power, martial law or state of siege or any of the events or causes which determine insurrection, strike, riot, rebellion, revolution, military or usurped
the proclamation or maintenance of martial law or state of
siege; or
ii) Any act of terrorism, including but not limited to the following:
a
Biologicalor chemical contamination;
b Missiles, bombs, grenades, explosives.
For the purpose of this endorsement an act of terrorism means an act,
including but not limited to the use of force or violence and/or the threat
thereof, of any person or group(s) of persons, whether acting alone or on behalf of or in
committed for political, religious, ideological, or ethnic purposes or reasons including theconnection
intention
with any organisation(s) or government(s),
to influence any government and/or to put the
public, or any section of the public, in fear.
á¬æContaminationa¬ means the contamination, poisoning, or prevention and/or limitation of the use of objects due to the effects of chemical
and/or biological substances.
This endorsement also excludes loss, damage, cost or expenses of
whatsoever nature directly or indirectly cause by, resulting from or in connection
with any action taken in controlling, preventing, suppressing or in any way relating to i) And
ii) above.
Subiect otherwise to the terms and conditions of this Policy, except for the specific
terms, conditions and exclusions made applicable herein.
Company ldentity Number - U66000MH2009PLC190546, IRDAI Registration No.144 UIN -
SBG-WC-P12-43-v01-11-12
OSBI) 9eneral
INSURANCE
SURAKSHA AUR BHAROSADONO
EMPLOYEES COMPENSATION INSURANCE POLICY
Attached to and forming part of the Schedule to the Policy No.
0000000036927170
Clauses Applicable :
SpecialCondition Clause
The provision of this clause shall override any provisions of any other clauses contained / attached to this Policy which may conflict.
Insofar as liability is incurred by the Insured under this Policy in respect of legal liability for Occupational Disease or Physical Impairment which does
not arise from asudden and identifiable accident or event, this Policy shallprovide cover only on the following basis:
i)Where the Occupational Disease or Physical Impairment results from exposure to a hazard of the employment of the claimant, any one claim in
respect of any one employee of an the Insured arising out of this exposure shall be considered individually as one event for the purpose of recovery
hereunder.
i)Where the legal liabilityof the Insured to the claimant is established on "exposure basis" that is legal liability attached for the whole or part of the
period which the claimant is exposed to the hazard of the employment then recovery hereunder shallbe as follows:
a.lhe proportion of the total claim amount in respect of any one employee attributable to any one Period of Insurance shall be that proportion of the
total amount which the period concerned bears to the total period during which employee was exposed to the hazard of the employment and,
b.The retention of the Insured and the liability of the insurer under the Policy shall be reduced in the proportion which each Period of lnsurance bears
to the total period during which the employer was insured by the Company and the employee was exposed to the hazard of the employment.
Provided always that exposure took place during the Period of the Insurance
ijlin the event of legal liability being established to the insured on other than an "exposure basis' as described above then for the purpose of recovery
hereunder the date of loss occurrence hereon shall be the date applicable to which such legal liability is established.
In the event of any change in legislation or interpretation of the law (provided that such change in interpretation is made by the highest court of any
individual state or by any federal or supranational court of higher authority) at any time after the inception of this Policy, by which the liability
hereunder of either party is materially increased, the parties hereto agree to take up for immediate discussion, at the written request of the either
party, a suitable revision in the terms and/or conditions of this Policy.
Should the parties fail to agree asuitable revision in the terms and/or conditions of this Policy within six months of the receipt of the written request
by the other party and after the effective inception of any such change in law, it is agreed that this Policy shall operate as if such changes had not
occurred.
Subject otherwise to the terms and conditions of this Policy, except for the specific terms, conditions and exclusions made applicable herein.
Company ldentity Number- U66000MH2009PLC190546, IRDAI Registration No.144 UIN -SBG-WC-P12-43-V01-11-12
