1NNP-RPP-24/08/2015 12:50:32-3-1 30010210000010 - 6.9.0.0

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In witness whereof the undersigned being authorised by and on behalf of the company has/have herein to set his/their hands.

Duly Constituted Attorney (s)

For and on behalf ofNational Insurance Company Limited

CIN No: U10200WB1906GOI001713, IRDA Regn. No: 58

Risks Covered Basic Rate(PerMille)

Disc/Load(%)

Sum Insured (In Rupees)

Premium(In Rupees)

Srl Description of PropertySum Insured

The property is situated at :- BUILDING WITH PLINTH AND FOUNDATION. BUILDING NO- M/14/157 ( GROUND FLOOR ) GUJ HOU BOARD.AT SOLA ROAD. AT NARANPURA. AHMEDABAD. AND BUILDING USE FOR DWELLING PURPOSE. - 382220

Risk/RateCode No.

The Sum(s) Insured is/are as under:-

STFI Excl(PerMille)

Building:Stock(s)/Content(s) :

1 /01 0.300 0.300

0.000 0.000

0.0000 0.0000

0.000 0.000

0.00 0.00

0.3000 0.3000

15,00,000 0

450 0

Srl Risk Description of Risk Rate ApplicableThe Risk Covered is/are as under :-

Earthquake (Fire and Shock)

Add-On Description Rate Applied Sum Insured Premium

75.00Total Addon Premium :

RSMD Excl (PerMille)

Description of Risk : BUILDING WITH PLINTH AND FOUNDATION. BUILDING NO- M/14/157 ( GROUND FLOOR ) GUJ HOU BOARD.AT SOLA ROAD. AT NARANPURA. AHMEDABAD. AND BUILDING USE FOR DWELLING PURPOSE.

BlockNo.

01

1 1 Dwellings .3

Escl(%)

EscalationPremium(Rs)

75.00 15,00,000.05

Building(s) Only 1

Net Rate(%0)

ClaimExp(%)

24-Shiv Ganga Complex, Station Road, Mukhi No Dhal, Bavla, Dist: Ahmedabad, Gujarat, Pin : 382220Policy Issuing Office

Tele : 02714 231661, 232519 Fax: 027

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Cash

NIC 300102 : 100%

Mode of Payment:

Co-insurance Details :

RUPEES THREE THOUSAND SEVEN HUNDRED FIFTY ONLY )3750Net Premium: (

National Insurance Company Limited3, Middleton Street, Post Box No. 9229, Kolkata - 700 071

DUPLICATE SCHEDULE

31/05/2013 ( 30010281130000000455 )02:47 hours on 31/05/2013 to midnight of 30/05/2023Policy Period :

Receipt date & No:

Standard Fire and Special Perils PolicyDept : Fire

Agent Code: 886455Agent Name: HITESHBHAI J. PRAJAPATI A.D.C., BANK,

11502Agent Contact No: 9898749759

Insured’s Name: K.C.C BANK.A/C OF SONALBEN VIPULBHAIPATEL.

Address : GROUND FLOOR-FLATE NO-M/44/157, GOKUL APPARTMANT.SOLA ROAD. AT NRANPURA. AHMEDABAD.Dist. : Ahmedabad, GujaratPin Code :380013

Dev. Officer: 41009Policy No : 300102/11/13/3100000122

2NNP-RPP-24/08/2015 12:50:32-3-1 30010210000010 - 6.9.0.0

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In witness whereof the undersigned being authorised by and on behalf of the company has/have herein to set his/their hands.

Duly Constituted Attorney (s)

For and on behalf ofNational Insurance Company Limited

CIN No: U10200WB1906GOI001713, IRDA Regn. No: 58

Total Sum Insured(In Figures) :

1 Subject to Earthquake (Fire and Shock) Clause As Attached

Sr. No.-------

Description of Clauses-------------------------------------------------------------------------------------------------------------------------

1Kalupur Commercial Co-Op Bank Ltd BAVLA

NAME OF BANK/FINANCER :

Srl No.-------

Financier Name-----------------------------------------------

Branch Name

0 0.00 1 15,00,000BUILDING WITH PLINTH AND FOUNDATION. BUILDING NO- M/14/157 ( GROUND FLOOR ) GUJ HOUBOARD.AT SOLA ROAD. AT NARANPURA. AHMEDABAD. AND BUILDING USE FOR DWELLING PURPOSE.

Non-AOG Excess(%)

AOG Excess(%)

00

Min Excess for Non-AOG Perils(Rs.):

Min Excess for AOG Perils(Rs.):

00

Policy Premium :Long Term Discount

50% :Net Premium :

Service Tax 12.36%:Total :

Rs.5,250Rs.2,250Rs.3,750

Rs.464Rs.4214

Less

Add

Premium For 1 Year : Rs.525.00

Rs.15,00,000

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Remarks/Special Conditions :

Description of Risk : BUILDING WITH PLINTH AND FOUNDATION. BUILDING NO- M/14/157 ( GROUND FLOOR ) GUJ HOU BOARD.AT SOLA ROAD. AT NARANPURA. AHMEDABAD. AND BUILDING USE FOR DWELLING PURPOSE.

300102/11/13/3100000122ATTACHED TO AND FORMING PART OF POLICY NO. :

The Insurance under this Policy is subject to :warranties & clauses (as per forms attached) & is :extended to cover risks of (as per forms attached) :

1.Agreed Bank Condition no. 3(b) of the Policy is hereby deleted

.05STFI Rate Charged : Per Milli .05EQ Rate Charged : Per Milli

National Insurance Company Limited3, Middleton Street, Post Box No. 9229, Kolkata - 700 071

DUPLICATE SCHEDULE

Visit us at www.nationalinsuranceindia.com for information on Products, Services and Grievance Redressal.

Total Sum Insured (in words): Rupees Fifteen Lakh Only

Policies having Sum Insured up to INR 10 cr per location - 5% of claim amount subject to a minimum of Rs. 10,000/- .