Reference No.
: W503314784
Date: Jan 05, 2026
NO
Dispatch Advice Letter
Dear Sir/Madam,
We value your relationship with ICICI Lombard General Insurance Company Limited and thank you
for choosing us as your preferred insurance provider.
Please find attached herewith 4010/423708819/00/000 which has been issued based on the
details furnished to us on 05-Jan-2026 as per attached format by the following insured:
A TO Z BEST QUALITY SERVICES
HBR LAYOUTNEAR LIDKAR COLONY
BANGALORE
KARNATAKA - 560045
Please go through the details as furnished in the format and also as provided in the policy
document to ensure that they are in order. If you feel that there are any discrepancies/variations,
please write to us immediately for the necessary changes/rectification. In the absence of any
communication from you in this regard within a period of 15 days of receipt of this letter, we would
understand that you have accepted the contents and the coverage to be in accordance with your
application.
Your original policy will be handed over to you shortly by your Relationship Manager/ Agent/
Broker. In case you don't receive it within 10 days, please mail us at info@[Link]
stating the policy number.
Thank you once again and look forward to a lasting relationship.
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Authorised Signatory
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ICICI Lombard General Insurance Company Ltd.
Signature Not Verified
Digitally signed by DS ICICI
LOMBARD GENERAL
INSURANCE CO LTD 1
Date: 2026.01.05 [Link] IST
ICICI Lombard General Insurance Company Limited
IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 UIN : IRDAN115CP0017V02201920 EMPLOYEE'S COMPENSATION INSURANCE
Mailing Address: Registered Office Address: Toll free no : 1800 2666
601 & 602, 6th Floor, Interface 16, ICICI Lombard House, 414, Veer Alternate no : 86552 22666 (chargeable)
New Linking Road, Malad (West) Savarkar Marg, Near Siddhi Vinayak E-mail : customersupport@[Link]
Mumbai - 400 064 Temple, Prabhadevi, Mumbai 400 025 Website : [Link] 1/6
Reference No.: W503314784
Date: Jan 05, 2026
A TO Z BEST QUALITY SERVICES
HBR LAYOUTNEAR LIDKAR COLONY
BANGALORE
KARNATAKA - 560045
Risk Assumption Letter
Dear Sir/Madam,
We value your relationship with ICICI Lombard General Insurance Company Limited and thank you
for choosing us as your preferred insurance provider.
Please find attached herewith Policy No. 4010/423708819/00/000 which has been issued based
on the details furnished to us on 05-Jan-2026
Please go through the details as furnished in the format and also as provided in the policy
document to ensure that they are in order. If you feel that there are any discrepancies/variations,
please write to us immediately for the necessary changes / rectification. In the absence of any
communication from you in this regard within a period of 15 days of receipt of this letter, we would
understand that you have accepted the contents and the coverage to be in accordance with your
application.
Thank you once again and look forward to a lasting relationship.
Authorized Signatory
D:/CLICK/images/Gaurav_Arora.png
ICICI Lombard General Insurance Company Ltd.
ICICI Lombard General Insurance Company Limited
IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 UIN : IRDAN115CP0017V02201920 EMPLOYEE'S COMPENSATION INSURANCE
Mailing Address: Registered Office Address: Toll free no : 1800 2666
601 & 602, 6th Floor, Interface 16, ICICI Lombard House, 414, Veer Alternate no : 86552 22666 (chargeable)
New Linking Road, Malad (West) Savarkar Marg, Near Siddhi Vinayak E-mail : customersupport@[Link]
Mumbai - 400 064 Temple, Prabhadevi, Mumbai 400 025 Website : [Link] 2/6
EMPLOYEE'S COMPENSATION INSURANCE
Part 1 of the POLICY SCHEDULE
31
Policy No. 4010/423708819/00/000
Issued at: NARAIN MANZIL
Name of the Insured: A TO Z BEST QUALITY SERVICES
Address of the Insured: HBR LAYOUTNEAR LIDKAR COLONY, BANGALORE, KARNATAKA -
560045
Period of Insurance: From: 05-Jan-2026 00:00 Hours To Midnight of 04-Feb-2026
Total Sum Insured: ₹ 1,00,000.00
UIN: IRDAN115CP0017V02201920
Intermediary Code: 202147536685
Intermediary Name: POLICY BAZAAR INSURANCE BROKERS PVT LTD
Intermediary Details:
Intermediary Contact: 1800120800
Intermediary E-mail ID: corporatecrt@[Link]
HR Contact Number:
HR Details
HR Email Address:
[Link] Calculations:
Premium ₹ 872.00
Stamp Duty ₹ 0.00
CGST ₹ 0.00
SGST ₹ 0.00
IGST ₹ 156.96
UGST ₹ 0.00
Total GST ₹ 157.00
Total Premium* ₹ 1,029.00
*Premium value mentioned above is inclusive of taxes applicable
2. No. of lives: 10
[Link] of employees to be insured:
Estimated Occupation Estimated Estimated Place or Places of Industry Sub Industry Risk
Number of of Total Total Employment Classification Classification Classification
Employees Employees Salaries Earnings Code
Wages for the
and other Policy
money Duration
earnings
10 Skilled 10000 100000 HBR LAYOUT Engineering NA 157
Workers NEAR LIDKAR workshop &
COLONY Fabrication
BENGALURU works (up to 9
KARNATAKA meters)
560045--------KARNA
TAKA--BANGALORE
--560045
Total: 10 Total : ₹
100000
4. Scope of cover
Main Coverage: EC Liability Cover Table 'A' 0
Extensions
Per Person Limit Only Medical Extension is covered upto ₹50,000.00 per person for the policy period 50000
ICICI Lombard General Insurance Company Limited
IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 UIN : IRDAN115CP0017V02201920 EMPLOYEE'S COMPENSATION INSURANCE
Mailing Address: Registered Office Address: Toll free no : 1800 2666
601 & 602, 6th Floor, Interface 16, ICICI Lombard House, 414, Veer Alternate no : 86552 22666 (chargeable)
New Linking Road, Malad (West) Savarkar Marg, Near Siddhi Vinayak E-mail : customersupport@[Link]
Mumbai - 400 064 Temple, Prabhadevi, Mumbai 400 025 Website : [Link] 3/6
0
Coverages:
1 Engineering workshop & Fabrication works (up to 9 meters) : NA 10
2 Policy is issued on unnamed basis.
3 Occupational Diseases are not covered.
4 Terrorism is not covered under the policy.
5 No of workers : 10
6 Risk classification code : 157
7 Policy for Table A only.
8 Risk Location : Hbr Layout Near Lidkar Colony Bengaluru Karnataka 560045, BANGALORE, 560045
9 Sub Contractors are Covered
10 2801087566/NP52-glass aluminium partition jobs
Exclusions:
17
1 Any employment compensation in excess of the actual sum insured for workmen compensation ordinance (not to apply
in respect of common law awards)
2 Underground and/or underwater mines and/or underground services in connection therewith. However, this exclusion
shall only apply where more than 20 people are working at the same location at any one time.
3 Subaqueous work (underwater work).
4 Quarries, where explosives are used.
5 Contractors engaged exclusively in wrecking or demolition of building and/or scrap metal merchants.
6 Aircraft crews in respect of flight risk. However, this exclusion shall not apply to aircraft which are set aside for non
fare paying executive use and which are crewed by six persons or less.
7 Ship crews other than on inland vessels or on vessels operating within territorial waters. However, this exclusion shall
not apply to a vessel crewed by six persons or less.
8 Fire bridges other than those formed privately for loss prevention purposes.
9 Service in any kind of armed forces (including, but not limited to military, police, security services).
10 Operation of railways, other than sidings.
11 Employees employed on a permanent basis in USA and/or Canada.
12 Professional sports team.
13 Fire crackers mfg.
14 Losses suffered in the course of manufacturing and /or supplying and/or producing storing, filling, breaking down,
transporting:- (a) Fireworks, ammunition, fuses, cartridges, powder, nitroglycerine, or any explosives. (b) Gases and/or
air under pressure in containers. (c) Butane, methane, propane, and other liquefied gases. (d) Celluloid and pyroxylin.
(e) Petrochemicals and also chemicals of a toxic (as defined under India's Public Liability Act 1991), noxious, explosive
and/or highly flammable nature. (f) Asbestos and/or asbestos products. (It is understood and agreed, however, that the
storage, transport and/or handling if any of the substances above mentioned other than f) which is merely incidental to
the operation and/or trade of the Insured not otherwise excluded, is covered.)
15 Losses suffered on or in connection with offshore rigs.
16 Any compensation in medical extension expenses if the injured is hospitalized for more than 12 month due to an
accident as per the coverage opted in WC policy.
17 Pandemics/epidemics as declared by WHO and /or Government of India
Nature of work/activity 2801087566/NP52-glass aluminium partition jobs
Policy type: Unnamed
Entry age limit As per EC Act
Policy cover Table A
Subject otherwise to terms and conditions of Employee’s Compensation Insurance Policy
Signed for and on behalf of the ICICI Lombard General Insurance Company limited, at Mumbai on this date Jan 05, 2026. The
Policy shall stand cancelled ab initio in the event of nonrealization of premium.
ICICI Lombard General Insurance Company Limited
IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 UIN : IRDAN115CP0017V02201920 EMPLOYEE'S COMPENSATION INSURANCE
Mailing Address: Registered Office Address: Toll free no : 1800 2666
601 & 602, 6th Floor, Interface 16, ICICI Lombard House, 414, Veer Alternate no : 86552 22666 (chargeable)
New Linking Road, Malad (West) Savarkar Marg, Near Siddhi Vinayak E-mail : customersupport@[Link]
Mumbai - 400 064 Temple, Prabhadevi, Mumbai 400 025 Website : [Link] 4/6
Authorised Signatory
ICICI Lombard General Insurance Company Ltd.
Click here or scan the QR code to view the Customer Information Sheet (CIS). It provides an
overview of the policy features, service and claim processes, as well as other important terms.
GSTIN Reg. No: 07AAACI7904G1ZP
IL GIC GSTIN Address: Fourth Parsavnath Capital Tower Bhai Veer Singh Marg, New Delhi New Delhi 110001
HSN/SAC code: 997139 GENERAL INSURANCE SERVICES
The stamp duty of ₹ 0 paid in cash or by demand draft or by pay order, vide Reciept/challan no. dated .
Scan here for the Policy Terms and Conditions
ICICI Lombard General Insurance Company Limited
IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 UIN : IRDAN115CP0017V02201920 EMPLOYEE'S COMPENSATION INSURANCE
Mailing Address: Registered Office Address: Toll free no : 1800 2666
601 & 602, 6th Floor, Interface 16, ICICI Lombard House, 414, Veer Alternate no : 86552 22666 (chargeable)
New Linking Road, Malad (West) Savarkar Marg, Near Siddhi Vinayak E-mail : customersupport@[Link]
Mumbai - 400 064 Temple, Prabhadevi, Mumbai 400 025 Website : [Link] 5/6
31
TAX INVOICE
(ORIGINAL FOR RECIPIENT)
Name of the Customer : A TO Z BEST QUALITY SERVICES
Address of the Customer : HBR LAYOUTNEAR LIDKAR COLONY INDIA KARNATAKA BANGALORE PIN - 560045 -
560045
GSTIN/ Unique Id of registered recipient : 29ACPPI6389F1ZY
Invoice Number 100126279644 ICICI LOMBARD GENERAL INSURANCE COMPANY LIMITED
Policy Number 4010/423708819/00/000 Bill from Address (IL 3 rd Floor Narain Manzil, 23Barakhamba
GSTIN Address) Road, New Delhi- 110 001, Delhi, 110001
Invoice Date 05/01/2026 GSTIN 07AAACI7904G1ZP
Sr. No Particulars PAN SAC Code of service Amount (`)
GENERAL INSURANCE
1 AAACI7904G 997139 872
SERVICES
Total value of services (Premium Value without Tax) (`) 872
Sr No. Applicable taxes Rate of applicable taxes (%) Tax Amount (`)
1 CGST 0 0
2 SGST 0 0
3 IGST 18 156.96
4 UTGST 0 0
Total Tax Amount (`) 156.96
Whether tax payable under reverse charge? No
Tax payable by the receiver (`) 0
Total Premium inclusive Tax (`) 1028.96
Place of Supply: KARNATAKA
We hereby declare that though our aggregate turnover in any preceding financial year from 2017-18 onwards is more than the
aggregate turnover notified under sub-rule (4) of rule 48, we are not required to prepare an invoice in terms of the provisions of
the said sub-rule.
ICICI Lombard General Insurance Company Limited
IRDA Reg. No. 115 CIN: L67200MH2000PLC129408 UIN : IRDAN115CP0017V02201920 EMPLOYEE'S COMPENSATION INSURANCE
Mailing Address: Registered Office Address: Toll free no : 1800 2666
601 & 602, 6th Floor, Interface 16, ICICI Lombard House, 414, Veer Alternate no : 86552 22666 (chargeable)
New Linking Road, Malad (West) Savarkar Marg, Near Siddhi Vinayak E-mail : customersupport@[Link]
Mumbai - 400 064 Temple, Prabhadevi, Mumbai 400 025 Website : [Link] 6/6
