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GROUP PERSONAL ACCIDENT SCHEDULE Policy Branch Office Code: 1602 Agent/Broker Code:Direct Policy No: 1602362914000209 Date of proposal:07/09/2016 Details of previous policy (in case of renewal) ProposalNo:P090116101031 Previous policy No:1602352914000177 Policy Issuing Office :4th floor, Ajay bunglows,Opp. HDFC House,Meethakhali Six Road,Navrangpura,Ahmedabad - 380009,contact no : 079-39829659 Date of expiry: 31/08/2016 INSURED NAME : DAIICT ADDRESS: NR INDRODA CIRCLE,GANDHINAGAR GUJARAT GANDHINAGAR 382007 Period of Insurance: From 01/09/2016 to mid night on 31/08/2017 Total No of Employees Covered 1573 Total No of Lives Covered 1573 Type of Policy Named Total Sum Insured(Rs) 78650000.00 Description of Group Employees Nature of Business Coverage Details and List of members covered as per Schedule attached. Premium (Rs) 40000.00 Service Tax 5600.00 Education Cess 0.00 Secondary & Higher Education Cess 0.00 Sales Tax** 0.00 Surcharge** 0.00 Swachh Bharat Cess 200.00 Krishi Kalyan Cess 200.00 TOTAL PREMIUM PAYABLE(Rs) 46000.00 Consolidated Stamp duty Paid vide GRAS GRN No. MH001675469201617E dated 09 June 2016** ** Not Applicable for the State of Jammu & Kashmir Category-General Insurance Business Service 00440005. Service Tax Regn. No. : AABCR6747BST001 ** Applicable for the state of Jammu & Kashmir **Sales Tax Registration No. 01101051414 IRDAI Registration No. 103. An ISO 9001:2008 Certified Company Corporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited. Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001. Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055 PAN No. : AABCR6747B UIN : IRDA/NL-HLT/RGI/P-P/V.I/320/13-14 "Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License” 1 of 69
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GROUP PERSONAL ACCIDENT SCHEDULE

Apr 20, 2023

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Page 1: GROUP PERSONAL ACCIDENT SCHEDULE

GROUP PERSONAL ACCIDENT SCHEDULE

Policy Branch Office Code: 1602 Agent/Broker Code:Direct

Policy No: 1602362914000209

Date of proposal:07/09/2016 Details of previous policy (in case of renewal)

ProposalNo:P090116101031 Previous policy No:1602352914000177

Policy Issuing Office :4th floor, Ajay bunglows,Opp. HDFC House,Meethakhali Six Road,Navrangpura,Ahmedabad - 380009,contact no : 079-39829659

Date of expiry: 31/08/2016

INSURED NAME : DAIICT

ADDRESS:

NR INDRODA CIRCLE,GANDHINAGAR

GUJARAT

GANDHINAGAR

382007

Period of Insurance: From 01/09/2016 to mid night on 31/08/2017

Total No of Employees Covered 1573

Total No of Lives Covered 1573

Type of Policy Named

Total Sum Insured(Rs) 78650000.00

Description of Group Employees

Nature of Business

Coverage Details and List of members covered as per Schedule attached.

Premium (Rs) 40000.00

Service Tax 5600.00

Education Cess 0.00

Secondary & Higher Education Cess 0.00

Sales Tax** 0.00

Surcharge** 0.00

Swachh Bharat Cess 200.00

Krishi Kalyan Cess 200.00

TOTAL PREMIUM PAYABLE(Rs) 46000.00

Consolidated Stamp duty Paid vide GRAS GRN No. MH001675469201617E dated 09 June 2016**** Not Applicable for the State of Jammu & KashmirCategory-General Insurance Business Service 00440005.Service Tax Regn. No. : AABCR6747BST001** Applicable for the state of Jammu & Kashmir**Sales Tax Registration No. 01101051414

IRDAI Registration No. 103. An ISO 9001:2008 Certified CompanyCorporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited. Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055 PAN No. : AABCR6747B UIN : IRDA/NL-HLT/RGI/P-P/V.I/320/13-14"Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License”

1 of 69

Page 2: GROUP PERSONAL ACCIDENT SCHEDULE

In the event of dishonor of Cheque, this policy automatically stands cancelled from inception irrespective of whether a separate communication is sent or not.

In witness whereof this policy has been signed at Mumbai on 07/09/2016

For and on behalf of

Reliance General Insurance Company Limited.

Agent Code Direct

Agent Contact No Authorised Signatory

User ID: 70175496 Policy Generation Date :07/09/2016

IRDAI Registration No. 103. An ISO 9001:2008 Certified CompanyCorporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited. Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055 PAN No. : AABCR6747B UIN : IRDA/NL-HLT/RGI/P-P/V.I/320/13-14"Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License”

2 of 69

Page 3: GROUP PERSONAL ACCIDENT SCHEDULE

Schedule attached to and forming part of Policy No.1602362914000209

Cover Name Sum insured Co-pay Special Conditions

Table C-Death +Permanent Total Disability +Permanent Partial Disability

Table C covers, Accidental Death+Permanent Total Disablement+Permanent Partial Disablement due to external accidental means

Medical expenses Medical expenses 20% of sum insured or 40% of admissible claim or actuals whichever is lower, only when claim is admissible under benefit table A,B,C or D

Carriage of Dead Body Carriage of Dead body - 2% of Capital Sum Insured or Rs. 2500/- Whichever is less.

General Conditions: Conditions 1) Policy will be on named basis 2) AOA Rs.4 crores 3) Maximum any one life limit will be Rs 50000. 4) Sum insured should not exceed 100 times of monthly gainful income of any employee 5) Subject to condition that no employee is involved in any hazardous activity 6) Insured to submit salary certificate of month prior to date of accident at the time of claim 7) Addition-deletion will be done on pro-rata premium basis for employees once in a month only, subject to all relevent details being forwarded to insurer before 7th day of succeeding month. 8) Minimum age of beneficiary 16 years and maximum 70 years 9) 24 Hours World wide Cover 10) Ambulance charges upto Rs. 1000/- 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) Risk category I & II covered under the policy

Special Conditions: 1) Below mentioned activity shall be outside the scope of the policy 2) Professional sports team in respect of specific benefit for inability to perform 3) Participation in any kind of motor speed contest 4) While engaged in aviation, or whilst mounting or dismounting from or traveling in any aircraft. ( Not applicable for fare Paying Passengers) 5) Underground mining & contractor specializing in tunneling and Offshore actvities 6) Naval, military or air force personnel 7) Radioactivity, Nuclear risks, ionizing radiation 8) Animal bite/Insect bite is not covered. 9) Perils of the sea are excluded from the scope of the 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 misdemeanor 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 Employee is involved in high power transmission, high voltage transmission, excavation, tunneling work, mining, quarrying and off shore activity.

IRDAI Registration No. 103. An ISO 9001:2008 Certified CompanyCorporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited. Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055 PAN No. : AABCR6747B UIN : IRDA/NL-HLT/RGI/P-P/V.I/320/13-14"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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Page 4: GROUP PERSONAL ACCIDENT SCHEDULE

SCHEDULE ATTACHED TO AND FORMING PART OF POLICY NO.: '1602362914000209' MEDICAL EXPENSES EXTENSION (Group Insurance)Endorsement extending Insurance under Policy No. '1602362914000209' in the name of 'DAIICT ' 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.

IRDAI Registration No. 103. An ISO 9001:2008 Certified CompanyCorporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited. Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055 PAN No. : AABCR6747B UIN : IRDA/NL-HLT/RGI/P-P/V.I/320/13-14"Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License”

4 of 69

Page 5: GROUP PERSONAL ACCIDENT SCHEDULE

Schedule of Members covered attached to and forming part of Policy No 1602362914000209

SNo Emp Code

Name Nominee Grade Age Table A

Table B

Table C Table D

Total Sum Insured

DateofJoining

Location Remarks

1 201021004

CHANDRA PRAKASH

NA STUDENT

42 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

2 201021009

CH V NARASIMHA RAO

NA STUDENT

48 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

3 201021010

DOSHI RAMESHKUMAR JASHVANTLAL

NA STUDENT

50 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

4 201021013

SONAM NAHAR NA STUDENT

29 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

5 201021015

DESAI NIKITA SUNIL NA STUDENT

34 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

6 201101149

GUPTA DEEP PINAKIN

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

7 201121001

SHAH JALPA BHARATKUMAR

NA STUDENT

35 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

8 201121003

MAULIK CHANDULAL MADHAVI

NA STUDENT

28 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

9 201121004

V. RAM NARESH KUMAR

NA STUDENT

34 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

10 201121007

NILESHKUMAR VAISHNAV

NA STUDENT

31 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

11 201121009

PATEL RASHMIT KUMAR

NA STUDENT

40 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

12 201121010

SANJAY KUMAR KASODNIYA

NA STUDENT

40 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

13 201121011

VASAVADA TEJAS MUKESHBHAI

NA STUDENT

34 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

14 201121013

SARITA AGRAWAL NA STUDENT

41 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

15 201121014

CHAUDHARI PAYAL DEVENDRABHAI

NA STUDENT

33 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

16 201121016

SHRISHAIL SHARAD GAJBHAR

NA STUDENT

29 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

17 201201003

MAKWANA HARSH DIPAKBHAI

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

18 201201040

AGRAWAL ANSUL NARAYANBHAI

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

19 201201049

HARDIK JAYESHKUMAR SONI

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

20 201201052

ZALA ROHAN VASANTBHAI

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

21 201201066

ARCHIT MANISHKUMAR GAJJAR

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

22 201201089

CHIRAG SHAILESH CHANGRANI

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

23 201201118

SOURABH MESHRAM

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

24 201201127

SIDDHARTH DALMIA NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

IRDAI Registration No. 103. An ISO 9001:2008 Certified CompanyCorporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited. Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055 PAN No. : AABCR6747B UIN : IRDA/NL-HLT/RGI/P-P/V.I/320/13-14"Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License”

5 of 69

Page 6: GROUP PERSONAL ACCIDENT SCHEDULE

Schedule of Members covered attached to and forming part of Policy No 1602362914000209

SNo Emp Code

Name Nominee Grade Age Table A

Table B

Table C Table D

Total Sum Insured

DateofJoining

Location Remarks

25 201201128

DODIA ASHKA BHAGIRATH

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

26 201201172

SHIVAM CHAUDHARY

NA STUDENT

23 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

27 201201174

TAPAN KUMAR NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

28 201201208

SHAH SHAUNAK MANOJ

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

29 201201211

ANKIT NAGARWAL NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

30 201201232

HIMANSHU DIXIT NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

31 201221001

MODHA SANDIP JAYANTILAL

NA STUDENT

35 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

32 201221002

PADIYA TRUPTI JAYANTILAL

NA STUDENT

34 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

33 201221003

TANVINA BHUPENDRABHAI PATEL

NA STUDENT

28 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

34 201221005

PATEL HARDIK NAYANKUMAR

NA STUDENT

30 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

35 201221007

KRISHNA GOPAL NA STUDENT

31 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

36 201221008

NUPUR JAIN NA STUDENT

28 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

37 201221009

SHAH HIRAVKUMAR JAGATBHAI

NA STUDENT

27 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

38 201221013

VANDANA RAVINDRAN

NA STUDENT

28 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

39 201221014

DIXITA HASMUKHBHAI LIMBACHIYA

NA STUDENT

27 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

40 201221015

JADEJA MAHIPAL PRITHVISINH

NA STUDENT

25 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

41 201301001

SIMLAI SAMRIDDHI SHIBAJI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

42 201301002

PATEL HIMANSHU BALDEV BHAI

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

43 201301003

BARKHA BHOJAK NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

44 201301005

DHOLAKIYA PRERAK NANDISH

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

45 201301006

VIKANI BHAGYESH RAJNIKANT

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

46 201301007

PANCHAL SAURABH RAJESHKUMAR

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

47 201301008

PATEL YASH NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

48 201301009

KALOLA VIVEKKUMAR

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

49 201301010

SHAH RAJAT ASHWINBHAI

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

IRDAI Registration No. 103. An ISO 9001:2008 Certified CompanyCorporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited. Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055 PAN No. : AABCR6747B UIN : IRDA/NL-HLT/RGI/P-P/V.I/320/13-14"Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License”

6 of 69

Page 7: GROUP PERSONAL ACCIDENT SCHEDULE

Schedule of Members covered attached to and forming part of Policy No 1602362914000209

SNo Emp Code

Name Nominee Grade Age Table A

Table B

Table C Table D

Total Sum Insured

DateofJoining

Location Remarks

50 201301011

VYAS UTSAV NEHALBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

51 201301012

PATEL PARIN ALPESHBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

52 201301013

JASOLIYA HARSHKUMAR VINODBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

53 201301014

PATEL NAMAN SHASHIKANT

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

54 201301015

SHAH HEM RAJENDRAKUMAR

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

55 201301016

KAMARIA SIDDHARTH

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

56 201301017

PARIKH JINAL NITISHKUMAR

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

57 201301018

PATEL TEJ NAGINBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

58 201301019

KALARIA PARTHKUMAR BHARATBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

59 201301020

VYAS KARAN PRAVINCHANDRA

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

60 201301021

KEYA RAJUL MEHTA NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

61 201301022

SHAH HARSHIL RAJESHBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

62 201301023

PATEL MANALI JITENDRABHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

63 201301024

BHAVSAR SHIVAM KAMLESHKUMAR

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

64 201301025

NEHA AGARWAL NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

65 201301026

SHAH CHAITANYA MINESHKUMAR

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

66 201301027

KOMAL JAIN NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

67 201301028

ANURAG GUPTA NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

68 201301029

JHALA HIMANJALI JAYDEEPSINH

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

69 201301030

JHALA KULJEETSINH

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

70 201301031

MANGROLIYA PARTH MANSUKHBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

71 201301032

PARSANA DARSHAN ATULBHAI

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

72 201301033

RASHMI WILSON NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

73 201301034

SHAH DHRUMIL AJAYBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

IRDAI Registration No. 103. An ISO 9001:2008 Certified CompanyCorporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited. Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055 PAN No. : AABCR6747B UIN : IRDA/NL-HLT/RGI/P-P/V.I/320/13-14"Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License”

7 of 69

Page 8: GROUP PERSONAL ACCIDENT SCHEDULE

Schedule of Members covered attached to and forming part of Policy No 1602362914000209

SNo Emp Code

Name Nominee Grade Age Table A

Table B

Table C Table D

Total Sum Insured

DateofJoining

Location Remarks

74 201301035

PARIKH RUSHIN DEEPAK

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

75 201301036

ALAMURU NIHIT RAMIREDDY

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

76 201301037

PARMAR NEEL HASMUKHBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

77 201301038

DESAI DHWANIL SANJAYBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

78 201301039

SUVARIYA RAJ RAMNIKBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

79 201301040

PADALIYA PRIYESHKUMAR SHANTILAL

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

80 201301041

BHAYANI GAURAV POPATBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

81 201301042

SUKRITI JHINGTA NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

82 201301043

SHREYANS PRADEEP GANDHI

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

83 201301044

PANDIT NEEL RAKESHKUMAR

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

84 201301045

SHAH VIRAJ PRADIPKUMAR

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

85 201301046

JADAV KRUPAL NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

86 201301047

YASHWANT RAMESH KESWANI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

87 201301048

BERWANI MANISH MOHAN

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

88 201301049

MARKANDEYA RIDDHESH SHRIKRISHNA

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

89 201301050

DAXINI DHRUMAN MAHESHBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

90 201301051

GANDHI KUSH NITESH

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

91 201301053

PANDYA NIKUNJ NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

92 201301054

CHAVDA ANKUR ASHOKBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

93 201301055

SUTARIA AAYUSHI PANKAJ

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

94 201301057

BATHWAR VIRAJ RAJABHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

95 201301058

PARTH RAJENDRAKUMAR MODH

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

96 201301059

TANK NISHANT HARESHKUMAR

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

97 201301060

KEVAL HADIYA NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

IRDAI Registration No. 103. An ISO 9001:2008 Certified CompanyCorporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited. Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055 PAN No. : AABCR6747B UIN : IRDA/NL-HLT/RGI/P-P/V.I/320/13-14"Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License”

8 of 69

Page 9: GROUP PERSONAL ACCIDENT SCHEDULE

Schedule of Members covered attached to and forming part of Policy No 1602362914000209

SNo Emp Code

Name Nominee Grade Age Table A

Table B

Table C Table D

Total Sum Insured

DateofJoining

Location Remarks

98 201301061

CHAUDHARI MOINAKHTAR ALIHUSEN

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

99 201301062

SHREYANSH PRAJAPATI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

100 201301063

AHIR KIRANKUMAR BACHUBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

101 201301065

GOSAI PRERNA PRAVINPARI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

102 201301066

EKTABEN DODIYA NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

103 201301067

PANCHAL UMANG NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

104 201301068

HARIYANI JAY NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

105 201301069

CHAUDHARY YOGESHKUMAR HARIBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

106 201301070

BAKARANIYA DHARMIN BIPINBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

107 201301071

PRAJAPATI MUKESH SURYNARAYAN

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

108 201301072

CHAUDHARY MAULIK DALSANGBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

109 201301073

CHAUDHARI JAYKUMAR

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

110 201301074

RAMANUJ CHINTAN SURESHBHAI

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

111 201301075

DUDHREJIYA AJAY DAYARAMBHAI

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

112 201301076

GOHIL MAULIK RAJENDRAKUMAR

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

113 201301077

PARMAR PARESHKUMAR ARAJANBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

114 201301078

MODI MRUGESH KAMLESHBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

115 201301079

CHAUHAN DWIMITRA DHARMENDRA

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

116 201301080

GAJJAR TIRTH JAGDISH

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

117 201301081

SOLANKI GAURAVKUMAR NATVARSINH

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

118 201301082

VEGAD JAHNAVI JAYANTIBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

119 201301083

JADAV HARSH MUKESHKUMAR

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

120 201301084

PATEL NISARG KIRIT

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

IRDAI Registration No. 103. An ISO 9001:2008 Certified CompanyCorporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited. Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055 PAN No. : AABCR6747B UIN : IRDA/NL-HLT/RGI/P-P/V.I/320/13-14"Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License”

9 of 69

Page 10: GROUP PERSONAL ACCIDENT SCHEDULE

Schedule of Members covered attached to and forming part of Policy No 1602362914000209

SNo Emp Code

Name Nominee Grade Age Table A

Table B

Table C Table D

Total Sum Insured

DateofJoining

Location Remarks

121 201301085

CHAUHAN PARAG PUNJALAL

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

122 201301087

TARAL ANKITKUMAR

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

123 201301089

PATEL AYUSH KAMLESH

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

124 201301090

PARTH P CHAUDHARY

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

125 201301091

PATEL RISHITA PRASHANT

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

126 201301092

PATEL DIGVIJAYKUMAR JUGALBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

127 201301094

SABUWALA MUSTUFA

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

128 201301095

PATEL HARSHIT NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

129 201301096

VYAS NIDHI NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

130 201301097

PATEL ANAND PRAVINBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

131 201301098

PANCHAL PARTH DIXITBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

132 201301099

ANKIT K MUCHHALA NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

133 201301100

SAUMYA BHADANI NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

134 201301101

RAHUL SHASHANK SARANJAME

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

135 201301102

SISHTLA CHAITANYA PRASAD

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

136 201301103

PARSHWA BHAVESH MEHTA

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

137 201301104

ROSHANI NARASIMHAN

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

138 201301105

MAHIMA TARAK PATEL

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

139 201301106

TARUSHI BHATIA NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

140 201301107

JAYA MUNDRA NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

141 201301108

KRATI AGRAWAL NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

142 201301109

SHAH VAISHAV BHAVESH

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

143 201301110

ANSHUMAN AGARWAL

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

144 201301111

SAHIL JAIN NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

145 201301112

ASHWIN KIRTANE NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

IRDAI Registration No. 103. An ISO 9001:2008 Certified CompanyCorporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited. Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055 PAN No. : AABCR6747B UIN : IRDA/NL-HLT/RGI/P-P/V.I/320/13-14"Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License”

10 of 69

Page 11: GROUP PERSONAL ACCIDENT SCHEDULE

Schedule of Members covered attached to and forming part of Policy No 1602362914000209

SNo Emp Code

Name Nominee Grade Age Table A

Table B

Table C Table D

Total Sum Insured

DateofJoining

Location Remarks

146 201301113

TEJASV GUPTA NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

147 201301114

SHAH MALAV MITESH

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

148 201301115

YASH INDRAWAT NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

149 201301116

RUPANK BANSAL NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

150 201301117

GAURUV SINGH NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

151 201301118

RISHABH TRIVEDI NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

152 201301119

PANDYA BHAVARTH BHAVINKUMAR

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

153 201301120

KOMAL FALODIYA NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

154 201301121

TANAY AGRAWAL NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

155 201301122

PRATYUSH REDDY PONAKA

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

156 201301123

ANUBHAV JAIN NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

157 201301124

SANGEETA MEENA NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

158 201301126

SHAH ALAY DIVYESHBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

159 201301127

KISHANBHAI BALDEVBHAI PUJARA

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

160 201301128

KALLAM RAJIV REDDY

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

161 201301129

SUBHODEEP MAJI NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

162 201301130

BARUNI GOEL NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

163 201301131

ROHAN AGARWAL NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

164 201301132

PATEL SNEH NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

165 201301133

GAURAV BANSAL NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

166 201301134

SALONI JAIN NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

167 201301135

PATEL ZEEL PRAVINBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

168 201301136

DEVESH SINGH NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

169 201301137

ANKIT LAKRA NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

170 201301138

RISHAB SINGLA NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

IRDAI Registration No. 103. An ISO 9001:2008 Certified CompanyCorporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited. Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055 PAN No. : AABCR6747B UIN : IRDA/NL-HLT/RGI/P-P/V.I/320/13-14"Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License”

11 of 69

Page 12: GROUP PERSONAL ACCIDENT SCHEDULE

Schedule of Members covered attached to and forming part of Policy No 1602362914000209

SNo Emp Code

Name Nominee Grade Age Table A

Table B

Table C Table D

Total Sum Insured

DateofJoining

Location Remarks

171 201301139

PATTIPATI CHAREESH SAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

172 201301140

VELAGA RAMA KRISHNA

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

173 201301141

KETAN MITTAL NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

174 201301142

BOPALIA MAULIK NARESHBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

175 201301143

TALLURI SAI SRUTHI NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

176 201301144

TOOMKUNTA NITHIN KUMAR REDDY

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

177 201301145

G OMKAR REDDY NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

178 201301146

MOHAMMAD SAIFUDDIN SAIFEE

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

179 201301147

VARUN SUNIL GARG NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

180 201301148

SHIVANG AGARWAL NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

181 201301149

DHRUV CHETANKUMAR SHAH

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

182 201301150

RASHI JAIN NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

183 201301151

NIKHIL TEKWANI NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

184 201301152

FATNANI VARUN KUMARBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

185 201301153

DHAVAL V VORA NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

186 201301154

PARTH NIGAM NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

187 201301155

NIKITA JAIN NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

188 201301156

SMRUTI NIRAJKUMAR PARIKH

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

189 201301157

VISHAL RATWANI NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

190 201301158

GOLLA CHINNA SAI BHARATHI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

191 201301159

ABHISHEK JAIN NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

192 201301161

KUMAR DHWANIT NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

193 201301162

VELAGANDULA SHRAVANI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

194 201301163

SANKALP NIGAM NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

195 201301164

YASH BHIMARAO DESHMUKH

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

IRDAI Registration No. 103. An ISO 9001:2008 Certified CompanyCorporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited. Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055 PAN No. : AABCR6747B UIN : IRDA/NL-HLT/RGI/P-P/V.I/320/13-14"Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License”

12 of 69

Page 13: GROUP PERSONAL ACCIDENT SCHEDULE

Schedule of Members covered attached to and forming part of Policy No 1602362914000209

SNo Emp Code

Name Nominee Grade Age Table A

Table B

Table C Table D

Total Sum Insured

DateofJoining

Location Remarks

196 201301165

PATEL ANUBEN JITENDRA

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

197 201301166

VINAYAK DUBEY NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

198 201301167

KALAVADIA BHUMIKA ASHVIN

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

199 201301168

KARRI KIRAN SATISH REDDY

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

200 201301169

MAHIMA SOGANI NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

201 201301170

PATEL VISMAY DHIRAJBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

202 201301171

CHILLAKURU NIKHIL REDDY

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

203 201301172

CHATURVEDULA SAI SRIKANTH

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

204 201301174

M MEENAKSHI NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

205 201301175

BATHULA AJAY RAJ NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

206 201301176

DHRUV BHUTANI NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

207 201301177

ZARANA PARESHKUMAR PAREKH

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

208 201301178

AVIRAL MITHAL NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

209 201301179

SAHIJWANI HARSHITA JAGDISH

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

210 201301180

LADLA KARAN GIANO

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

211 201301181

PARCHURI MOURYA TEJA

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

212 201301183

SARTHAK KHANDEKAR

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

213 201301184

NICCHANAMETLA ABHISHEK

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

214 201301185

STUTI MOHGAONKAR

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

215 201301186

RUCHI JAIN NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

216 201301187

SHUBHRANSHU JHA NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

217 201301188

MAVANI BHAUTIKKUMAR ANANDBHAI

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

218 201301189

KUSHAN JOSHI NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

219 201301191

GOPU ROSHINI REDDY

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

220 201301192

YOGESH KUMAR NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

IRDAI Registration No. 103. An ISO 9001:2008 Certified CompanyCorporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited. Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055 PAN No. : AABCR6747B UIN : IRDA/NL-HLT/RGI/P-P/V.I/320/13-14"Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License”

13 of 69

Page 14: GROUP PERSONAL ACCIDENT SCHEDULE

Schedule of Members covered attached to and forming part of Policy No 1602362914000209

SNo Emp Code

Name Nominee Grade Age Table A

Table B

Table C Table D

Total Sum Insured

DateofJoining

Location Remarks

221 201301193

NIRJHAR BALA NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

222 201301194

SUMIT SINGH NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

223 201301195

SHANKAR LAL PARMAR

NA STUDENT

23 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

224 201301196

KUNDAN KUMAR ARYA

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

225 201301197

DEEPALI VERMA NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

226 201301198

ARAVIND KUMAR BAIRWA

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

227 201301199

MAHIMA ACHHPAL NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

228 201301200

SHEFALI KASHYAP NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

229 201301202

RAMAN KUMAR DOUCHANIYA

NA STUDENT

23 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

230 201301204

RAHUL KUMAR NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

231 201301206

ISHITA CHOURASIA NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

232 201301207

MRIDUL SINGH NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

233 201301208

KARTIK SANKHLA NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

234 201301209

RAJAT DHOOT NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

235 201301210

DILIP KUMAR MEENA

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

236 201301211

UMANG ULIANA NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

237 201301212

SAKSHI MANGAL NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

238 201301213

RATHOD RAHUL NAYAK

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

239 201301215

ROHIT MEENA NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

240 201301216

MALLIPEDDI AKSHAY

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

241 201301218

SUNEET MEENA NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

242 201301223

PARNAVI  CHETANBHAI SHAH

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

243 201301224

SHEETAL NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

244 201301225

YASHODHAN MOHAN BHATNAGAR

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

245 201301226

MOHIT KAMAL NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

IRDAI Registration No. 103. An ISO 9001:2008 Certified CompanyCorporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited. Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055 PAN No. : AABCR6747B UIN : IRDA/NL-HLT/RGI/P-P/V.I/320/13-14"Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License”

14 of 69

Page 15: GROUP PERSONAL ACCIDENT SCHEDULE

Schedule of Members covered attached to and forming part of Policy No 1602362914000209

SNo Emp Code

Name Nominee Grade Age Table A

Table B

Table C Table D

Total Sum Insured

DateofJoining

Location Remarks

246 201301227

SHUBHAM CHATURVEDI

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

247 201301228

SHUBAM SINGH JAMWAL

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

248 201301229

PATEL RAJ NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

249 201301230

PATEL SHREYAS GAUTAMBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

250 201301231

SACHAPARA KIRTI RAMESHBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

251 201301232

PATEL KARANKUMAR JITENDRABHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

252 201301233

PATEL VIVEKKUMAR

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

253 201301234

SHAH FORAM SANJAYBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

254 201301235

MAYATRA AKSHIN KAUSHIKBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

255 201301237

VAGHELA TAPASVI AJIT

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

256 201301238

KAUSHAL JETHVA NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

257 201301239

PANCHAL JINAL RAJENDRAKUMAR

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

258 201301240

GOHIL JAY RITESH NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

259 201301241

PARMAR MEET NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

260 201301242

PATEL MAUSAMEEBEN PARESHKUMAR

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

261 201301401

ANTHONY MARKPIERCE

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

262 201301402

VARMA SUMEET BHARATBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

263 201301403

KANAKIA HITARTH MUKUNDRAY

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

264 201301404

NIDHI NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

265 201301405

JOSHI KANDARP RAJESHKUMAR

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

266 201301406

KHYATI CHANDRASHEKHAR MAHAJAN

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

267 201301407

POPAT SMIT NATVARLAL

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

268 201301408

PATEL BHAVYABAHEN PRAVINBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

269 201301409

PARMAR DIVYESH BHARATKUMAR

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

IRDAI Registration No. 103. An ISO 9001:2008 Certified CompanyCorporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited. Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055 PAN No. : AABCR6747B UIN : IRDA/NL-HLT/RGI/P-P/V.I/320/13-14"Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License”

15 of 69

Page 16: GROUP PERSONAL ACCIDENT SCHEDULE

Schedule of Members covered attached to and forming part of Policy No 1602362914000209

SNo Emp Code

Name Nominee Grade Age Table A

Table B

Table C Table D

Total Sum Insured

DateofJoining

Location Remarks

270 201301410

SOKHADIA HARSHIL MAHENDRAKUMAR

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

271 201301411

MODI UJASH DHARMENKUMAR

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

272 201301412

TERAIYA VATSAL HITESHBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

273 201301413

GUJJAR TAPAN JAYESH

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

274 201301414

SUTHAR JAHNAVI LALITKUMAR

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

275 201301415

PALASARA SHALIN HUSAINALI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

276 201301416

PATEL DHWANIL JAGDISHKUMAR

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

277 201301417

SHREYAS CHAUDHARY

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

278 201301419

THAKAR RAJ JAYRAJBHAI

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

279 201301422

KULDEEP PATEL NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

280 201301423

SHETH DEVARSH KARTIK

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

281 201301424

KHANDERIA JAIMIN DINESHBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

282 201301427

PEESAPATI SRI VENKATASATYA ADITYA

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

283 201301428

SHARVI KALPESH TALATI

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

284 201301429

SHALEEN KUMAR GUPTA

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

285 201301430

ABHISHEK KAMLESHBHAI PARIKH

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

286 201301431

RISHABH BHARDWAJ

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

287 201301432

MEHTA CHARMI KAMLESH

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

288 201301433

CHITTOORY NAGA PRADEET SWAMY

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

289 201301434

SONEJI ANANTA BALKRISHNA

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

290 201301435

DEEKSHA KOUL NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

291 201301436

SHAH HENIL KETANBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

292 201301438

VISHARAD BANSAL NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

293 201301439

GANATRA PARTH VINOD

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

294 201301440

DESAI RAJ CHETANBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

IRDAI Registration No. 103. An ISO 9001:2008 Certified CompanyCorporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited. Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055 PAN No. : AABCR6747B UIN : IRDA/NL-HLT/RGI/P-P/V.I/320/13-14"Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License”

16 of 69

Page 17: GROUP PERSONAL ACCIDENT SCHEDULE

Schedule of Members covered attached to and forming part of Policy No 1602362914000209

SNo Emp Code

Name Nominee Grade Age Table A

Table B

Table C Table D

Total Sum Insured

DateofJoining

Location Remarks

295 201301441

GANDHI SHUCHIT VIPUL

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

296 201301442

VARMA AKSHAR JAYANTH

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

297 201301443

SHERYANSH JAIN NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

298 201301444

ANKUL JAIN NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

299 201301445

MIHIR JOSHI NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

300 201301446

PRASHANT RAJORIYA

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

301 201301447

BHUPATHI VADHIR BABU

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

302 201301450

DUSHYANTKUMAR PARMAR

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

303 201301452

SHRUTI SINGH NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

304 201301453

PATEL KHUSHBU NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

305 201301454

JAY PRAVINKUMAR BHATT

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

306 201301455

DADHANIYA DIPEN RAMNIKLAL

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

307 201301456

DESAI SAMARTH NISHITH

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

308 201301457

GOHEL SACHIN VINODKUMAR

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

309 201301458

SHETHNA PINAKINBHAI DHARMESHBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

310 201301459

GOHIL DEERGHA BATUKBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

311 201321002

SAILOR HARDIK BHUPENDRA

NA STUDENT

27 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

312 201321003

KAMAL MANHARLAL CAPTAIN

NA STUDENT

28 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

313 201321004

VINEET KUMAR DAD NA STUDENT

31 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

314 201321005

PARTH MEHTA NA STUDENT

26 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

315 201321009

SHAH NIRMESH JAYESHKUMAR

NA STUDENT

27 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

316 201321010

KORINGA PURVI A. NA STUDENT

27 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

317 201401001

MEHTA MEDHA RAJESH

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

318 201401002

PENUGONDA VINEETH

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

319 201401003

SHARMA SMRITI MAN PRAKASH

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

IRDAI Registration No. 103. An ISO 9001:2008 Certified CompanyCorporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited. Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055 PAN No. : AABCR6747B UIN : IRDA/NL-HLT/RGI/P-P/V.I/320/13-14"Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License”

17 of 69

Page 18: GROUP PERSONAL ACCIDENT SCHEDULE

Schedule of Members covered attached to and forming part of Policy No 1602362914000209

SNo Emp Code

Name Nominee Grade Age Table A

Table B

Table C Table D

Total Sum Insured

DateofJoining

Location Remarks

320 201401004

KOTHARI SAMARTH KETANKUMAR

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

321 201401005

BALDHA PINAL VINODBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

322 201401006

DAIYA BRIJESH BHARAT

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

323 201401007

PIRATLA SHOURI NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

324 201401008

AKSHAT DUA NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

325 201401009

THAKKAR AADITYA RAJESHKUMAR

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

326 201401010

MUTTINENI AAKASH NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

327 201401011

KONICA TALLARI NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

328 201401012

PATEL KISHAN PRAFULBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

329 201401013

KADAKIA URMIL VIPULBHAIL

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

330 201401014

KEVIN VEGDA NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

331 201401016

SHASHWAT MISHRA NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

332 201401017

ABHINAV GADDE NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

333 201401018

SHAH RISHI DILPESHBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

334 201401019

CHAKKA THARUN NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

335 201401020

KENIL AMIT SHAH NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

336 201401021

KORADIA AKASHKUMAR AMRUTLAL

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

337 201401022

PANKAJ SIROHI NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

338 201401023

DIVYA VERMA NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

339 201401024

URVASHI BANTHIA NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

340 201401025

SHILPI CHAUDHURI NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

341 201401027

JADAV ROHAN DILIP NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

342 201401028

TANAY MADHUKAR BORKAR

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

343 201401029

SHAH AASKA JIGNESHKUMAR

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

344 201401030

HARSHUL VAISHNAV

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

IRDAI Registration No. 103. An ISO 9001:2008 Certified CompanyCorporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited. Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055 PAN No. : AABCR6747B UIN : IRDA/NL-HLT/RGI/P-P/V.I/320/13-14"Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License”

18 of 69

Page 19: GROUP PERSONAL ACCIDENT SCHEDULE

Schedule of Members covered attached to and forming part of Policy No 1602362914000209

SNo Emp Code

Name Nominee Grade Age Table A

Table B

Table C Table D

Total Sum Insured

DateofJoining

Location Remarks

345 201401031

AGRAWAL AMAY AJAYKUMAR

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

346 201401032

SARODE KARTIKEY SANJAY

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

347 201401033

JOSHI TORAL JAYANTKUMAR

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

348 201401034

GAJJAR ANIKET JAYESH

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

349 201401036

VASIREDDY V SAI TEJA

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

350 201401037

SHINJINI GOSWAMI NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

351 201401038

YASH KUMAR NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

352 201401039

RAHI UTPAL SHETH NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

353 201401040

SAI SWETHA PASAM NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

354 201401041

THAKKAR KARAN DEVIDAS

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

355 201401043

BHAWANA JALORIA NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

356 201401045

ANAMIKA MODI NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

357 201401046

SHIVANJALI S MEENA

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

358 201401047

NACHIKET VIKRAM TRIVEDI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

359 201401048

EAGAPATI INDRANI CHOWDARY

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

360 201401049

BHANDERI SHREYAS VELJIBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

361 201401051

TRAPASIYA MAULIK AMRUTLAL

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

362 201401052

SUDIPTA HALDAR NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

363 201401054

UDGIRKAR SANKET SHRIKANT

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

364 201401055

KRITIKA SOMANI NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

365 201401056

ANEREE MEHTA NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

366 201401057

DHRUV SINGH NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

367 201401058

PATEL ABHISHEK DIPAKBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

368 201401059

UDHANI JAYESH BHAGWANDAS

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

369 201401060

MAYANK KUMAR SAHLOT

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

IRDAI Registration No. 103. An ISO 9001:2008 Certified CompanyCorporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited. Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055 PAN No. : AABCR6747B UIN : IRDA/NL-HLT/RGI/P-P/V.I/320/13-14"Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License”

19 of 69

Page 20: GROUP PERSONAL ACCIDENT SCHEDULE

Schedule of Members covered attached to and forming part of Policy No 1602362914000209

SNo Emp Code

Name Nominee Grade Age Table A

Table B

Table C Table D

Total Sum Insured

DateofJoining

Location Remarks

370 201401061

AKSHAY BHAGCHAND VIJAYVERGIA

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

371 201401063

BHAGAT NIKITA RAJENBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

372 201401064

BALVINDER SINGH SETHI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

373 201401065

CHIMBILI SAI NEERAJ

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

374 201401066

ADARSH JAIN NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

375 201401067

KIKANI KARNAV MANISH

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

376 201401068

SHUBHAM KHANDELWAL

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

377 201401069

VERTIKA K BINDAL NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

378 201401070

ANURAG VIJAY GUPTA

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

379 201401072

NEELAMRAJU SRISAI KARTHIK

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

380 201401073

PITTA NANCY NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

381 201401074

RASHI GUPTA NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

382 201401075

DEEPIT PATEL NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

383 201401076

SHAH PARTH BHAVESH

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

384 201401077

GHADIA DIVYESH GIRDHARBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

385 201401078

AAYUSH DESHRAJ NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

386 201401079

SALONI DALAL NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

387 201401080

PATIL PRANAY KUMAR REDDY

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

388 201401081

GEOLANGSAT NARZARY

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

389 201401082

NADGERI ABHISHEK SANJEEV

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

390 201401083

TANGUDU SRIHITHA NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

391 201401084

BASIREDDYGARI JAYANTHESWAR REDDY

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

392 201401085

DARJI VAIDEHI PRAKASH

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

393 201401086

JOGLEKAR ADITYA VAIBHAV

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

394 201401087

KATRAGADDA PAAVAN PRANEETH

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

IRDAI Registration No. 103. An ISO 9001:2008 Certified CompanyCorporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited. Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055 PAN No. : AABCR6747B UIN : IRDA/NL-HLT/RGI/P-P/V.I/320/13-14"Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License”

20 of 69

Page 21: GROUP PERSONAL ACCIDENT SCHEDULE

Schedule of Members covered attached to and forming part of Policy No 1602362914000209

SNo Emp Code

Name Nominee Grade Age Table A

Table B

Table C Table D

Total Sum Insured

DateofJoining

Location Remarks

395 201401088

AKSHAY DHANANJAY BHAMARE

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

396 201401089

PARTH RATHOD NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

397 201401090

AVINASH CHAUDHARY

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

398 201401091

PATEL HETKUMAR SURESHBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

399 201401093

PADARTHY ABHISHANTH

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

400 201401094

VIJAY KUMAR NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

401 201401095

ATRAYEE DEB NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

402 201401096

SHAH UMANG PANKAJKUMAR

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

403 201401097

LAGADAPATI KRISHNA CHAITHVIKA

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

404 201401098

ANUSHA PHADNIS NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

405 201401099

PATEL ABHISHEK JITENDRABHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

406 201401100

PARTH NITESH KANAKIYA

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

407 201401101

GAMITA BANAPHAL NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

408 201401102

JONNALAGADDA DHARANI CHOWDARY

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

409 201401103

PINGE RAJDEEP SANTOSHKUMAR

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

410 201401104

SONAL DAMOR NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

411 201401105

SHAH RUCHITA CHANDRESH

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

412 201401106

RUSHIKESH NALLA NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

413 201401108

TIRTH CHETAN SHAH

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

414 201401110

SHASHANK BISWAS NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

415 201401111

BHIMANI MILANKUMAR KANTILAL

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

416 201401112

VINAY KUMAR MEENA

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

417 201401113

BIRVA HEMEN PATEL

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

418 201401114

DAMLE OMKAR VISHWESH

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

IRDAI Registration No. 103. An ISO 9001:2008 Certified CompanyCorporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited. Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055 PAN No. : AABCR6747B UIN : IRDA/NL-HLT/RGI/P-P/V.I/320/13-14"Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License”

21 of 69

Page 22: GROUP PERSONAL ACCIDENT SCHEDULE

Schedule of Members covered attached to and forming part of Policy No 1602362914000209

SNo Emp Code

Name Nominee Grade Age Table A

Table B

Table C Table D

Total Sum Insured

DateofJoining

Location Remarks

419 201401115

DEVANSHI BANSAL NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

420 201401116

JUGAL KALAL NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

421 201401117

URVASHI SINGH NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

422 201401118

SIDDHARTH SINH M RANA

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

423 201401119

DESAI BRIJ SURESHBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

424 201401120

BHUT HARSHIT ANILBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

425 201401121

NERURKAR NANDINI SUJIT

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

426 201401122

ANCHIT DAVE NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

427 201401123

PAREKH KEVAL MAYUR

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

428 201401124

NARMIT SWETAL MASHRUWALA

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

429 201401125

PATEL PANTH PRANAVBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

430 201401126

GOPAL SHAH NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

431 201401127

KRISHANU KONAR NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

432 201401128

VANDIT DARSHAN MODI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

433 201401129

CHANDAK RUDRA CHAMANLAL

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

434 201401130

DATANI PIYUSH NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

435 201401131

SUTHAR KUNAL VINAYKUMAR

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

436 201401132

TRIVEDI JAY KETANKUMAR

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

437 201401133

BHAVSAR ANUJKUMAR ASHOKKUMAR

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

438 201401134

SARADAVA RAVIBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

439 201401135

DAVE MITHIL PARESHBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

440 201401136

KOSHIYAR DHRUV ASHOKBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

441 201401137

SAVALIYA MOHIT JAGDISHKUMAR

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

442 201401138

PRAJAPATI DHAVAL HARSHADBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

443 201401139

SARDHARA HARDIK NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

IRDAI Registration No. 103. An ISO 9001:2008 Certified CompanyCorporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited. Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055 PAN No. : AABCR6747B UIN : IRDA/NL-HLT/RGI/P-P/V.I/320/13-14"Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License”

22 of 69

Page 23: GROUP PERSONAL ACCIDENT SCHEDULE

Schedule of Members covered attached to and forming part of Policy No 1602362914000209

SNo Emp Code

Name Nominee Grade Age Table A

Table B

Table C Table D

Total Sum Insured

DateofJoining

Location Remarks

444 201401140

CHAUHAN PARTH ASHOKKUMAR

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

445 201401141

SHRIMALI NILAY KANUBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

446 201401142

PARATE HITESHKUMAR PRABHAKARBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

447 201401143

PATEL AKSHAYKUMAR MAHESHBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

448 201401144

SHAH KISHAN VIJAYKUMAR

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

449 201401145

PALADIYA KETAN HARIBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

450 201401146

CHAUDHARI PRASHANTKUMAR KIRANBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

451 201401147

PATEL VINAYKUMAR MERUBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

452 201401148

PATEL MITALI NARENDRABHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

453 201401149

MEHUL N VASAVA NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

454 201401152

DODIA DIMPLE MANOJBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

455 201401154

GUNDIGARA MIT JAYDEEPBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

456 201401155

SHETH VIRAJ APURVABHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

457 201401156

PATEL YASH ATULKUMAR

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

458 201401157

BORISAGAR PANAV ASHISHKUMAR

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

459 201401158

BORISAGAR PALLAV ASHISHKUMAR

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

460 201401159

KACHHIA RUCHI MILANBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

461 201401161

VALA SURJIT BAVKUBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

462 201401162

PANJWANI DHAVAL PRAKASH

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

463 201401163

PIPALIYA RAJAN DINESHBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

464 201401164

TARUNKUMAR BARIA

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

465 201401165

SHAH HARSHAL BHADRESHKUMAR

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

466 201401166

PARMAR RAHUL DILIPBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

IRDAI Registration No. 103. An ISO 9001:2008 Certified CompanyCorporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited. Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055 PAN No. : AABCR6747B UIN : IRDA/NL-HLT/RGI/P-P/V.I/320/13-14"Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License”

23 of 69

Page 24: GROUP PERSONAL ACCIDENT SCHEDULE

Schedule of Members covered attached to and forming part of Policy No 1602362914000209

SNo Emp Code

Name Nominee Grade Age Table A

Table B

Table C Table D

Total Sum Insured

DateofJoining

Location Remarks

467 201401167

GHUSAR HARDIK NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

468 201401168

KACHA GAURAV NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

469 201401169

SHAH MILAP CHIRAG

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

470 201401170

LALAIYA MAYANK DINESHBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

471 201401171

DAVE HEET AMITKUMAR

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

472 201401172

BHUSARA ARCHANAKUMAREE DINESHBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

473 201401173

DRASHTI BIPINCHANDRA BHARTI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

474 201401174

MEHTA SUPARSHVA RAKESH

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

475 201401175

PRATIHAR SAURAVKUMAR KIRANKUMAR

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

476 201401176

DEVARSHI CHANDRAKANT KACHA

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

477 201401177

VAGHELA PARTH DINESHBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

478 201401178

KACHARIYA JAYRAJ MAHESHBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

479 201401179

PATEL NIRAV KAMLESHBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

480 201401180

SHAH KELAY KANUBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

481 201401182

SINGAL KEYUR ANILKUMAR

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

482 201401183

VAJA NISHANT DINESHBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

483 201401184

PATEL PARTH VIJAYKUMAR

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

484 201401185

PATEL DIGMAKUMARI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

485 201401186

AKSHAT PATEL NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

486 201401187

ARPIT PRAJAPATI NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

487 201401189

LIMBADIYA MAULIK VAJUBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

488 201401190

RONAK CHANDRAKANT ODHAVIYA

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

489 201401191

PRATISH ANAND NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

IRDAI Registration No. 103. An ISO 9001:2008 Certified CompanyCorporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited. Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055 PAN No. : AABCR6747B UIN : IRDA/NL-HLT/RGI/P-P/V.I/320/13-14"Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License”

24 of 69

Page 25: GROUP PERSONAL ACCIDENT SCHEDULE

Schedule of Members covered attached to and forming part of Policy No 1602362914000209

SNo Emp Code

Name Nominee Grade Age Table A

Table B

Table C Table D

Total Sum Insured

DateofJoining

Location Remarks

490 201401192

PARMAR HIRAL UMAKANT

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

491 201401194

GAJJAR PRATIK MAHESHKUMAR

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

492 201401195

CHAUDHARY AMITKUMAR DHAGALCHAND

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

493 201401199

AGARWAL RESHEIL SANJEEV

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

494 201401200

PIYUSHI PAWAN NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

495 201401201

AYUSHI JAIN NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

496 201401202

PRAJAPATI SMITKUMAR MAHENDRABHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

497 201401204

GAJJAR MANAN BHARATBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

498 201401205

DALIA BHARGAV OJASKUMAR

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

499 201401206

VAGHELA VIRALKUMAR CHANDRAKANTBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

500 201401207

ASHUTOSH ADHIKARI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

501 201401208

MALIK AASIM MOHMMODASFAK

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

502 201401210

SAPARIYA ABHI MUKESHKUMAR

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

503 201401211

DIVECHA RUSHI ASHOKKUMAR

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

504 201401212

KOSHIYA JAYMIL BHARATBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

505 201401213

PRAJAPATI KALPESH TULSHIBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

506 201401214

MANVA MOHIBAHEMAD ABDULMAZID

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

507 201401215

PATEL DHRUV PRAKASHBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

508 201401216

VIMAL PRAJAPATI NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

509 201401217

DALSANIYA VIVEKKUMAR SURESHBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

510 201401218

PARMAR VIKAS SURESHBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

511 201401219

AGRAWAL PRACHI RAJESH

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

512 201401221

RAIYA DEEP KIRTIKUMAR

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

IRDAI Registration No. 103. An ISO 9001:2008 Certified CompanyCorporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited. Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055 PAN No. : AABCR6747B UIN : IRDA/NL-HLT/RGI/P-P/V.I/320/13-14"Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License”

25 of 69

Page 26: GROUP PERSONAL ACCIDENT SCHEDULE

Schedule of Members covered attached to and forming part of Policy No 1602362914000209

SNo Emp Code

Name Nominee Grade Age Table A

Table B

Table C Table D

Total Sum Insured

DateofJoining

Location Remarks

513 201401222

PATEL VAIBHAVKUMAR

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

514 201401223

NAYAK KUNTAL KETANKUMAR

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

515 201401224

TRADA JASMIN KANTIBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

516 201401225

THAKKAR HARSH KIRITKUMAR

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

517 201401226

SHAH DEVAM NRUPESH

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

518 201401227

CHHATRALA NISHIT ASHISHKUMAR

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

519 201401228

MANAN ASHISH KSHATRIYA

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

520 201401229

BODA NISHTHA AMRUTBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

521 201401230

ROHAN BANSAL NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

522 201401231

SHETH AKAR JAYESHBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

523 201401232

SORIYA MANTHAN NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

524 201401233

SHAH PARSHWA RAVINDRA

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

525 201401234

PARTH VASAVA NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

526 201401235

DIVYESHKUMAR SAVALIYA

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

527 201401236

PATEL MITESHKUMAR KIRTIKUMAR

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

528 201401237

PATEL MITHIL PRAVINBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

529 201401238

PATEL MEET SHAILESHBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

530 201401239

RAJDEV PARTH DINESHKUMAR

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

531 201401240

PALOD PRACHI GHANSHYAM

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

532 201401241

SHAH JAY GAURANG

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

533 201401242

PATEL JAY SHAILESHKUMAR

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

534 201401243

PATEL SAUMIL KAMLESHBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

535 201401244

PARIKH SAMARTH SANJAY

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

536 201401245

SHAH SAURABH VINAY

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

537 201401246

PATEL DVIJESH NANDLAL

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

IRDAI Registration No. 103. An ISO 9001:2008 Certified CompanyCorporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited. Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055 PAN No. : AABCR6747B UIN : IRDA/NL-HLT/RGI/P-P/V.I/320/13-14"Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License”

26 of 69

Page 27: GROUP PERSONAL ACCIDENT SCHEDULE

Schedule of Members covered attached to and forming part of Policy No 1602362914000209

SNo Emp Code

Name Nominee Grade Age Table A

Table B

Table C Table D

Total Sum Insured

DateofJoining

Location Remarks

538 201401247

PARMAR DHAVAL JAGDISHBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

539 201401401

ADITYA RAJ NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

540 201401402

GOHEL KUNAL KAMLESHBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

541 201401403

AARUSHI ILESH SANGHANI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

542 201401404

VIRENDRA PRATAP NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

543 201401405

LALCHETA NIHAR SHARADBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

544 201401406

SHAH JINESH JAYESH

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

545 201401407

KAPADIA AAYUSH SHRIKANT

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

546 201401408

KEVAL DHRUVESHKUMAR SHAH

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

547 201401409

TANMAY BHUPESH PATEL

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

548 201401410

SINGULUR SURYA VAMSI GOWTAM

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

549 201401411

SYED MOHAMMAD FUZAIL AHAMED

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

550 201401412

PARVATANENI MANASA

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

551 201401413

K.KAMALESH NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

552 201401414

VYAS MAHARSHI DIPAKKUMAR

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

553 201401415

HARSH DILIPKUMAR GAGLANI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

554 201401416

BHAVYA MITESH MEHTA

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

555 201401417

SHAH PURVIK HITESHBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

556 201401418

DHRUV NARESHBHAI SACHDEV

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

557 201401420

ADITYA VYAS NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

558 201401421

MANKAD NIRVISHA PIYUSH

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

559 201401422

SNEHA MANDAN NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

560 201401423

SURBHIT RAO NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

561 201401424

CHAUDHARI HARSH SHANKAR

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

562 201401425

NAIK TWISHA GAURANG

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

IRDAI Registration No. 103. An ISO 9001:2008 Certified CompanyCorporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited. Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055 PAN No. : AABCR6747B UIN : IRDA/NL-HLT/RGI/P-P/V.I/320/13-14"Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License”

27 of 69

Page 28: GROUP PERSONAL ACCIDENT SCHEDULE

Schedule of Members covered attached to and forming part of Policy No 1602362914000209

SNo Emp Code

Name Nominee Grade Age Table A

Table B

Table C Table D

Total Sum Insured

DateofJoining

Location Remarks

563 201401426

PREETI MINJ NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

564 201401427

HARSH VARDHAN HYANKEY

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

565 201401428

MALVIKA SINGH NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

566 201401429

PANDYA SHAIRIL BHAVINKUMAR

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

567 201401431

CHANDWANI KHUSHBOO MUKESH

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

568 201401432

PATEL ABHIJIT SUNIL

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

569 201401433

DALAL AALISHA PRANAV

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

570 201401434

PRAJAPATI BIREN GANPATBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

571 201401435

MODI AKASH MUKESHBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

572 201401436

JARIWALA SAUMYA NIRAV

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

573 201401437

SHAH ABHI DHARMESH

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

574 201401438

GANDHI ADWAIT ALKESH

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

575 201401439

ANISHI MEHTA NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

576 201401440

DANGAR MAYURKUMAR VINUBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

577 201401442

SHAH KARTIK PARESHKUMAR

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

578 201401443

AKSHAY MITERANI NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

579 201401444

THAKKAR VATSAL JAYESHBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

580 201401446

GELAT HARSHIT NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

581 201401447

CHANGELA ISHAN NARENDRABHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

582 201401448

NARIA MIT JAYANTIBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

583 201401449

GANDHI PARTHKUMAR ANILKUMAR

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

584 201401450

SHAH RAJ KETAN NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

585 201401451

DEVANSH ASHWINKUMAR GOHIL

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

586 201401452

GHETIA KISHAN BIPINBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

IRDAI Registration No. 103. An ISO 9001:2008 Certified CompanyCorporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited. Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055 PAN No. : AABCR6747B UIN : IRDA/NL-HLT/RGI/P-P/V.I/320/13-14"Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License”

28 of 69

Page 29: GROUP PERSONAL ACCIDENT SCHEDULE

Schedule of Members covered attached to and forming part of Policy No 1602362914000209

SNo Emp Code

Name Nominee Grade Age Table A

Table B

Table C Table D

Total Sum Insured

DateofJoining

Location Remarks

587 201401453

CHAUDHARI APURV JAYANTBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

588 201401455

VIRAL PANDEY NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

589 201401456

LIMBACHIA MIHIR NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

590 201401457

CHAUDHARI UTTAMKUMAR SHANKARBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

591 201401459

DETROJA MAYUR NILESHBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

592 201401461

VAGHELA RONAKSINH RAMSINH

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

593 201411014

SHAH KUSHAN RAJNIKANT

NA STUDENT

23 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

594 201411052

ABHAY SINGH NA STUDENT

34 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

595 201412088

RANA DHARABEN KAMLESHKUMAR

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

596 201412090

SHIKHA SANADHYA NA STUDENT

23 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

597 201421001

ARCHANA NIGAM NA STUDENT

27 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

598 201421002

SUMUKH BANSAL NA STUDENT

27 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

599 201421003

PATEL NIKITABEN RATILAL

NA STUDENT

24 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

600 201421004

HARDIK GAJERA NA STUDENT

26 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

601 201421005

DESAI NIDHI NITINBHAI

NA STUDENT

28 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

602 201421006

RAHUL VASHISTH NA STUDENT

28 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

603 201501001

PATELIYA JEETESHKUMAR RAMANBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

604 201501002

PARV CHADHA NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

605 201501003

HIMANSHU CHANDAK

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

606 201501004

AASHINI NILESHKUMAR SONI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

607 201501005

AMARNATH KARTHI NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

608 201501006

SOUMYA AGRAWAL NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

609 201501007

AGRAWAL ABHISHEK MANOJ

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

610 201501008

RAVIRAM MAMIDI NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

IRDAI Registration No. 103. An ISO 9001:2008 Certified CompanyCorporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited. Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055 PAN No. : AABCR6747B UIN : IRDA/NL-HLT/RGI/P-P/V.I/320/13-14"Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License”

29 of 69

Page 30: GROUP PERSONAL ACCIDENT SCHEDULE

Schedule of Members covered attached to and forming part of Policy No 1602362914000209

SNo Emp Code

Name Nominee Grade Age Table A

Table B

Table C Table D

Total Sum Insured

DateofJoining

Location Remarks

611 201501009

PRAKHAR ANANYA NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

612 201501010

ISAAC MALSAWMA NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

613 201501011

KUNAL NIRAV KHATRI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

614 201501012

KEYA DESAI NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

615 201501013

KOLI POOJA TUKARAM

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

616 201501014

NIKITA VERMA NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

617 201501015

PATEL PARTH HITENDRAKUMAR

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

618 201501016

SALONI MUNDRA NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

619 201501017

PATEL RAHUL HASMUKHBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

620 201501018

VARIA NEELANSHI ATUL

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

621 201501019

RAGHAV AGARWAL NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

622 201501020

SHUBHAM D ANNADATE

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

623 201501021

ROSHAN ASHOKBHAI SHAH

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

624 201501022

SHETH RUTVIK LALITKUMAR

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

625 201501023

PATEL DEV NARENDRAKUMAR

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

626 201501024

PARAMJEET SUNIL DESAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

627 201501025

SHUBHAM SONKAR NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

628 201501026

SHUBHAM S MEENA NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

629 201501027

PRASHIK NAGRALE NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

630 201501028

BHANSALI YASH GAURANGBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

631 201501029

VANAMALA VYSHNAVI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

632 201501030

PUROHIT DEVANSH NARESHKUMAR

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

633 201501031

SHAH MIHIR BIRENDRAKUMAR

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

634 201501032

DIVYANSHU SINGH NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

635 201501033

DAVAWALA NIDHI DEVANG

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

IRDAI Registration No. 103. An ISO 9001:2008 Certified CompanyCorporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited. Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055 PAN No. : AABCR6747B UIN : IRDA/NL-HLT/RGI/P-P/V.I/320/13-14"Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License”

30 of 69

Page 31: GROUP PERSONAL ACCIDENT SCHEDULE

Schedule of Members covered attached to and forming part of Policy No 1602362914000209

SNo Emp Code

Name Nominee Grade Age Table A

Table B

Table C Table D

Total Sum Insured

DateofJoining

Location Remarks

636 201501034

HARDIK BANSAL NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

637 201501035

PATEL HARSH ALPESH

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

638 201501036

SHAH DHAIRYA MUKESHBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

639 201501037

GOSWAMI JAY SURESHGIRI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

640 201501038

DOBARIYA HARDIK PARESHBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

641 201501039

MEENA ABHISHEK HARI SHANKAR

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

642 201501040

MAYANK NAHAR NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

643 201501041

VIDISH PANKAJKUMAR TRIVEDI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

644 201501042

VINEETA MEENA NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

645 201501043

R P KOUSHIK NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

646 201501044

PRAKRUTI HASIT JOSHI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

647 201501045

PATEL SHREEMAD SANSKAR

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

648 201501046

PATEL YASH MANHARBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

649 201501047

JAYANTHI ARAVIND NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

650 201501048

SHIWANGI KASHYAP

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

651 201501049

SHUBHAM ATRI NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

652 201501050

CHAUDHARY KEYURKUMAR

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

653 201501051

RAMAVATH SASANK RATHOD

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

654 201501052

BAROCHIYA DHRUV DILIPBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

655 201501053

KHATNANI BHAVESH

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

656 201501054

RATHOD MIHIRBHAI MANSUKHBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

657 201501055

SAI ANISH GARAPATI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

658 201501056

DOSHI NIRAV JAYANTILAL

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

659 201501057

DHANVANTHRI KUMAR AGARWAL

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

660 201501058

PATEL RAVIBHAI BHARATBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

IRDAI Registration No. 103. An ISO 9001:2008 Certified CompanyCorporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited. Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055 PAN No. : AABCR6747B UIN : IRDA/NL-HLT/RGI/P-P/V.I/320/13-14"Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License”

31 of 69

Page 32: GROUP PERSONAL ACCIDENT SCHEDULE

Schedule of Members covered attached to and forming part of Policy No 1602362914000209

SNo Emp Code

Name Nominee Grade Age Table A

Table B

Table C Table D

Total Sum Insured

DateofJoining

Location Remarks

661 201501059

SHAH FENIL MUKESH

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

662 201501060

VIDHI SHAILESHBHAI KATKORIA

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

663 201501061

MAVURAPU UMESH REDDY

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

664 201501062

BHATT RISHIKESH JAYESHBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

665 201501063

VIKANI PREMANG BHARATBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

666 201501065

GUNDAPANENI LOHITA

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

667 201501066

CHINTALAPATI VENKATA RAMA RAHUL

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

668 201501067

UPPU KAAVYA NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

669 201501068

RAM NIRBHAY JESABHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

670 201501069

KASHISH NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

671 201501070

RISHAB ARORA NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

672 201501071

SHAH JAY NILESHKUMAR

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

673 201501072

SOLANKI SHARVIL ATULBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

674 201501073

SHAH MALHAR BHARAT

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

675 201501074

RAJAT GARG NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

676 201501075

ASHUTOSH MAHESHWARI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

677 201501076

DHOLAKIA NINAD SHIRISHBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

678 201501077

PATEL DARSHAN BHARATKUMAR

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

679 201501078

KUNJAL RUPALA NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

680 201501079

ANUPRIYA JAJU NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

681 201501080

JADAV HARDIK PRAVINBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

682 201501081

SHAH MEGH RAJESHKUMAR

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

683 201501082

NASIT SAMARTH GORDHANBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

684 201501083

RUTVIK SHAH NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

685 201501085

AKSHIT SONI NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

IRDAI Registration No. 103. An ISO 9001:2008 Certified CompanyCorporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited. Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055 PAN No. : AABCR6747B UIN : IRDA/NL-HLT/RGI/P-P/V.I/320/13-14"Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License”

32 of 69

Page 33: GROUP PERSONAL ACCIDENT SCHEDULE

Schedule of Members covered attached to and forming part of Policy No 1602362914000209

SNo Emp Code

Name Nominee Grade Age Table A

Table B

Table C Table D

Total Sum Insured

DateofJoining

Location Remarks

686 201501086

LILA DHAVALKUMAR JAYANTILAL

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

687 201501087

BHUVA JAYKUMAR ANILKUMAR

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

688 201501088

ETTA SRI POOJITHA NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

689 201501089

SANGHANI ANILKUMAR GOPALBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

690 201501090

PIYUSH AJMERIA NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

691 201501091

DHOLIYA DHUMIL ASHOK

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

692 201501092

CHIRANG MALVIYA NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

693 201501093

GOTI MEET RAJENDRAKUMAR

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

694 201501095

DIVYANSHU SHEKHAR

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

695 201501096

PATEL SHASHANK NARESHBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

696 201501097

KRITI UPADHYAY NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

697 201501098

THAKRANI POOJA AMRUTLAL

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

698 201501099

AGAM ALKESHKUMAR SHAH

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

699 201501100

AMIN MEET ANILKUMAR

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

700 201501101

HARSH VYAS NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

701 201501102

SAKET JAJOO NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

702 201501103

HITESH KAUSHIK KORABATHINA

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

703 201501104

KALANGI SRAVANI NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

704 201501105

SAINI KARAN RAJSINGH

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

705 201501107

SHRIMALI JAY NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

706 201501108

SOLANKI DIVYAKUMAR BIPINKUMAR

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

707 201501109

MADHURYA SANKHLA

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

708 201501110

MISTRY DARREN JAYKANT

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

709 201501111

MITESH KAPASIA NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

IRDAI Registration No. 103. An ISO 9001:2008 Certified CompanyCorporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited. Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055 PAN No. : AABCR6747B UIN : IRDA/NL-HLT/RGI/P-P/V.I/320/13-14"Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License”

33 of 69

Page 34: GROUP PERSONAL ACCIDENT SCHEDULE

Schedule of Members covered attached to and forming part of Policy No 1602362914000209

SNo Emp Code

Name Nominee Grade Age Table A

Table B

Table C Table D

Total Sum Insured

DateofJoining

Location Remarks

710 201501112

SAKSHI SHARMA NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

711 201501113

SHAH SHREY MANISHBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

712 201501114

VAGHELA BHARAT JETHALAL

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

713 201501115

MAKWANA VIRAJ NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

714 201501116

VADALIYA KARN KAUSHIK

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

715 201501117

GANATRA HARMISH SANDIPBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

716 201501118

KAUSHIK P MAKWANA

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

717 201501119

PATIL TEJASKUMAR RAVINDRA

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

718 201501120

ETTA MADHUMITHA NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

719 201501121

ANDHARIA DHAVAL KALPESHKUMAR

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

720 201501122

HIMANSHU GUPTA NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

721 201501123

ASHRAY BHARAMBE

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

722 201501124

SHUBHANGI MEHROTRA

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

723 201501125

PATEL POOJA KALPESHBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

724 201501126

ATKURI SRI DUTTA SAI SANDEEP

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

725 201501127

GAJERA MIHIR HASMUKHBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

726 201501128

SHIRISH JAIN NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

727 201501129

PRATIK N WANKHEDE

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

728 201501130

RAVAL PARTH SANJAYBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

729 201501131

ADITI SOGRA NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

730 201501132

SHAH MAULI NILESH

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

731 201501133

MEHTA AAGAM PARESHBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

732 201501134

NISARG PATEL NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

733 201501135

GADHVI VEDANT NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

734 201501136

MEHTA YASH DIPAK NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

IRDAI Registration No. 103. An ISO 9001:2008 Certified CompanyCorporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited. Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055 PAN No. : AABCR6747B UIN : IRDA/NL-HLT/RGI/P-P/V.I/320/13-14"Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License”

34 of 69

Page 35: GROUP PERSONAL ACCIDENT SCHEDULE

Schedule of Members covered attached to and forming part of Policy No 1602362914000209

SNo Emp Code

Name Nominee Grade Age Table A

Table B

Table C Table D

Total Sum Insured

DateofJoining

Location Remarks

735 201501137

RATHOD KAUSTUK AJAYBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

736 201501138

PRIYANKKUMAR PRAJAPATI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

737 201501139

AGRAWAL AAYUSH KAILASH

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

738 201501140

MACHIRAJU UNNATHI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

739 201501141

ENGINEER TIRTH JIGNESHBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

740 201501142

SHAH LABDHI JIGNESHKUMAR

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

741 201501143

ONKAR PANDIT NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

742 201501144

KHOKHAR SOHIL ABDULRASID

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

743 201501145

CHANDNANI CHIRAG KHUSHIRAM

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

744 201501146

AKSHAY MARU NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

745 201501147

PATEL KISHANKUMAR HASMUKHBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

746 201501148

RATHOD ANKITKUMAR DHIRAJLAL

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

747 201501149

PANCHAL UMANG HASMUKHBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

748 201501150

SAJAL TIWARI NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

749 201501151

VIKASH KUMAR NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

750 201501152

MUKUL JOSHI NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

751 201501153

TIWARI RAVIKUMAR VYAS

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

752 201501154

RIYA TALWAR NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

753 201501155

AASHAY BINAYKIA NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

754 201501156

VAISHNAV ASHISH ANIRUDHBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

755 201501157

PATEL NIKISHA NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

756 201501158

BRINDA JENA NA STUDENT

27 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

757 201501159

KIRTANKUMAR A PATEL

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

758 201501160

SIDDHARTH MISHRA NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

IRDAI Registration No. 103. An ISO 9001:2008 Certified CompanyCorporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited. Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055 PAN No. : AABCR6747B UIN : IRDA/NL-HLT/RGI/P-P/V.I/320/13-14"Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License”

35 of 69

Page 36: GROUP PERSONAL ACCIDENT SCHEDULE

Schedule of Members covered attached to and forming part of Policy No 1602362914000209

SNo Emp Code

Name Nominee Grade Age Table A

Table B

Table C Table D

Total Sum Insured

DateofJoining

Location Remarks

759 201501163

CHINMAY V GAMETI NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

760 201501164

PATEL DHVANI PRASHANT

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

761 201501165

AJAYKUMAR SHAMLA

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

762 201501166

NEHALKUMAR VASAVA

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

763 201501171

RAJ AJITKUMAR GAMIT

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

764 201501172

CHAUDHARI DVEEP PARESHBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

765 201501173

GAMIT DEEP KANALAL

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

766 201501174

KARTIK MUDGAL NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

767 201501175

PATEL MAULIK BHARATKUMAR

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

768 201501176

SHAH HET PRASHANTBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

769 201501177

DODIA NAITIK NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

770 201501178

BHAGYASHREE SOLANKI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

771 201501179

SHAH ADIT JAYESHKUMAR

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

772 201501180

KRUTI VYOMESH SHETH

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

773 201501181

PRIYAM MALAYKUMAR VORA

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

774 201501182

LUKHI DRASHTI DHIRAJLAL

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

775 201501183

AMAN VANGANI NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

776 201501184

HEMIL HASMUKHBHAI JAIN

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

777 201501185

SHAH MEET DIMPLEKUMAR

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

778 201501186

PATEL JAY RASIKBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

779 201501187

KAPADIA AASHKA BHADRESH KUMAR

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

780 201501188

PRAJAPATI DHAVALKUMAR GOVINDBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

781 201501189

PATEL NIRMAL JAGDISHBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

782 201501190

VORA DARSHIT GIRISHBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

783 201501191

MAKWANA HARSH JAYVEERBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

IRDAI Registration No. 103. An ISO 9001:2008 Certified CompanyCorporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited. Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055 PAN No. : AABCR6747B UIN : IRDA/NL-HLT/RGI/P-P/V.I/320/13-14"Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License”

36 of 69

Page 37: GROUP PERSONAL ACCIDENT SCHEDULE

Schedule of Members covered attached to and forming part of Policy No 1602362914000209

SNo Emp Code

Name Nominee Grade Age Table A

Table B

Table C Table D

Total Sum Insured

DateofJoining

Location Remarks

784 201501192

PARMAR MIHIR NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

785 201501193

BAMBHANIA PRATIK JAYANTI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

786 201501194

NAIK DHAIWAT NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

787 201501195

CHAUHAN HIRENKUMAR JITENDRA

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

788 201501196

DARJI CHIRAG BHAVESHBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

789 201501197

MODI SMIT JIGNESHKUMAR

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

790 201501198

PRAJAPATI PRATIK ARVINDBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

791 201501199

MODI TAPAN RAJNIKANT

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

792 201501200

SACHIN CHAUHAN NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

793 201501201

GOHIL AJAY ASHOKKUMAR

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

794 201501203

SHUKLA ADARSH DWARIKANATH

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

795 201501204

MISTRY KHUSHIL BHADRESHKUMAR

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

796 201501205

PATEL SKENY SATISHCHANDRA

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

797 201501206

CHAUHAN YAGNESH SURESHBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

798 201501207

GOHIL AVANIBEN ASHOKKUMAR

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

799 201501208

VRAJ JITENDRA MEHTA

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

800 201501209

CHAUDHARI PRIYANGIKUMARI KALPESHBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

801 201501210

BHAT KOPAL VIR KUMAR

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

802 201501211

PRAJAPATI PARTH RAMESHCHANDRA

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

803 201501212

GAJJAR AKASHKUMAR ASHOKBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

804 201501213

PRAJAPATI JEELKUMAR MAHENDRABHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

805 201501214

DARJI ATMAN JAYESHKUMAR

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

806 201501215

VADHAIYA NIRAJKUMAR SURESHBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

IRDAI Registration No. 103. An ISO 9001:2008 Certified CompanyCorporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited. Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055 PAN No. : AABCR6747B UIN : IRDA/NL-HLT/RGI/P-P/V.I/320/13-14"Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License”

37 of 69

Page 38: GROUP PERSONAL ACCIDENT SCHEDULE

Schedule of Members covered attached to and forming part of Policy No 1602362914000209

SNo Emp Code

Name Nominee Grade Age Table A

Table B

Table C Table D

Total Sum Insured

DateofJoining

Location Remarks

807 201501216

DARJI JAYMINKUMAR NAVINBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

808 201501217

APPURVA MURAWAT

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

809 201501218

HIMANSHU AGARWAL

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

810 201501219

PATEL KAUSHAL PANKAJKUMAR

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

811 201501220

DOSHI SAVAN DIXESH

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

812 201501221

KALYANI RISHABH SANJAYKUMAR

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

813 201501223

MEGHPARA RAJKUMAR PRAVINBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

814 201501224

SHAH ROMIL RAJESHBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

815 201501225

OZA DHRUMIL UMESHBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

816 201501226

PATEL NILKUMAR BABUBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

817 201501227

PATEL AMAN MUKESHBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

818 201501228

KAHODARIYA MAHARSHI MAHESHBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

819 201501229

DOSHI PARTH NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

820 201501230

PATEL PRITHVI VIJAYKUMAR

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

821 201501231

PATEL HELLY JIGNESHBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

822 201501232

SHAH ANURAG AJAYKUMAR

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

823 201501233

TAPODHAN KIRTI DINESHBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

824 201501234

PATEL KAVAN NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

825 201501235

JEEL SANTOKI NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

826 201501236

ARNAV KAUSHIK SHARMA

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

827 201501237

DARSH BHARAT VAJARIA

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

828 201501238

PATEL BRIJESHKUMAR

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

829 201501240

BHUPTANI DHRUVIL MITESHBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

830 201501241

KASUNDRA TEJAS RAJESHBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

IRDAI Registration No. 103. An ISO 9001:2008 Certified CompanyCorporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited. Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055 PAN No. : AABCR6747B UIN : IRDA/NL-HLT/RGI/P-P/V.I/320/13-14"Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License”

38 of 69

Page 39: GROUP PERSONAL ACCIDENT SCHEDULE

Schedule of Members covered attached to and forming part of Policy No 1602362914000209

SNo Emp Code

Name Nominee Grade Age Table A

Table B

Table C Table D

Total Sum Insured

DateofJoining

Location Remarks

831 201501242

KAVAR RUSHIKESH PRAFULBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

832 201501243

GOSALIYA KAJAL PARESH

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

833 201501244

PATEL RUTUL NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

834 201501245

PATEL KADAMKUMAR BHARATBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

835 201501246

PATEL MANTHAN DILIPBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

836 201501247

LAD GAURAVKUMAR JAYESHBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

837 201501248

KAYASTHA PRATIK JAYESH

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

838 201501249

SUTHAR PRIYAM DIPAKBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

839 201501250

PATEL KUSH DIPESHBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

840 201501251

MIT SWAMI NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

841 201501401

JIVANI KARAN PRAFULBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

842 201501402

BHORANIYA EKTA NITINBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

843 201501403

BHATT UJAVAL GUNVANTBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

844 201501404

VINEET MEHTA NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

845 201501405

VASOYA HARSH DINESHBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

846 201501406

UNNATI PARESHBHAI PAREKH

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

847 201501407

SAVALIYA SAGARKUMAR NAVNITBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

848 201501408

RAJ ASHOKBHAI JAKASANIYA

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

849 201501409

THESIYA KISHAN MOHANBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

850 201501410

PATEL SMIT JASHVANTBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

851 201501411

JOSHI RUTVIK BHARATKUMAR

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

852 201501412

MANVAR KRISHNA ARVINDBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

853 201501413

KOTHARI YASH SANJAYBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

854 201501414

PATEL GAURANG SURESHBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

IRDAI Registration No. 103. An ISO 9001:2008 Certified CompanyCorporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited. Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055 PAN No. : AABCR6747B UIN : IRDA/NL-HLT/RGI/P-P/V.I/320/13-14"Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License”

39 of 69

Page 40: GROUP PERSONAL ACCIDENT SCHEDULE

Schedule of Members covered attached to and forming part of Policy No 1602362914000209

SNo Emp Code

Name Nominee Grade Age Table A

Table B

Table C Table D

Total Sum Insured

DateofJoining

Location Remarks

855 201501415

DOSHI SAUMYA PARESHBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

856 201501416

HASNAIN AKIL GANDHI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

857 201501417

RAMRAKHIA YASH RAJENDRA

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

858 201501418

MAKADIYA SAVAN MAHESHBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

859 201501419

KAKKAD ABHIN KETAN

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

860 201501420

MEHTA MANTHAN DHARMESHKUMAR

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

861 201501421

GOYAL VISHAL NARENDRABHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

862 201501422

MEHTA CHAHAK PARAS

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

863 201501423

SWASTIKA SATISH NAYAK

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

864 201501424

PATEL ANERI ASHISH

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

865 201501425

DARSHAN Y MAKWANA

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

866 201501426

CHAVDA JAKSHIL DHIRUBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

867 201501427

PARMAR EKTA PANKAJBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

868 201501428

MAHESHWARI ROHAN PREMJI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

869 201501429

PARMAR VYOM JAYSUKHLAL

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

870 201501430

PRAJEET THAKUR NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

871 201501431

AKRITI THAKUR NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

872 201501432

MAKWANA BHARGAV MAHESHKUMAR

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

873 201501433

SUBHANIYA AYUB ANWER

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

874 201501434

SISODIYA SIDDHARAJ SADURBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

875 201501435

CHAUDHARY MAULIKKUMAR

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

876 201501436

KALASWA RAJDEEPKUMAR CHANDULAL

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

877 201501437

SELOT PRIYANSHIBEN

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

878 201501438

PATEL HIRAL ASHVINKUMAR

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

IRDAI Registration No. 103. An ISO 9001:2008 Certified CompanyCorporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited. Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055 PAN No. : AABCR6747B UIN : IRDA/NL-HLT/RGI/P-P/V.I/320/13-14"Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License”

40 of 69

Page 41: GROUP PERSONAL ACCIDENT SCHEDULE

Schedule of Members covered attached to and forming part of Policy No 1602362914000209

SNo Emp Code

Name Nominee Grade Age Table A

Table B

Table C Table D

Total Sum Insured

DateofJoining

Location Remarks

879 201501439

KARNAVAT PRADIPKUMAR MAHESHBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

880 201501440

THAKKAR SMIT RAJESHKUMAR

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

881 201501441

THAKKER DHRUV VIKRAM

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

882 201501442

JOSHI ISHANI BHASKARBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

883 201501443

PATEL UTSAV PRAHLADBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

884 201501444

RAYVADERA MEET HITESHKUMAR

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

885 201501445

PARMAR UMANG JASHVANTBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

886 201501446

MASTER KARAN RAJENDRABHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

887 201501447

MORI ABHIJITSINH SHAILESHBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

888 201501448

PRAJAPATI KAVI YAGNESHBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

889 201501449

GANDHI DHARMIL NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

890 201501450

SHINGALA VISHALKUMAR BABUBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

891 201501452

PATEL DHRUV MAHESHBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

892 201501453

PATEL TIRTH JITENDRA

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

893 201501454

ANUSHRUTI PANDEY

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

894 201501456

DHARAK CHANDUBHAI GAMETI

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

895 201501457

GAMIT PROMIL LAXMANBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

896 201501458

UPADHYAY UMANGBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

897 201501459

PATEL LUV DIPESHBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

898 201501460

CHAUDHARY VISHNUKUMAR BHARMALBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

899 201501461

KHODIFAD HARSHAL VALLABHBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

900 201511001

PEDHADIYA NIRAVKUMAR SURESHBHAI

NA STUDENT

24 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

901 201511002

DESAI MEET NITIN NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

IRDAI Registration No. 103. An ISO 9001:2008 Certified CompanyCorporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited. Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055 PAN No. : AABCR6747B UIN : IRDA/NL-HLT/RGI/P-P/V.I/320/13-14"Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License”

41 of 69

Page 42: GROUP PERSONAL ACCIDENT SCHEDULE

Schedule of Members covered attached to and forming part of Policy No 1602362914000209

SNo Emp Code

Name Nominee Grade Age Table A

Table B

Table C Table D

Total Sum Insured

DateofJoining

Location Remarks

902 201511003

PATEL VISMAY NAVINKUMAR

NA STUDENT

24 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

903 201511004

SHARMA AYUSHI RAMPRAKASH

NA STUDENT

23 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

904 201511005

SHAH AKASH PRAVINCHANDRA

NA STUDENT

23 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

905 201511006

MISHRA AJAY SURENDRA

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

906 201511007

DHOLARIYA PANKAJKUMAR VRAJLAL

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

907 201511008

SEKSARIA KHUSHBOO SURYAKANT

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

908 201511009

HARSHIT BHATNAGAR

NA STUDENT

23 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

909 201511010

TRIVEDI SHAILI NARESHKUMAR

NA STUDENT

24 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

910 201511011

BADGUJAR JIGNESH SANTOSHBHAI

NA STUDENT

24 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

911 201511012

AGRAWAL JATIN BHARAT

NA STUDENT

24 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

912 201511013

TUSHIN SHROTRIYA NA STUDENT

23 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

913 201511014

HARSHIT PRATIK NA STUDENT

24 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

914 201511015

JAINIKKUMAR PRAVINCHANDRA RANPURA

NA STUDENT

24 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

915 201511016

POPAT NIRALI DINESHBHAI

NA STUDENT

23 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

916 201511017

RAJPUT PRUTHVISH RAJESH

NA STUDENT

25 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

917 201511018

SHIHORA RUTVI NAYANKUMAR

NA STUDENT

23 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

918 201511019

KARAVADRA RAJU DUDA

NA STUDENT

26 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

919 201511020

KADIYA BHAUMIK ASHWINKUMAR

NA STUDENT

23 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

920 201511021

MANSI SINGH NA STUDENT

25 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

921 201511023

NEELASHA SEN NA STUDENT

28 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

922 201511024

K. HEMANTHA NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

923 201511025

CHRISTIAN RUZVELT RAMESHBHAI

NA STUDENT

23 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

924 201511026

TANDEL DEEP ISHVARBHAI

NA STUDENT

23 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

IRDAI Registration No. 103. An ISO 9001:2008 Certified CompanyCorporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited. Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055 PAN No. : AABCR6747B UIN : IRDA/NL-HLT/RGI/P-P/V.I/320/13-14"Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License”

42 of 69

Page 43: GROUP PERSONAL ACCIDENT SCHEDULE

Schedule of Members covered attached to and forming part of Policy No 1602362914000209

SNo Emp Code

Name Nominee Grade Age Table A

Table B

Table C Table D

Total Sum Insured

DateofJoining

Location Remarks

925 201511027

BATAVIA DARSHAN NARESH

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

926 201511028

MULLA ZUBAIN CHANDSAHEB

NA STUDENT

27 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

927 201511029

ANUBHA JAIN NA STUDENT

25 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

928 201511030

MARAL VISHAL RANGNATH

NA STUDENT

26 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

929 201511031

APEKSHA JAGDISHBHAI NAIK

NA STUDENT

24 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

930 201511032

DHARMESHKUMAR MAHESHCHANDRA AGRAWAL

NA STUDENT

23 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

931 201511033

DHAVAL PATEL NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

932 201511034

RATHOD SAMKIT DINESHBHAI

NA STUDENT

23 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

933 201511035

PRIYANKA SHARMA NA STUDENT

26 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

934 201511036

RISHABH AGARWAL NA STUDENT

24 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

935 201511037

BHANUSHALI ARTIBEN KAMLESHKUMAR

NA STUDENT

25 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

936 201511038

POOJA TIWARI NA STUDENT

23 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

937 201511039

SAYAN CHAKRABORTY

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

938 201511040

SADHWANI JAY DILIPKUMAR

NA STUDENT

24 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

939 201511042

SAURABH TYAGI NA STUDENT

35 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

940 201511043

MAYANK DUBEY NA STUDENT

26 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

941 201511044

ANKIT PALIWAL NA STUDENT

24 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

942 201511045

PRADIP TILALA NA STUDENT

23 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

943 201511047

DIGANT DILIPBHAI DOSHI

NA STUDENT

23 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

944 201511049

SURABHI JAIN NA STUDENT

24 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

945 201511050

MANGUKIYA CHIRAGKUMAR PRAVINBHAI

NA STUDENT

24 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

946 201511051

KAMLESH KARKI NA STUDENT

28 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

947 201511052

VINAY LATA NA STUDENT

23 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

948 201511053

LATHIYA MAYUR NAROTTAMBHAI

NA STUDENT

25 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

IRDAI Registration No. 103. An ISO 9001:2008 Certified CompanyCorporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited. Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055 PAN No. : AABCR6747B UIN : IRDA/NL-HLT/RGI/P-P/V.I/320/13-14"Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License”

43 of 69

Page 44: GROUP PERSONAL ACCIDENT SCHEDULE

Schedule of Members covered attached to and forming part of Policy No 1602362914000209

SNo Emp Code

Name Nominee Grade Age Table A

Table B

Table C Table D

Total Sum Insured

DateofJoining

Location Remarks

949 201511054

RISHABH TAK NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

950 201511055

SATYAM SATYAJEET

NA STUDENT

25 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

951 201511056

KOTAK NISHITH ASHOKKUMAR

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

952 201511057

DAVE KEVAL NARAYANBHAI

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

953 201511058

SHRUTI RAJENDRAKUMAR NAIK

NA STUDENT

23 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

954 201511059

THAKKAR SHAIVAL YOGESH

NA STUDENT

23 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

955 201511060

DHWANI D PATEL NA STUDENT

24 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

956 201511061

HEMANT KAUSHIK NA STUDENT

29 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

957 201511062

LANKA MOHAN NA STUDENT

33 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

958 201512001

KHEDKAR KAPIL DINESH

NA STUDENT

23 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

959 201512002

RAUT PRIYANKA MOHAN

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

960 201512003

RUTUL MANGESHBHAI THAKKAR

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

961 201512004

SHAH SAGAR MUKESHBHAI

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

962 201512005

SUNIL SURESH CHAWLA

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

963 201512006

SANGHAVI CHINTAN CHANDRAKANT

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

964 201512007

PADHYA DARSHIT BHAVESHBHAI

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

965 201512008

VIRANI JITENDRAKUMAR BAVACHANDBHAI

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

966 201512009

BUHA SAGARKUMAR RAMJIBHAI

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

967 201512010

PATEL SAVANKUMAR ARVINDBHAI

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

968 201512011

SAXENA TIKSHA PRADIPKUMAR

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

969 201512013

FANSE ANUSHKA APURVA

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

970 201512014

PATEL DHYAN CHANDULAL

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

971 201512015

KUKAWALA MOHINI RAMKRISHNA

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

IRDAI Registration No. 103. An ISO 9001:2008 Certified CompanyCorporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited. Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055 PAN No. : AABCR6747B UIN : IRDA/NL-HLT/RGI/P-P/V.I/320/13-14"Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License”

44 of 69

Page 45: GROUP PERSONAL ACCIDENT SCHEDULE

Schedule of Members covered attached to and forming part of Policy No 1602362914000209

SNo Emp Code

Name Nominee Grade Age Table A

Table B

Table C Table D

Total Sum Insured

DateofJoining

Location Remarks

972 201512016

CHHABRA JASPREET KAUR HARVINDER

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

973 201512017

GANDHI VISHAL KANAIYABHAI

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

974 201512018

FATEMA M K NA STUDENT

23 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

975 201512019

TANVI SAXENA NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

976 201512020

PARASIA BHARAT AMRUTBHAI

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

977 201512021

PATEL VISHAL YOGESHKUMAR

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

978 201512022

MISTRY AKSHAR PARESH

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

979 201512023

BINU FRANCIS JOSEPH

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

980 201512024

BATHIA YASH VIMALBHAI

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

981 201512025

SHAH MANSI MUKESHBHAI

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

982 201512026

DESAI MITULKUMAR BHUPATBHAI

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

983 201512027

PRAJAPATI DEEPAK TARAJI

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

984 201512028

BHATT URMIL NIKUNJKUMAR

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

985 201512029

PRACHI NARENDRA MODI

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

986 201512030

PATEL HERAT BABUBHAI

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

987 201512031

MAJMUDAR GAURAV VINAY

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

988 201512032

AKSHAY JAIN NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

989 201512033

SINGHAL SANCHI MUKESH

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

990 201512034

BHAVESH GOYAL NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

991 201512036

GEETIKA SHARMA NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

992 201512037

MEHTA DHRUVA PULKESHBHAI

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

993 201512038

RAMNANI NITIN GOPALDAS

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

994 201512039

JANI VIRAL KAMLESHKUMAR

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

995 201512040

AKASH GOSALIA NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

996 201512041

JUHI PURSWANI NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

IRDAI Registration No. 103. An ISO 9001:2008 Certified CompanyCorporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited. Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055 PAN No. : AABCR6747B UIN : IRDA/NL-HLT/RGI/P-P/V.I/320/13-14"Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License”

45 of 69

Page 46: GROUP PERSONAL ACCIDENT SCHEDULE

Schedule of Members covered attached to and forming part of Policy No 1602362914000209

SNo Emp Code

Name Nominee Grade Age Table A

Table B

Table C Table D

Total Sum Insured

DateofJoining

Location Remarks

997 201512042

SHAH KUSH RAJESH

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

998 201512043

RITU GARG NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

999 201512044

JAIN ADITI RAJENDRA

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1000 201512045

DESAI SHIVANI JANAKBHAI

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1001 201512046

VEJANI UTSAV MANISH

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1002 201512047

SHIVANGINI KOTIYAL

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1003 201512048

DESAI SHWET ANANTBHAI

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1004 201512049

SHAH VISMAY KETANBHAI

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1005 201512050

CONTRACTOR GOPAL BHUPENDRABHAI

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1006 201512051

LAKKAD PRITESHKUMAR PRABHUDASBHAI

NA STUDENT

23 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1007 201512052

MEHTA JAINAM NILESHBHAI

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1008 201512053

VORA TEJAS BHARATKUMAR

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1009 201512055

LATHIYA ANKURKUMAR

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1010 201512057

GUPTA SHUBHAM CHHOTELAL

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1011 201512058

KANANI KARAN YASHWANTKUMAR

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1012 201512059

KUNDNANI PIYUSH JAIDEV

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1013 201512060

GOSALIYA KAUSHAL

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1014 201512061

AGGARWAL INDU BAJRANGLAL

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1015 201512062

BOHRA HARDIK UTTAMKUMAR

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1016 201512063

MAYANK LADDHA NA STUDENT

24 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1017 201512064

LAKHENDER SINGH NA STUDENT

23 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1018 201512065

GADHVI JANKIBEN RAMESH

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1019 201512066

SHIVENDRA PRATAP

NA STUDENT

24 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1020 201512067

SHAH HARSHIT PRADIPKUMAR

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1021 201512068

LAKHWANI JITESH DILIP

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

IRDAI Registration No. 103. An ISO 9001:2008 Certified CompanyCorporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited. Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055 PAN No. : AABCR6747B UIN : IRDA/NL-HLT/RGI/P-P/V.I/320/13-14"Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License”

46 of 69

Page 47: GROUP PERSONAL ACCIDENT SCHEDULE

Schedule of Members covered attached to and forming part of Policy No 1602362914000209

SNo Emp Code

Name Nominee Grade Age Table A

Table B

Table C Table D

Total Sum Insured

DateofJoining

Location Remarks

1022 201512069

AMI JAYESHKUMAR THAKKAR

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1023 201512070

BAMBHANIA ANAND MAHENDRABHAI

NA STUDENT

27 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1024 201512071

DASWANI PRATHAM DEEPAKKUMAR

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1025 201512072

PALASH KHANDELWAL

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1026 201512073

RADADIYA ARTI GOGANBHAI

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1027 201512074

RAM KRISHAN SHARMA

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1028 201512075

SAXENA ADITYA MANOJKUMAR

NA STUDENT

23 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1029 201512076

JOSHI JAGRUTI ANANDBHAI

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1030 201512077

WATWANI KHUSHBU JAIKISHIN

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1031 201512078

SHAH SARTHAK HIMANSHUBHAI

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1032 201512079

SONPARATE KRUNAL PRAKASHBHAI

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1033 201512080

JETANI RAVIBHAI MANJIBHAI

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1034 201512081

MEHTA HEMANG DILIPKUMAR

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1035 201512082

SHRADDHA RANPURWALA

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1036 201512083

CHAUHAN SHREYABEN GOVINDBHAI

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1037 201512084

THAKKAR HARDIK RAJANIKANTBHAI

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1038 201512085

PATEL PRATIKKUMAR BABUBHAI

NA STUDENT

23 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1039 201512086

MEMON JABBAR RAZAKBHAI

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1040 201512087

ANSARI TANVIRAEHMAD AKILAEHMAD

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1041 201512088

CHOUDHARY MANOJ DEVARAM

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1042 201512089

PATEL DISHANT MUKESHBHAI

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1043 201512090

VANSADIA PRIYANKAKUMARI PRAVINSINH

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1044 201512092

NATHWANI KHUSHBOO HARESHKUMAR

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

IRDAI Registration No. 103. An ISO 9001:2008 Certified CompanyCorporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited. Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055 PAN No. : AABCR6747B UIN : IRDA/NL-HLT/RGI/P-P/V.I/320/13-14"Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License”

47 of 69

Page 48: GROUP PERSONAL ACCIDENT SCHEDULE

Schedule of Members covered attached to and forming part of Policy No 1602362914000209

SNo Emp Code

Name Nominee Grade Age Table A

Table B

Table C Table D

Total Sum Insured

DateofJoining

Location Remarks

1045 201512093

SHAH SHIVANI NILESHKUMAR

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1046 201512094

SHAH DHRUVI MEHULBHAI

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1047 201513001

TRIVEDI DRASHTI NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1048 201513002

SHAH SNEHA KANAIYALAL

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1049 201513003

KARNAVAT DILIP KARSANBHAI

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1050 201513004

ASHISH AGARWAL NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1051 201513005

RITESH UPADHYAY NA STUDENT

25 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1052 201513009

PATEL ASHVINIBEN KANUBHAI

NA STUDENT

23 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1053 201513010

HIMANSHU CHOUBISA

NA STUDENT

23 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1054 201514001

SAURAV SHARMA NA STUDENT

26 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1055 201514002

KAVTHEKAR PRAJAKTA UDAY

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1056 201514003

DESAI RIDDHI DEVANGKUMAR

NA STUDENT

24 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1057 201514004

KUNAL GUPTA NA STUDENT

27 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1058 201514005

KRINA PRAJAPATI NA STUDENT

23 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1059 201514006

SHYAM ATTREYA NA STUDENT

26 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1060 201514007

AKANKSHA GUPTA NA STUDENT

24 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1061 201514008

VANSHIKA ARORA NA STUDENT

23 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1062 201514009

ASHITA JAIN NA STUDENT

24 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1063 201521001

CHAUDHARY PANKAJ PRABHUBHAI

NA STUDENT

26 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1064 201521002

RAHUL MANE NA STUDENT

33 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1065 201521003

SUJATA NA STUDENT

23 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1066 201521004

SANKHAVARA JAINISHA

NA STUDENT

23 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1067 201521005

KAMBLE MADHU RAYAPPA

NA STUDENT

25 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1068 201521006

RISHIKANT RAJDEEPAK

NA STUDENT

24 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1069 201521007

MADHULIKA AGRAWAL

NA STUDENT

27 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

IRDAI Registration No. 103. An ISO 9001:2008 Certified CompanyCorporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited. Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055 PAN No. : AABCR6747B UIN : IRDA/NL-HLT/RGI/P-P/V.I/320/13-14"Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License”

48 of 69

Page 49: GROUP PERSONAL ACCIDENT SCHEDULE

Schedule of Members covered attached to and forming part of Policy No 1602362914000209

SNo Emp Code

Name Nominee Grade Age Table A

Table B

Table C Table D

Total Sum Insured

DateofJoining

Location Remarks

1070 201521008

PATEL PURVIBEN JAYPRAKASH

NA STUDENT

24 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1071 201521009

SHAIKH MOHAMMEDSAYEEMUDDIN KALIMUDDIN

NA STUDENT

38 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1072 201521010

DOMADIYA PRASHANT MANSHUKHBHAI

NA STUDENT

26 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1073 201521011

PATEL JIGNESH RAMESHCHANDRA

NA STUDENT

28 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1074 201521012

PATEL MAYANKKUMAR LALABHAI

NA STUDENT

26 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1075 201521013

ANJALI DIWAN NA STUDENT

39 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1076 201601001

SHIVANI BHANDARI NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1077 201601002

SHETH VISHWA VILPESHKUMAR

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1078 201601003

VIDHIN HITESH PARMAR

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1079 201601004

ADARSH MISRA NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1080 201601005

RAVAL DEVARSHI JAGATKISHORE

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1081 201601006

SWAPNIL DHIMMAR NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1082 201601007

PONAKA PRAYAG REDDY

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1083 201601008

BHUMITRA SAHWAL NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1084 201601009

TIRTH BHAVESHBHAI SHAH

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1085 201601010

PATEL JAINUL SURESHBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1086 201601011

SHAH DHRUVIL MANISH

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1087 201601012

AJINKYA JEETENDRA MATSAWAR

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1088 201601013

PATEL SMIT BHAVESHKUMAR

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1089 201601014

JOSHI SHIVANG GIRISHKUMAR

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1090 201601015

SHREYA SANJAYKUMAR SAGAR

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1091 201601016

SASTRY SRIKUMAR NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

IRDAI Registration No. 103. An ISO 9001:2008 Certified CompanyCorporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited. Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055 PAN No. : AABCR6747B UIN : IRDA/NL-HLT/RGI/P-P/V.I/320/13-14"Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License”

49 of 69

Page 50: GROUP PERSONAL ACCIDENT SCHEDULE

Schedule of Members covered attached to and forming part of Policy No 1602362914000209

SNo Emp Code

Name Nominee Grade Age Table A

Table B

Table C Table D

Total Sum Insured

DateofJoining

Location Remarks

1092 201601017

BADIYANI GAURANG KAMLESHKUMAR

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1093 201601018

PATEL RIDDHI DIPAKBHAI

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1094 201601019

SHETH PARITA MANOJBHAI

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1095 201601020

PRAPTI TRIVEDI NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1096 201601021

JANI VISHVESH MUKESHKUMAR

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1097 201601022

ARNAV SAHA NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1098 201601023

ASHWIN PORWAL NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1099 201601024

PATEL PARTHKUMAR VASUDEVBHAI

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1100 201601025

MAYANK SHANTILAL SAVALIYA

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1101 201601026

MANSI OD NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1102 201601027

ZANZARUKIYA ABHI RAJENDRABHAI

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1103 201601028

ANKIT NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1104 201601029

MALONDKAR VISMAY JAYDIP

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1105 201601030

TIKAM ALMA NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1106 201601031

SHAH HILLONI HITESH

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1107 201601032

JAINIL MANOJKUMAR PARIYA

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1108 201601033

TANYA PUSHKIN GARG

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1109 201601034

HET THAKKAR NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1110 201601035

SANJOLI CHAUHAN NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1111 201601036

PATEL ARPITKUMAR JAYESHBHAI

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1112 201601037

DIVAKAR BHARGAV JAGDISHCHANDRA

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1113 201601038

DESAI ANUSHKA BHUPENDRA

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1114 201601039

MAVANI TARUN JAYESHBHAI

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1115 201601040

BHAVSAR SHACHI DIVYANG

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

IRDAI Registration No. 103. An ISO 9001:2008 Certified CompanyCorporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited. Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055 PAN No. : AABCR6747B UIN : IRDA/NL-HLT/RGI/P-P/V.I/320/13-14"Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License”

50 of 69

Page 51: GROUP PERSONAL ACCIDENT SCHEDULE

Schedule of Members covered attached to and forming part of Policy No 1602362914000209

SNo Emp Code

Name Nominee Grade Age Table A

Table B

Table C Table D

Total Sum Insured

DateofJoining

Location Remarks

1116 201601041

SHAH MANISH RASIKLAL

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1117 201601042

MUNSHI JALANSH SAUMIL

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1118 201601043

DOSHI PRITHVISH RAKESH

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1119 201601044

MIRANI YASH NILESHKUMAR

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1120 201601045

JAIN ISHITA HEMENDRA

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1121 201601046

PAREKH YASH ATULBHAI

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1122 201601047

SARANGI PATEL NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1123 201601048

NIDHI GUPTA NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1124 201601049

SONI MONIL PINAKIN

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1125 201601050

VAGHELA MAULIK JITENDRA

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1126 201601051

PARTH ARUN DADHANIA

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1127 201601052

SHRUTI ARVIND CHAUDHARI

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1128 201601053

BHAVSAR MAHER NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1129 201601054

VANDAN SONI NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1130 201601055

RANK RAKSHA ARVINDBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1131 201601056

MARU PRANJALI RAJIV

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1132 201601057

SHEREKAR VAIBHAV RAJU

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1133 201601058

PRAJAPATI NISHIT PRAHLADBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1134 201601059

ROSHANI NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1135 201601060

DHRUV JADAV NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1136 201601061

PAREKH NIKESH BHARAT

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1137 201601062

SHIVAM AGARWAL NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1138 201601063

CHIRAG PODDAR NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1139 201601064

SHAH RIYA HEMENDRA

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1140 201601065

GUNDAM SAMHITHA NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

IRDAI Registration No. 103. An ISO 9001:2008 Certified CompanyCorporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited. Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055 PAN No. : AABCR6747B UIN : IRDA/NL-HLT/RGI/P-P/V.I/320/13-14"Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License”

51 of 69

Page 52: GROUP PERSONAL ACCIDENT SCHEDULE

Schedule of Members covered attached to and forming part of Policy No 1602362914000209

SNo Emp Code

Name Nominee Grade Age Table A

Table B

Table C Table D

Total Sum Insured

DateofJoining

Location Remarks

1141 201601066

JAIN PRIYA PRITAMCHANDRA

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1142 201601067

ROHIT CHAKU NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1143 201601068

THANKI DEEP JAYSUKH

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1144 201601069

GHATE AMEY ABHAY

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1145 201601070

MUNENDRA RATHOOD

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1146 201601071

VISHRUT CHETAN JETLY

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1147 201601072

RAJANI PRATIK PRAVINBHAI

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1148 201601073

JAYATI AMRUTBHAI PATEL

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1149 201601074

BRIJESH PANARA NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1150 201601075

MAYANK KUMAR JETHWA

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1151 201601076

NILESH MEENA NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1152 201601077

ANERY KIRTIBHAI PATEL

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1153 201601078

KALLAKURI N V S PUSHPA RAMA MANASA

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1154 201601079

RITWIK BHARADWAJ

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1155 201601080

HARSHA MAHAVER NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1156 201601081

PATEL KIRTAN DARSHANKUMAR

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1157 201601082

PURVA MAKARAND MHASAKAR

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1158 201601083

GARIKIPATI GANESHSAI

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1159 201601084

PATEL KSHITIJ DINESHBHAI

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1160 201601085

PANDIT ADITYA SHIRISHBHAI

NA STUDENT

16 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1161 201601086

PARTH RAJESHBHAI SHAH

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1162 201601087

HIMANSHU KUMAR NA STUDENT

16 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1163 201601088

VISHNU KANDURI SREENIVAS

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1164 201601089

HARDIK MODI NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1165 201601090

JANI SMEET BHAVESHBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

IRDAI Registration No. 103. An ISO 9001:2008 Certified CompanyCorporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited. Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055 PAN No. : AABCR6747B UIN : IRDA/NL-HLT/RGI/P-P/V.I/320/13-14"Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License”

52 of 69

Page 53: GROUP PERSONAL ACCIDENT SCHEDULE

Schedule of Members covered attached to and forming part of Policy No 1602362914000209

SNo Emp Code

Name Nominee Grade Age Table A

Table B

Table C Table D

Total Sum Insured

DateofJoining

Location Remarks

1166 201601091

GAURAV SOFAT NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1167 201601092

NONGHANVADRA PRAGNESH BHARATBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1168 201601093

MEGH MAHESHKUMAR CHOKSI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1169 201601094

CHANDAN VATSAL VISHALBHAI

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1170 201601095

KHATRI HARSH RAVINDRA

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1171 201601096

DUNGARANI MILAN VINODKUMAR

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1172 201601097

KEYUR GARSONDIYA

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1173 201601098

DESAI MUDRA PIYUSH

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1174 201601099

SANMUKHANI DHWANI GOPAL

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1175 201601100

AVINASH AREKATLA NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1176 201601101

JIGNESH BAJAK NA STUDENT

16 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1177 201601102

PATEL NISHARG SHANKARBHAI

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1178 201601103

PATEL DHARMIL CHANDRESHBHAI

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1179 201601104

PAREEK CHHAVI SURESH

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1180 201601105

ATHARVA SUNE NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1181 201601106

E SAHITHI NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1182 201601107

AARUSH SINGH NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1183 201601108

SAI ADITYA PARUCHURI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1184 201601109

VAISHYA ABHINAV RAJESHKUMAR

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1185 201601110

YASH PANWAR NA STUDENT

16 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1186 201601111

RAJKOTIYA DIVYESH SHAILESHBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1187 201601112

SHREYANSH KUMAR

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1188 201601113

DETROJA SMIT CHANDULAL

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1189 201601114

RUPAPARA ANKIT NARANBHI

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

IRDAI Registration No. 103. An ISO 9001:2008 Certified CompanyCorporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited. Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055 PAN No. : AABCR6747B UIN : IRDA/NL-HLT/RGI/P-P/V.I/320/13-14"Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License”

53 of 69

Page 54: GROUP PERSONAL ACCIDENT SCHEDULE

Schedule of Members covered attached to and forming part of Policy No 1602362914000209

SNo Emp Code

Name Nominee Grade Age Table A

Table B

Table C Table D

Total Sum Insured

DateofJoining

Location Remarks

1190 201601115

RADADIYA GAUTAMKUMAR HIMMATBHAI

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1191 201601116

DOBARIYA NIRAV CHATURBHAI

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1192 201601117

SUNNAM CHANDRA LEKHA

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1193 201601118

DHAMELIYA DIPESH SHAMJIBHAI

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1194 201601119

JADHWANI RISHABH KAMAL

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1195 201601120

SAWLANI RAVI GHANSHYAMDAS

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1196 201601121

SAMARTH SAXENA NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1197 201601122

PATEL DARSHANKUMAR

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1198 201601123

PATEL UMANG NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1199 201601125

JETHWA BHARGAV HARISHKUMAR

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1200 201601126

MEET PRAVINBHAI SINOJIA

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1201 201601127

JETHWA SWAPNIL NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1202 201601129

KRITIKA GUPTA NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1203 201601131

SHAH BHAVYA BIMAL

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1204 201601132

PATEL SAKSHEE NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1205 201601133

AAYUSH BHAT NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1206 201601134

BHALANI UMANG GANESHBHAI

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1207 201601135

ABHISHEK BHOWMIK

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1208 201601136

AJUDIYA BHARGAV GIRDHARBHAI

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1209 201601137

SHAH KALPIT NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1210 201601140

YASH DEVANG SHAH

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1211 201601141

PANCHAL PANKIL NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1212 201601142

KUNIYA SANJAY BHAVANBHAI

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1213 201601143

PATEL VISHVAKUMARI BHARATBHAI

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1214 201601147

MALAVIYA HARSHIT NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

IRDAI Registration No. 103. An ISO 9001:2008 Certified CompanyCorporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited. Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055 PAN No. : AABCR6747B UIN : IRDA/NL-HLT/RGI/P-P/V.I/320/13-14"Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License”

54 of 69

Page 55: GROUP PERSONAL ACCIDENT SCHEDULE

Schedule of Members covered attached to and forming part of Policy No 1602362914000209

SNo Emp Code

Name Nominee Grade Age Table A

Table B

Table C Table D

Total Sum Insured

DateofJoining

Location Remarks

1215 201601148

PATEL MAYURBHAI JAGDISHBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1216 201601150

KACHHADIYA RAVI NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1217 201601151

PATEL KAVAN NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1218 201601153

PATEL YOGESH NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1219 201601154

PANDYA SHLOKA NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1220 201601157

PARMAR NAYAN NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1221 201601158

MEHTA MAUSAM NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1222 201601160

PATEL MAITREYA NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1223 201601161

HARSH KOTTA NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1224 201601162

RATHOD SONALI RAJESHBHAI

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1225 201601163

PATEL JEET NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1226 201601164

CHAUDHARY NEEL NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1227 201601165

MODI CHIRAG NARESHKUMAR

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1228 201601166

PANCHASARA MILIT DIXITBHAI

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1229 201601167

RABADIYA JINAL NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1230 201601168

DASA VISHAL MENANDBHAI

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1231 201601169

GOHIL KASHYAP DINESHBHAI

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1232 201601170

DAVE KEVAL NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1233 201601171

CHOTALIYA KARAN NITINBHAI

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1234 201601174

MODI PRAHAR NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1235 201601175

SUTHAR DHRUVAL MINESH KUMAR

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1236 201601176

KAVIT AMIT SHAH NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1237 201601177

PRAJAPATI DEVEN NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1238 201601178

PATEL HARSHILKUMAR VIPULKUMAR

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1239 201601179

KAPADIYA DARSHANKUMAR MADHABHAI

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

IRDAI Registration No. 103. An ISO 9001:2008 Certified CompanyCorporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited. Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055 PAN No. : AABCR6747B UIN : IRDA/NL-HLT/RGI/P-P/V.I/320/13-14"Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License”

55 of 69

Page 56: GROUP PERSONAL ACCIDENT SCHEDULE

Schedule of Members covered attached to and forming part of Policy No 1602362914000209

SNo Emp Code

Name Nominee Grade Age Table A

Table B

Table C Table D

Total Sum Insured

DateofJoining

Location Remarks

1240 201601180

CHAUHAN SUJITSINH SUNILSINH

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1241 201601181

PRAJAPATI NAMRA BHARATKUMAR

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1242 201601182

VAGHELA KISHANBHAI BHURSINGBHAI

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1243 201601183

CHAUDHARI ARPITKUMAR

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1244 201601184

RATHVA KALPESH SUBHASHCHANDRA

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1245 201601185

PATEL RAVIKUMAR BALKRISHNA

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1246 201601187

CHAUDHARI VAISHVIKKUMAR

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1247 201601188

PRANAV PARIMALBHAI CHAUDHARI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1248 201601189

NISHITH VASAVA NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1249 201601190

GAMAR VISHNUBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1250 201601191

CHARPOT KAUSHIL NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1251 201601192

NAJA MAKWANA NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1252 201601193

BHAVESH K DAMOR NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1253 201601194

PRIYANK ASHWINKUMAR PATEL

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1254 201601195

PATEL YAGNESH NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1255 201601196

PARADHI DHRUVILKUMAR

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1256 201601197

PARADHI DHVANILKUMAR

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1257 201601200

STAVAN SUMANT PATEL

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1258 201601201

GANDHI PIYUSH NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1259 201601202

JOGI YASH NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1260 201601203

VAGHELA HIREN NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1261 201601204

MAINAK CHAUDHURI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1262 201601205

NISHTHA DHARMESH PANDYA

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

IRDAI Registration No. 103. An ISO 9001:2008 Certified CompanyCorporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited. Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055 PAN No. : AABCR6747B UIN : IRDA/NL-HLT/RGI/P-P/V.I/320/13-14"Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License”

56 of 69

Page 57: GROUP PERSONAL ACCIDENT SCHEDULE

Schedule of Members covered attached to and forming part of Policy No 1602362914000209

SNo Emp Code

Name Nominee Grade Age Table A

Table B

Table C Table D

Total Sum Insured

DateofJoining

Location Remarks

1263 201601206

PANKTI B SHAH NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1264 201601207

SWETAL VRAJ MASHRUWALA

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1265 201601208

PATEL MITULKUMAR RAJENDRABHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1266 201601209

AAKLIT TANEJA NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1267 201601210

KIRTANA SUNIL PHATNANI

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1268 201601211

MOHAMED SHADAB NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1269 201601212

AKSHAT GAUTAM NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1270 201601213

MOHMEDSAIF MOHMEDHABIB KOTWAL

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1271 201601214

RAGHAV MATTAD NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1272 201601215

GUPTA ARNAB ARUP

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1273 201601216

BHARDA PRASHANT PARESHBHAI

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1274 201601217

SIDDHANT JAIN NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1275 201601220

PATEL JEET NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1276 201601222

CHHATRALA HARDIKKUMAR KANTILAL

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1277 201601223

MEHTA BHAVIK NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1278 201601224

DAVE JAY NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1279 201601225

RANA MANOHARSINH BABUJI

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1280 201601228

PATEL DHRUMIL BHUPENDRAKUMAR

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1281 201601229

VAGHASIYA PRIYANKABEN ISHWARBHAI

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1282 201601230

SHAH NILAY NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1283 201601231

THAKKAR AVAN NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1284 201601232

JOBANPUTRA YASH NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1285 201601233

MALHOTRA AYUSHI NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

IRDAI Registration No. 103. An ISO 9001:2008 Certified CompanyCorporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited. Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055 PAN No. : AABCR6747B UIN : IRDA/NL-HLT/RGI/P-P/V.I/320/13-14"Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License”

57 of 69

Page 58: GROUP PERSONAL ACCIDENT SCHEDULE

Schedule of Members covered attached to and forming part of Policy No 1602362914000209

SNo Emp Code

Name Nominee Grade Age Table A

Table B

Table C Table D

Total Sum Insured

DateofJoining

Location Remarks

1286 201601234

PATEL UJJVAL NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1287 201601236

RADIA KISHAN BHUPENDRABHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1288 201601237

VALA MEETRAJSINH HARESHKUMAR

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1289 201601238

SHAH MEET NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1290 201601239

HIRPARA VATSAL PARESHBHAI

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1291 201601240

PANCHANI MEET ASHOKBHAI

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1292 201601241

SOLANKIKETUL NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1293 201601243

ABHI RATNMAN NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1294 201601244

PARMAR DARSHAN VINODBHAI

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1295 201601245

PANCHAL HAVYAKUMAR

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1296 201601246

MADAKIYA FAIZAN NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1297 201601248

POGUL SIDDHARTH NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1298 201601250

TADHA NILESHBHAI NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1299 201601252

CHAUHAN JAMIL SALIMBHAI

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1300 201601253

CHAUDHARI JAIMINKUMAR ASHOKBHAI

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1301 201601254

VADHER DHAVAL MATHURKUMARDAS

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1302 201601255

PANCHAL VISHVESH ASHWINBHAI

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1303 201601256

PRAJAPATI ASHOKKUMAR

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1304 201601257

CHAVDA HIMANSHU NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1305 201601401

VASANI MIT PADMANABHBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1306 201601402

SANGHVI JITESH HEMANSHUBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1307 201601403

ABHIGNYANA LAKSHMI CHALAMCHARLA

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1308 201601404

AYUSH JAIN NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1309 201601405

PANDYA KALPESH ARUN

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

IRDAI Registration No. 103. An ISO 9001:2008 Certified CompanyCorporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited. Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055 PAN No. : AABCR6747B UIN : IRDA/NL-HLT/RGI/P-P/V.I/320/13-14"Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License”

58 of 69

Page 59: GROUP PERSONAL ACCIDENT SCHEDULE

Schedule of Members covered attached to and forming part of Policy No 1602362914000209

SNo Emp Code

Name Nominee Grade Age Table A

Table B

Table C Table D

Total Sum Insured

DateofJoining

Location Remarks

1310 201601406

SHAH SULAY ANANDBHAI

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1311 201601407

CELLY PRATEEK KAPIL

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1312 201601408

DOSHI NISHI MITESHKUMAR

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1313 201601409

PATEL HIMILKUMAR JITENDRABHAI

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1314 201601410

SMIT SHAH NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1315 201601411

SAKSENA DEVANSH JAYANTKUMAR

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1316 201601412

RINDANI KHANTI NISHCHALBHAI

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1317 201601413

BISHESH ORAM NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1318 201601414

BHAVSAR SHIVAM RAKESHKUMAR

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1319 201601415

PATEL PARVA CHANDUBHAI

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1320 201601416

RUTVIK SHAH NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1321 201601417

RUTVIK JAYESHBHAI KOTHARI

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1322 201601418

SARDHARA PREETKUMAR JAYSUKHLAL

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1323 201601419

KARAN JAIN NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1324 201601420

MEHTA DHVANEE MANISH

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1325 201601421

ROHAN DHANWANI NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1326 201601422

VACHHANI RUSHI UMANGBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1327 201601423

ASNANI DHRUVESH PAHARJIT

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1328 201601424

VRUND SHAH NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1329 201601425

MALLAVARAPU ROHIT

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1330 201601426

RAJPARA UTSAV RASHMIKANT

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1331 201601427

SAVANI DEEP DEEPAKKUMAR

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1332 201601428

KATBA YOGI RAJESHBHAI

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1333 201601429

MIHIR THAKKAR NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1334 201601430

AYUSHI MAYAL NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

IRDAI Registration No. 103. An ISO 9001:2008 Certified CompanyCorporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited. Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055 PAN No. : AABCR6747B UIN : IRDA/NL-HLT/RGI/P-P/V.I/320/13-14"Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License”

59 of 69

Page 60: GROUP PERSONAL ACCIDENT SCHEDULE

Schedule of Members covered attached to and forming part of Policy No 1602362914000209

SNo Emp Code

Name Nominee Grade Age Table A

Table B

Table C Table D

Total Sum Insured

DateofJoining

Location Remarks

1335 201601431

PATEL PARTHKUMAR

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1336 201601432

KISHAN KUMAR PATEL

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1337 201601433

VADGAMA MAITREY NAVINCHANDRA

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1338 201601434

VANSHIKA DARBARI NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1339 201601436

DETROJA SAKET SANJAYKUMAR

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1340 201601437

SOLANKI ATREY NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1341 201601438

CHAVDA VIVEK NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1342 201601439

MEHTA SHYAMKUMAR CHANDRAKANTBHAI

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1343 201601440

CHUDASAMA SATISH MAHESHBHAI

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1344 201601442

VASAVA DHAVALKUMAR

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1345 201601443

HARDIKI MUKESH DEVRE

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1346 201601444

KUNAL MANISH JANI NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1347 201601445

ANERI PIYUSH KUMAR PATEL

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1348 201601446

KSHITIZ SAREEN NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1349 201601447

PATEL ANSHU NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1350 201601448

ACHARYA ADITI NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1351 201601450

DHAMELIYA POOJAN

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1352 201601451

KAMARIA PARTH NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1353 201601452

PADARIYA ABHISHEK

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1354 201601453

BABRIYA RAVIKUMAR

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1355 201601454

PATEL YATINKUMAR SHASHIVADANBHAI

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1356 201601455

KALAVADIYA ANKIT NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1357 201601457

PIPALIYA ANAND JAYSUKHBHAI

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1358 201601458

PARMAR JAYKISHAN

NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

IRDAI Registration No. 103. An ISO 9001:2008 Certified CompanyCorporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited. Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055 PAN No. : AABCR6747B UIN : IRDA/NL-HLT/RGI/P-P/V.I/320/13-14"Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License”

60 of 69

Page 61: GROUP PERSONAL ACCIDENT SCHEDULE

Schedule of Members covered attached to and forming part of Policy No 1602362914000209

SNo Emp Code

Name Nominee Grade Age Table A

Table B

Table C Table D

Total Sum Insured

DateofJoining

Location Remarks

1359 201601459

BRAHMBHATT VAISHVIK

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1360 201601460

BAROT KULDIPSINH NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1361 201601461

RANSARIYA DIVYESH

NA STUDENT

18 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1362 201601462

PANSURIYA TANIK NA STUDENT

17 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1363 201611001

BHAVSAR TRUPAL PRADEEPKUMAR

NA STUDENT

23 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1364 201611002

TARUN PATIDAR NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1365 201611003

SHAH JENI SNEHAL NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1366 201611004

VISHAKHA AGRAWAL

NA STUDENT

24 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1367 201611005

RAHUL RATHORE NA STUDENT

23 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1368 201611006

MORADIYA BHARGAV DULABHAI

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1369 201611007

LOKESH KUMAR NA STUDENT

23 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1370 201611008

CHIRAGBHAI PARABAT USDADIYA

NA STUDENT

23 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1371 201611009

DEBADUTTA ROUT NA STUDENT

23 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1372 201611010

TRIVEDI VISHWAS VINODKUMAR

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1373 201611011

SAMKIT RAKESHBHAI GANDHI

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1374 201611012

SURAJ SURESH OGALE

NA STUDENT

23 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1375 201611013

SUSHANTINI N NA STUDENT

25 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1376 201611014

PATWA DOLLYBEN RAKESHBHAI

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1377 201611015

B RAJARAMAN NA STUDENT

23 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1378 201611016

PRATIK RAJENDRA LODHA

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1379 201611017

UDIT SHRIVASTAVA NA STUDENT

25 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1380 201611019

DOSHI PRARTHANA KALPESHBHAI

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1381 201611020

KHALPADA VAIDEHI SHAILESH

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1382 201611021

PURABIA POOJA RAJESHKUMAR

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

IRDAI Registration No. 103. An ISO 9001:2008 Certified CompanyCorporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited. Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055 PAN No. : AABCR6747B UIN : IRDA/NL-HLT/RGI/P-P/V.I/320/13-14"Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License”

61 of 69

Page 62: GROUP PERSONAL ACCIDENT SCHEDULE

Schedule of Members covered attached to and forming part of Policy No 1602362914000209

SNo Emp Code

Name Nominee Grade Age Table A

Table B

Table C Table D

Total Sum Insured

DateofJoining

Location Remarks

1383 201611022

KOSHTI NISHANT PUSHPAKBHAI

NA STUDENT

25 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1384 201611023

PALAK THAKUR NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1385 201611024

DEORE PRAJAKTA BALWANT

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1386 201611025

THAKKER AVANI DEEPAKKUMAR

NA STUDENT

23 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1387 201611026

SREERAJ R. NA STUDENT

27 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1388 201611027

TAPKIR PRASAD ANIL

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1389 201611028

ANJANA RITABEN ARJUNBHAI

NA STUDENT

23 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1390 201611029

LOKESH JIGALUR NA STUDENT

23 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1391 201611030

SHAH VIDHI KAMLESHKUMAR

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1392 201611031

CHINTAN SURYAKANT SHAH

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1393 201611032

PANARA BHAVIKABAHEN BACHUBHAI

NA STUDENT

23 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1394 201611033

SHETH HELI BIJALKUMAR

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1395 201611034

KOTAWALA FATEMA HAKIMUDDIN

NA STUDENT

24 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1396 201611035

SHUBHAM CHANDRA

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1397 201611036

JINITA PATEL NA STUDENT

23 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1398 201611037

PAREKH KRISHNA ASHISHKUMAR

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1399 201611038

GOSWAMI JANKHANA JITENDRAGIRI

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1400 201611039

RIDDHI KETANBHAI SOLANI

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1401 201611040

SAGATHIYA RIDHAMKUMAR DAHYALAL

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1402 201611041

PRASHANTKUMAR GOHEL

NA STUDENT

24 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1403 201611042

NIKITA LODHA NA STUDENT

23 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1404 201611043

KAMAL VERMA NA STUDENT

31 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1405 201611044

CHOTHANI CHINTANIKA MANSUKHLAL

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1406 201611045

DEEPANKAR DUBEY NA STUDENT

23 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

IRDAI Registration No. 103. An ISO 9001:2008 Certified CompanyCorporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited. Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055 PAN No. : AABCR6747B UIN : IRDA/NL-HLT/RGI/P-P/V.I/320/13-14"Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License”

62 of 69

Page 63: GROUP PERSONAL ACCIDENT SCHEDULE

Schedule of Members covered attached to and forming part of Policy No 1602362914000209

SNo Emp Code

Name Nominee Grade Age Table A

Table B

Table C Table D

Total Sum Insured

DateofJoining

Location Remarks

1407 201611046

THAKKAR SANKET NAVINKUMAR

NA STUDENT

24 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1408 201611047

THANKI JIGAR NARBHESHANKER

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1409 201611048

KANTHETI SRINIVAS NA STUDENT

23 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1410 201611049

NIKITA VISHWAKARMA

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1411 201611050

NEHA KUMARI SINGHAL

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1412 201611051

PANCHAL NAMRATA PRAKASHBHAI

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1413 201611052

KOTHURI VENKATA NAGA NEHA RAVALI

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1414 201611053

SHUBHANGI GUPTA NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1415 201611054

KRITI NA STUDENT

24 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1416 201611055

SHAH NEILKUMAR MILANKUMAR

NA STUDENT

23 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1417 201611056

RAHUL CHAUHAN NA STUDENT

23 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1418 201611057

NEHA RANI NA STUDENT

23 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1419 201611058

KOTECHA DHARA PRADIPKUMAR

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1420 201611059

AARUSHI DHAMI NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1421 201611061

HEMLATA TAK NA STUDENT

23 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1422 201611062

SATYANJALI YADAV NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1423 201611063

RONAK H DHOKAI NA STUDENT

23 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1424 201612001

VYAS DHWANIL NITIN

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1425 201612002

JADHAV DHRUVDUTT RANJITSINH

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1426 201612003

SHARMA DIPESH SHIVKUMAR

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1427 201612004

MANIYAR SURBHI HARISHBHAI

NA STUDENT

23 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1428 201612005

RANADE SANKALP PRASHANT

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1429 201612006

JAY BHARATBHAI SHAH

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1430 201612007

MUKESH BANSAL NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1431 201612008

PARIKH KUSHAL JAYESHBHAI

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

IRDAI Registration No. 103. An ISO 9001:2008 Certified CompanyCorporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited. Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055 PAN No. : AABCR6747B UIN : IRDA/NL-HLT/RGI/P-P/V.I/320/13-14"Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License”

63 of 69

Page 64: GROUP PERSONAL ACCIDENT SCHEDULE

Schedule of Members covered attached to and forming part of Policy No 1602362914000209

SNo Emp Code

Name Nominee Grade Age Table A

Table B

Table C Table D

Total Sum Insured

DateofJoining

Location Remarks

1432 201612009

ASHWANI TANWAR NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1433 201612010

JOSHI ASHWINI MILIND

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1434 201612011

MANVENDRA SINGH NA STUDENT

23 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1435 201612012

HALANI DIP NATVARLAL

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1436 201612013

SHETTY ADITYA VITTAL

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1437 201612014

THAKKAR CHANDNIBEN SHAILESHBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1438 201612015

PARIKH DIPEN VITTHALBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1439 201612016

PATEL RIYA MANISHKUMAR

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1440 201612017

MAKHIJA AMAR TIRTHDAS

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1441 201612018

JADAV NIKITA BIPINKUMAR

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1442 201612019

KAKADIYA HARDIKBHAI BHANUBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1443 201612020

DAVE PRIYA ASHOKKUMAR

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1444 201612021

SHAH YESHA MEHULBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1445 201612022

TIKEKAR SIDDHARTHA NAVINCHANDRA

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1446 201612023

SHAH SHARVIL PIYUSHBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1447 201612024

KHATRI JEET GAUTAMKUMAR

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1448 201612025

SONAVANE VARUN PRAKASH

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1449 201612026

PURAN SUTHAR NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1450 201612027

SHAH DRASHTI MITESHBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1451 201612028

PRIYANKA NITINKUMAR SHAH

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1452 201612029

DELHIWALA RONAK YOGESH

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1453 201612030

AMRELIYA UDIT SURESHBHAI

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1454 201612031

ANAM DIVYA SHAILESH ARUNA

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1455 201612032

HITAISHI DINESHBHAI MARFATIYA

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

IRDAI Registration No. 103. An ISO 9001:2008 Certified CompanyCorporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited. Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055 PAN No. : AABCR6747B UIN : IRDA/NL-HLT/RGI/P-P/V.I/320/13-14"Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License”

64 of 69

Page 65: GROUP PERSONAL ACCIDENT SCHEDULE

Schedule of Members covered attached to and forming part of Policy No 1602362914000209

SNo Emp Code

Name Nominee Grade Age Table A

Table B

Table C Table D

Total Sum Insured

DateofJoining

Location Remarks

1456 201612033

ZARANA KISHORBHAI VYAS

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1457 201612034

SHAH HELI PARESHKUMAR

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1458 201612035

PANDYA POORVA NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1459 201612036

ASHIM KUMAR UPADHYAY

NA STUDENT

23 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1460 201612037

SOLANKI PANTH KIRANKUMAR

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1461 201612038

THAKKAR AVNISH VINODCHANDRA

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1462 201612039

PATEL RUTVIJ MAYURKUMAR

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1463 201612040

PRAJAPATI ARCHIL NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1464 201612041

DHOLAKIA MANASI ATUL

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1465 201612042

KEWALRAMANI VIKAS GOVINDBHAI

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1466 201612043

GANDHI SHREYANSH

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1467 201612044

PATEL RIDDHI NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1468 201612045

MAHMADSOHIL DADHORIYA

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1469 201612046

HATHI SAGAR KAMLESH

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1470 201612047

PANCHAL KRUPALI KISHOR

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1471 201612048

GUPTA ADITI SANJAY

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1472 201612049

VORA ISHANI SAURINKUMAR

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1473 201612050

SHAH JANAHVEE RASHMIKANT

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1474 201612051

MANDALIYA ABHILASH BHANUKANT

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1475 201612052

SHAH MANSI PRAKASHCHANDRA

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1476 201612053

RATHORE AKSHAY PRADEEPSINGH

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1477 201612054

CHOTALIYA CHINTAN LABHUBHAI

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1478 201612055

SHAH VIRAL RAHULKUMAR

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1479 201612056

VAGHANI ATISH RAMESHBHAI

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

IRDAI Registration No. 103. An ISO 9001:2008 Certified CompanyCorporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited. Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055 PAN No. : AABCR6747B UIN : IRDA/NL-HLT/RGI/P-P/V.I/320/13-14"Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License”

65 of 69

Page 66: GROUP PERSONAL ACCIDENT SCHEDULE

Schedule of Members covered attached to and forming part of Policy No 1602362914000209

SNo Emp Code

Name Nominee Grade Age Table A

Table B

Table C Table D

Total Sum Insured

DateofJoining

Location Remarks

1480 201612057

CHAUHAN JAYENDRASINH KIRANKUMAR

NA STUDENT

26 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1481 201612058

RANA YUVRAJSINH ASHVINSINH

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1482 201612059

FARHAN ANSARI NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1483 201612060

SHAH HARSHIL PRUTHVISH

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1484 201612061

LAKHANI ANKIT RAJUBHAI

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1485 201612062

DIVEN KUMAR SAMBHWANI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1486 201612063

HARMEET SINGH SAINI

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1487 201612064

VISHAL GARG NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1488 201612065

VAMSI KRISHNAGUNTHI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1489 201612066

KANIYA DHIRAL SHAILESHBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1490 201612067

DHRUVIL SHAH NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1491 201612068

DEVAM SHAH NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1492 201612069

BINAYAK GOURI SHANKAR

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1493 201612070

NIRALI UPADHYAY NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1494 201612071

SHAH KAVISHA NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1495 201612072

MEHTA NINAD HARSHADBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1496 201612073

UNDHAD HEMANSHI RASIKBHAI

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1497 201612074

AKHANI HARSHADKUMAR MAHESHBHAI

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1498 201612075

SADHWANI SNEHA MAHESHKUMAR

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1499 201612076

ANIL KUMAR TUDU NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1500 201612077

VARMA KUNAL VIJAYKUMAR

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1501 201612078

MEHTA DIMPLE SIDDHARTH

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1502 201612079

PATEL AMISHA JITENDRABHAI

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1503 201612080

PUJA SINGH NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1504 201612081

LUHAR SAVAN KISHORBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

IRDAI Registration No. 103. An ISO 9001:2008 Certified CompanyCorporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited. Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055 PAN No. : AABCR6747B UIN : IRDA/NL-HLT/RGI/P-P/V.I/320/13-14"Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License”

66 of 69

Page 67: GROUP PERSONAL ACCIDENT SCHEDULE

Schedule of Members covered attached to and forming part of Policy No 1602362914000209

SNo Emp Code

Name Nominee Grade Age Table A

Table B

Table C Table D

Total Sum Insured

DateofJoining

Location Remarks

1505 201612082

AASTHA DWIVEDI NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1506 201612083

PARIKH SHLOK KISHORE

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1507 201612084

THAKKAR KISHANKUMAR JAGDISHBHAI

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1508 201612085

MEENAKSHI PRAVINSINH ZALA

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1509 201612086

THAKOR MITESH NEHALKUMAR

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1510 201612087

SHAH KARAN HIREN NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1511 201612088

SUNIL KUMAWAT NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1512 201612089

DESAI PRITESH JAYESHBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1513 201612090

SHETH BIJEN RAKESHBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1514 201612091

SHAAZ MANJIYANI NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1515 201612092

KADIYA STUTI GAURANGBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1516 201612093

VASUNDHARA GUPTA

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1517 201612094

AGRAWAL JEETU KEDARNATH

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1518 201612095

CHANDAN KUMAR VISHWAKARMA

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1519 201612096

SHAH DEVANSHI BHARATKUMAR

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1520 201612097

VANANI VIRAL BATUKBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1521 201612098

SHAH KUSHAL KETANKUMAR

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1522 201612099

VAGHASIYA GOPAL PARSOTAMBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1523 201612100

JIANDANI GAURAV KESHAV

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1524 201612101

SHAH NILAM SHAILESHKUMAR

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1525 201612102

PRATHAM JAIN NA STUDENT

23 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1526 201612103

LILAN SHRESHTHA DINESHRAJ

NA STUDENT

23 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1527 201612104

SHAH PARIN VIKRAMBHAI

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1528 201612105

MAKHIJA SAGAR GURMUKH

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1529 201612106

ANIMESH KUMAR NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

IRDAI Registration No. 103. An ISO 9001:2008 Certified CompanyCorporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited. Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055 PAN No. : AABCR6747B UIN : IRDA/NL-HLT/RGI/P-P/V.I/320/13-14"Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License”

67 of 69

Page 68: GROUP PERSONAL ACCIDENT SCHEDULE

Schedule of Members covered attached to and forming part of Policy No 1602362914000209

SNo Emp Code

Name Nominee Grade Age Table A

Table B

Table C Table D

Total Sum Insured

DateofJoining

Location Remarks

1530 201612107

SHAILESH MISHRA NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1531 201612108

NASIT SAGAR PRAFULBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1532 201612109

MAHETA PARTH RAJESHBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1533 201612110

RUPAREL JANVI PRAKASHBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1534 201612111

PARESH KUMAR NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1535 201612112

PRAJAPATI DIPAK PRATAPBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1536 201612113

ANSHIKA SINHA NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1537 201612114

CHAUHAN KELIN LAWRENCEBHAI

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1538 201612115

TAGADIYA MITESHKUMAR RAJUBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1539 201612116

RATHOD AUDARYA LALITNARAYAN

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1540 201612117

RISHABH CHAUHAN NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1541 201612118

KAMDAR RAJ ASHWINBHAI

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1542 201612119

OMISHA GUPTA NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1543 201612120

SEVAK PRIYANK KIRITKUMAR

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1544 201613001

JARIWALA HARSH HITESHKUMAR

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1545 201613002

PRIYANKA HANSAWAT

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1546 201613003

AGARKAR HARSH ATULKUMAR

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1547 201613004

SHINAI MALLIKA KRISHNKUMAR

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1548 201613005

MEET JAYESHBHAI THAKER

NA STUDENT

20 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1549 201613006

DVIVEDI SATYAM ASHOKKUMAR

NA STUDENT

19 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1550 201614001

ASHWIN SHARMA NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1551 201614002

AYUSHI SHARMA NA STUDENT

24 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1552 201614003

SHAINA GULATI NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1553 201614004

HIMANSHU VARDHAN

NA STUDENT

23 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1554 201614006

SHAH SHAILAJA SHALINBHAI

NA STUDENT

23 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

IRDAI Registration No. 103. An ISO 9001:2008 Certified CompanyCorporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited. Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055 PAN No. : AABCR6747B UIN : IRDA/NL-HLT/RGI/P-P/V.I/320/13-14"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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Page 69: GROUP PERSONAL ACCIDENT SCHEDULE

Schedule of Members covered attached to and forming part of Policy No 1602362914000209

SNo Emp Code

Name Nominee Grade Age Table A

Table B

Table C Table D

Total Sum Insured

DateofJoining

Location Remarks

1555 201614007

SARATH K NA STUDENT

24 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1556 201614008

GANDAMALLA PRAKRUTHI PULE

NA STUDENT

23 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1557 201614009

SHETH AARSH JAYKUMAR

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1558 201614010

NEERJA JAIN NA STUDENT

23 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1559 201614011

ANANDITA AGRAWAL

NA STUDENT

23 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1560 201614012

ROSHNI PRAKASH THARIAN

NA STUDENT

21 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1561 201614013

YAIPHAHENBA LAISHRAM

NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1562 201614014

SAURABH SINGH NA STUDENT

22 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1563 201621001

AMIT KISHORCHANDRA MANKODI

NA STUDENT

46 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1564 201621002

PANDYA JUHI MEHULKUMAR

NA STUDENT

23 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1565 201621003

JOSHI NIKITA RAJESHBHAI

NA STUDENT

24 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1566 201621004

VYAS HARDIK SHYAM

NA STUDENT

23 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1567 201621005

MANAS SINGH SAKRWAR

NA STUDENT

26 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1568 201621006

TEJENDRA PRATAP GAUTAM

NA STUDENT

29 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1569 201621007

SHAH MIRAL ASHOKKUMAR

NA STUDENT

30 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1570 201621008

PATIL ANKUR TUKARAM

NA STUDENT

28 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1571 201621009

GADHIYA TUSHARKUMAR DAMJIBHAI

NA STUDENT

25 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1572 201621010

SHAH AMI MAHENDRABHAI

NA STUDENT

23 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

1573 201621011

EKTA RAJPUT NA STUDENT

25 Yr 00 M

0 0 50000 0 50000 GANDHINAGAR

Grand Total 0 0 78650000 0 78650000

IRDAI Registration No. 103. An ISO 9001:2008 Certified CompanyCorporate Identity Number U66603MH2000PLC128300. Reliance General Insurance Company Limited. Registered Office: 19, Reliance Centre, Walchand Hirachand Marg, Ballard Estate, Mumbai 400001.Corporate Office: Reliance Centre, South Wing, 4th Floor, Off. Western Express Highway , Santacruz (East), Mumbai - 400 055 PAN No. : AABCR6747B UIN : IRDA/NL-HLT/RGI/P-P/V.I/320/13-14"Trade Logo displayed above belongs to Anil Dhirubhai Ambani Ventures Private Limited and used by Reliance General Insurance Company Limited under License”

69 of 69