Policy No.

: 2019-M1264628-FSS
Date : 25/03/2019
Mr. Mithun Das
Maldiha,
Kabilpur,
Birbhum,
West Bengal, Pincode: 731127
Intermediary Name : UCO BANK-COB
Dear Mr. Mithun Das
Welcome to the Future Generali Experience.

We thank you for choosing us for your insurance requirements. Your Policy No. is 2019-M1264628-FSS.
Our initiatives will provide you with the highest standards of service, convenience and quality in insurance and it is our endeavour to
constantly better your experience by innovating and evolving our basket of conveniences.
In case of any service requirement, do call our care lines below:
1800-220-233, 1860-500-3333, 022-67837800.
Once again, thank you for choosing to insure with Future Generali and we look forward to being of service to you.

If undelivered, please return to:

For Future Generali India Insurance Co. Ltd.
Future Generali India Insurance Company Limited
4th Floor, Crosspace
Plot No. 821 (P)
Gandhi More, City Centre
Durgapur (Authorised Signatory)
West Bengal, 713216

Please review the communication address, email or contact nos. noted on this letter for correctness. In case of any change please contact our
nearest branch or call our care lines mentioned above. This will ensure you do not miss out on 'Service Updates' and 'Renewal Reminders'.
Now you can buy Health, Personal Accident, Travel, Home, Motor insurance & also renew your Future Generali Private Car Insurance
policy online. Visit us at www.futuregenerali.in
For any service request please sms SERVE to 9222211100. To provide feedback on our service, kindly sms HAPPY or UNHAPPY to
9222211100. We will call you back.
Future Generali India Insurance Company Limited, Corporate & Registered Office: 6th Floor, Tower - 3, Indiabulls Finance Center, Senapati Bapat
Marg, Elphinstone Road, Mumbai - 400013, Maharashtra. Care Line:- 1800-220-233, 1860-500-3333, 022-67837800, Email: fgcare@futuregenerali.in,
Website: www.futuregenerali.in. IRDA Regn.No. 132, CIN - U66030MH2006PLC165287.
 Tax Invoice

INSURED DETAILS
Policy Number : 2019-M1264628-FSS Address of Service Provider: Off Code-72,Future Generali India Insurance Co
Ltd, 4th Floor, Crosspace, Plot No. 821 (P),
Invoice Number : 201819PNT0047216 Gandhi More, City Centre, Durgapur, West
Bengal, Pincode - 713216

Reverse Charge : No Area Code : Durgapur Branch Office

Name of Insured/Proposer : Mr. Mithun Das FGI State Code : 19
Address : Maldiha, Kabilpur, Birbhum, West Bengal, FGI GSTIN Number : 19AABCF0191R1Z6
Pincode- 731127
Place of Supply(State Code): 19 Intermediary Name \ Code : UCO BANK \ 60051558
GSTIN / UIN Number : - Date of Issue / Invoice : 25/03/2019
Date
Period of Insurance : From 00:00 hours of 18/03/2019 HSN : 997139
To Midnight of 17/03/2020 Nature of Service : General Insurance Service

Received with thanks from Mithun Das a sum of ₹ 225.00 towards Premium on the above mentioned policy.

PARTICULARS TAX(%) PREMIUM ( ₹ )

Gross Premium 190.33
Add : CGST 9% 17.13
Add : SGST 9% 17.13
Add : Cess -
Total (Rounded to nearest rupee) 225.00

NOTE :
1. In case of payment by cheque, in the event of dishonour of cheque for any reason whatsoever,insurance cover provided under this receipt automatically stands
cancelled from the inception irrespective of whether a seperate communication is sent or not.
2. Excess amount, if any, will be adjusted against subsequent policies, or will be refunded on demand.

For FUTURE GENERALI INDIA INSURANCE CO. LTD.

(Authorised Signatory)

Signature Not Verified

Digitally signed by SHARADA
RAMAKRISHNAN
Date: 2019.03.25 14:18:05
IST
Location: Mumbai
Note:This document is digitally signed by Sharada Ramakrishnan, Authorised Signatory of Future Generali
India Insurance Company Limited on 25/03/2019

Future Generali India Insurance Company Limited, Corporate & Registered Office: 6th Floor, Tower - 3, Indiabulls Finance Center, Senapati Bapat
Marg, Elphinstone Road, Mumbai - 400013, Maharashtra. Care Line:- 1800-220-233, 1860-500-3333, 022-67837800, Email: fgcare@futuregenerali.in,
Website: www.futuregenerali.in. IRDA Regn.No. 132, CIN - U66030MH2006PLC165287.
 Business Suraksha- Policy Schedule
Policy Servicing Office : Off Code-72,Future Generali India Insurance Co Ltd, 4th Floor, Crosspace, Plot No. 821 (P), Gandhi More, City Centre, Durgapur,
West Bengal, Pincode- 713216., Tel_No : -
Policy No : 2019-M1264628-FSS Period of Insurance : From 00:00 18/03/2019 To Midnight of 17/03/2020
Insured : Mr. Mithun Das Intermediary Name/Code : UCO BANK/60051558 (605)
Address : Maldiha, Kabilpur, Birbhum, West Bengal, Telephone(Hom) : 3324109977
731127 Email Id : HOIMWKOLKATA@UCOBANK.CO.IN
GSTIN Number : - FGI GSTIN Number : 19AABCF0191R1Z6
In consideration of the Policy holder named here in paying to the Future Generali India Insurance Company Limited (herein after 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 with 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 here in after set forth.
Co-insurance Details Schedule Of Premium
Insurer Share (In %) Gross Premium 190.33
FUTURE GENERALI INDIA INSURANCE COMPANY LIMITED 100% Goods and Service Tax 34.26
Total Premium 225.00
Risk Details
Property Situated at : Maldiha Kabilpur Birbhum West Bengal
Occupancy : Shop
Hypothecated with : UCO BANK - MD BAZAR 6050510011751
Plan Name : NA
Serial
Description Sum Insured ( ₹ ) Excess
No.
I Fire and Allied Perils
1 Contents STOCK OF HOTEL 50,000.00 5% of claim amount subject to
minimum of INR 10,000 for each
and every claim
II Burglary
1 Contents STOCK OF HOTEL 50,000.00 5% of claim amount subject to
minimum of INR 2500 for each and
every claim
First Loss % 100.00 50,000.00
III Money Insurance
1 Cash in Transit SHOP TO BANK AND BANK TO SHOP 10,000.00 Nil
IV Plate Glass
1 Fixed Plate Glass 5,000.00 5% of claim amount subject to
minimum of INR 2500 for each and
every claim
V Baggage
1 Baggage 5,000.00 Nil
VI STFI
1 STFI 50,000.00
VII EARTH QUAKE
1 Earth Quake 50,000.00
Additional Clauses, Conditions, Warranties & Exclusions
Agreed Bank Clause
Designation of Property Clause
Earthquake (Fire and Shock)
Local Authorities Clause
Market Value Clause
Reinstatement Value Clause (Excluding Stock and Stock In Process)

Terrorism Damage Exclusion Clause

IMPORTANT - 1. All other Terms, Conditions and Exclusions as per attached Policy Wordings. 2. In case of payment by cheque, in the event of dishonor of cheque
for any reason whatsoever, insurance cover provided under this document automatically stands cancelled from the inception irrespective of whether a seperate
communication is sent or not.
Corporate Agency Registration No : CA0071 For FUTURE GENERALI INDIA INSURANCE CO. LTD.
SP Name -SP Code : ABHIK SENGUPTA-SP0071113076

Receipt No : Z9211747
Date of Issue : 25/03/2019
Place of Issuance : Mumbai*

*Address as mentioned below. (Authorised Signatory)

Future Generali India Insurance Company Limited, Corporate & Registered Office: 6th Floor, Tower - 3, Indiabulls Finance Center, Senapati Bapat
Marg, Elphinstone Road, Mumbai - 400013, Maharashtra. Care Line:- 1800-220-233, 1860-500-3333, 022-67837800, Email: fgcare@futuregenerali.in,
Website: www.futuregenerali.in. IRDA Regn.No. 132, CIN - U66030MH2006PLC165287.
 Note:This document is digitally signed by Sharada Ramakrishnan, Authorised Signatory of Future Generali
India Insurance Company Limited on 25/03/2019

The stamp duty of Rs. 0.50/- paid by Letter Of Authorisation CSD/311/2019/416/19, dated 29/01/2019. Mudrank - 2017/C.R.97/M-1,dated 09/01/2018.

Product UIN : IRDAN132P0005V01200910

Future Generali India Insurance Company Limited, Corporate & Registered Office: 6th Floor, Tower - 3, Indiabulls Finance Center, Senapati Bapat
Marg, Elphinstone Road, Mumbai - 400013, Maharashtra. Care Line:- 1800-220-233, 1860-500-3333, 022-67837800, Email: fgcare@futuregenerali.in,
Website: www.futuregenerali.in. IRDA Regn.No. 132, CIN - U66030MH2006PLC165287.