Sistema Shyam TeleServices Ltd. ORDER 21 je oF Gurgaon ne__P- 46-01 On Introduction in action of the Policy P-46-01 “Group Accident Policy” ‘With a view of optimization of the managerial processes and strengthen of discipline Itis hereby ORDERED: 1, To approve and introduce in action from the moment of signing of the present Order the Policy P-46-01 «Group Accident Policy» (the document is attached). 2. To lay the control over implementation and observation of requirements of the Policy P-46-01 « Group Accident Policy » on Chief Human Resources Officer of Sistema Shyam TeleServices Ltd 3. The control over the execution of the present Order is carried out by the President & CEO of Sistema Shyam TeleServices Ltd, President & CEO Vsevolod RozanovConfidential. For intemal usage only ADOPTED Order #_P — 46-0) of. ADOPTED Order # of Policy Group Accident Policy Chief Human Resource OfficerOB Group Accident Policy Content. Foriniemal sage on 1a This policy provides financial assistance to an employee and/or their family in case of loss of eaming capacity of the employee due to accident or death during the course of employment. 2.0 SCOPE & APPLICABILITY 2.1 These rules shall applicable to employees on the rolls of Sistema Shyam Teleservices Limited. 3.0 DETAILS OF BENEFIT 3.1 Coverage 3.1.1 The maximum sum insured coverage limit of an employee shalll be as under: Levels _ Entitlements President & CEO, Deputy CEO Functional Head (CXO), COO 1 Crore Department Level 70 Lacs Division Level 40 Lacs Group Level 30 Lacs Operational Staff 20 Lacs 3.2 Benefit 3.2.1 At any time during the period of policy the insured sustains any bodily injury resulting solely and directly from accident caused by external, violent and visible means, then the insurance company undertakes to pay the insured or his legal nominee as the case may be the following sums: 3.2.1.1 Death, full capital sum insured becomes payable. 3.2.12 Total and irrecoverable loss / use of — 3.2.1.2.1 Sight of both eyes 3.2.1.2.2 The actual loss by physical separation of the two entire hands 32 3 Two entire feet 3.2.1.2.4 One entire hand and one entire foot 3.2.1.2.5 Such loss of sight of one eye and such loss of one entire hand and one entire foot, 100% of the Capital im I is payable ital and irrecoverable loss / use of — 3.1 The sight of one eye Page No 3 of 93.2.1.3.3 One entire foot, 3.2.1.3.4 A hand or a foot without physical separation 3.2.1.3.5 50 % of the Capital Sum Insured is payable 3.2.1.4 Total and irrecoverable loss / use of — Group Accident Policy 3.2.1.3.2 The actual loss by physical separation of one entire hand ‘Confidential. For intemal usage only 3.2.1.3.6 For the purpose, physical separation of a hand or foot means separation of hand at or above the wrist and/or of the foot at or above the ankle. 3.2.1.3.7 The injury should be direct consequence where immediately permanently totally and absolutely disable the employee from engaging in being occupied with or giving attention to any employment or occupation of any description. 3.2.14.1 Physical separation of the following then the percentage of the Capital Sum Insured applicable to such employee shall be payable : ‘aPercentage of the Capital Sum Insured % of Sum Insured 20 Great - both Phalanges 5 Loss of toes ~ all Great - One Phalanx 2 ‘Other than great If more than one toe 1 lost each ii) Loss of hearing - both ears so | iii) Loss of hearing - one ear 15 iv)Loss of four fingers & thumb of 40 one hand v) Loss of four fingers 7 ~ 5H vi) Loss of thumb both phalanges 25 One phalanx 10 vii) Loss of Index Finger three phalanges 10 ‘Two phalanges 8 Page No 4 of 9[TOES | Stove Accident Pocy mma c One phalanx. viii) Loss of Middle Finger- three phalanges [ ‘Two phalanges ‘One phalanx ix) Loss of ring Finger three phalanges ‘Two phalanges ‘One phalanx. x)Loss of little finger three phalanges Two phalanges ‘One phalanx xi)Loss of metacarpals First or Second (Additional) ‘Third fourth or fifth 2 (Additional) xii) Any other permanent partial ‘Asscacedby. disablement The Doctor wl )e alo] alalrlalala ——-3.2.1.4.2 Temporary disablement ~ 25% of monthly salary subject to maximum Rs, 10000/- per week for period not exceeding 54 weeks. 3.2.1.4.3 Expenses for Carriage of Dead Body and/or Funeral Expenses: In the event of death of the employee, outside his/her residence, the insurance company will reimburse expenses incurred for transportation of Insured's dead body to the place of residence and/or funeral expenses subject to a maximum of 2% of Capital Sum Insured or Rs. 2,000/- whichever is less. 33 Table of Claim cover per employee (at a glance): Benefits Amount payable (in Rs.) Death Only Full capital sum insured becomes payable Permanent Total Disablement (PTD) | Full capital sum insured becomes payable from injury _ 7 Permanent Partial Disablement applicable percentage of capital sum insured are (PPD)) involving total & payable as enumerated in the policy irrecoverable loss of use of parts of imbs, - ‘Temporary Total Disablement 25% of monthly salary subject to maximum Rs. (TTD) 10000/- per week for period not exceeding 54_weeks. Medical expenses incurred following accident to be claimed under Group Health Policy by furnishing the various documents listed below under 4.2.2. “Disablement claims” Dead Body and/or Funeral Expenses [2% Sub Insured or Rs. 2000, whichever is less. Page No 5 of 9(6 | a ___onily 3.4 General Exclusions: 3.4.1 Compensation under more than one of the sub-Clause in respect of the same period of disablement of the Employee. 3.4.2 Not more than one Claim of such Employee during any one period of insurance by which the maximum liability of insurance company to such Employee exceeds the sum insured. 3.4.3 Payment of weekly compensation until the total amount shall have been ascertained and agreed. 3.44 Payment of compensation in respect of Death, Injury or Disablement of the Employee =. 3.4.4.1 From intentional self-injury, suicide or attempted suicide. 3.4.4.2 Whilst under the influence of intoxicating liquor or drugs. 3.4.4.3 Whilst engaging in aviation other than traveling as a passenger (in a duly licensed standards type of aircraft) any where inthe world, isease or insanity 3.4.4.4 Directly or indirectly caused by venereal 3.4.4.5 Arising or resulting from the Employee committing any breach of law with criminal intent. 3.4.4.6 War and allied perils 3.4.4.7 Nuclear explosion 3.4.4.8 Pregnancy Exclusion Clause - death or disablement resulting directly or indirectly caused by contributed to or aggravated or prolonged by childbirth or pregnancy or in consequence thereof. 3.4.5 Special Conditions Exclusions: 3.4.5.1 Immediate Notice with all particulars must be given to Insurance Company — 3.4.5.1.1 In case of death written notice immediately unless reasonable cause is shown be given before interment cremation and in any case within one calendar month after the death. 3.4.5.1.2 2. In the event of loss of sight or amputation of limbs, within one calendar month after such loss of amputation, 3.4.5.1.3 Proof to be submitted. Page No 6 of 93.4.5.1.4 3.4.5.1.5 3.4.5.1.6 Group Accident Policy Confidential For intemal usage only ‘Any Medical or other agent of the Company shall be allowed to examine the Employee on ion. In the event of death - to make a post mortem examination of the body of the Employee and a post mortem examination report, if necessary, be furnished within the space of fourteen days after in demand writing In the event of a claim in respect of loss of sight, the Employee needs to undergo at the Insured’s expenses, such operation or treatment as the Company may reasonable deem desirable. 3.4.6 Special Provisions: 3.4.7 All sums payable hereunder shall be payable: 3.4.7.1 Incase of death or permanent total disablement — after Deletion of name of that employee. 3.4.7.2 Incase of permanent partial disablement. ~ after reduction of Sum Insured of that employee 3.4.7.3 In case of temporary total disablement - upon termination of such disablement. Insurance company is not liable to make any payment be in any manner fraudulent or supported by any fraudulent statement or device 4.0 CLAIMS 4.1 Al claims should be reported immediately but within 30 days from the date of incident, In the prescribed form 42 Insurance Company is expected to settle all claims within a reasonable time on receipt of all the relevant documents, 42.1 For Death Claims : 4.2.1.1 Claim Intimation 42.1.2 Claim form, duly filled in 42.13 Death Certificate 4.2.1.4 — Medical reports of hospital/ Treating Doctor giving description of the accident mentioning date, time & place of the accident. 4.2.1.5 Postmortem report Page No7 of 942.1.6 42.17 4.2.1.8 42.1.9 Group AccideniPoley [casas | only Copy of FIR Investigation reports. Letter from Personnel or HR Dept. certifying his Grade & Post. Last drawn salary slip. Any other document as required by Insurance Company. 4.2.2 For Disablement cf 4.2.2.1 Claim Intimation 4.2.2.2 Claim form duly filled in 42.2.3 Medical Certificate & Discharge Card of the Hospital. 4.2.2.4 — Original Diagnostic Reports - X-Ray, Pathological, Scan 4.2.2.5 Original Bills / Stamped Receipts of all payments made to: 4.2.2.5.1 Hospital 4.2.2.5.2 Consultant / Surgeon 4.2.2.5.3 Pathological & other Investigation Laboratories 4.2.5.4 Chemist. 4.2.2.6 Supporting Doctor’s Prescriptions 42.2.7 Leave certificate from HR 42.2.8 Fitness Certificate from the Doctor certifying the period of unfitness and the date of fitness to resume normal duty. 4.2.2.9 A Statement showing break-up of Medical expenses. 4.2.2.10 Letter from Personnel or HR Dept. certifying his Grade & Post. 4.2.2.1. Last drawn salary slip. Page No 8 of 9Group Accident Policy Confidential. For intemal age oni 4.22.12 Copy of FIR 4.22.13 A Personal Accident Medical Report Form to be duly signed by the Doctor. 4.2.2.14 Any other document as required by Insurance Company 5.0 LOSS PAYEE Su Amounts payable in settlement of claims made is payable to or to the order of Sistema Shyam Teleservices Limited. 52 In case of such payment, a discharge signed by an authorized representative of Sistema Shyam Teleservices Limited is accepted as a valid discharge on behalf of all other parties interested in the insurance by the policy. 6.0 ROLE AND RESPONSIBILITY: Informing about the request ‘Communication to the Insurance Company Though Coordinator. ‘Communicating the status to the employee : Payment to be made (to Insurance Qo a Company) 10 | MIS Generation a (1* In case of death/ permanent disability claim should be processed by FIR on the basis of request of employec’s dependent. 0 fofaja] o 1 2 3__ | Approval of the request 4 6 Page No9 of 9