Bajaj Allianz General Insurance Co Ltd

PRODUCT RECALL

RISK ASSESSMENT QUESTIONNAIRE

Name and address of the insured:

Explanatory remarks:

The answers to the questionnaire should be listed on separate sheets of paper, additional

material such as sales brochures, business data should be included.

1.

General Business Data

1.1 Total estimated turnover for the following year: ................

thereof export to:

European Union / Switzerland / Norway ................%

USA / Canada ................%

Australia / New Zealand ................%

Japan / Far East ................%

Rest of the world ................%

1.2 For car part suppliers: estimated indirect export to USA/Canada: .......................................

(to be expected when producing parts for AUDI, BMW, Daimler-Chrysler, Porsche, Land

Rover, Jaguar, Saab, Volvo, Ferrari, Maserati)

1.3 Number of employees

1.4 Advertising budget of your company for the last two years and the following year

1.5 Name and activity of your (main) customers and sales achieved with those

1.6 Web-site address of the insured:

2. Product description

2.1 Description and Turnover Description of further processing of the product

Please note this question 2.1 is the core information for the risk assessment, therefore

please fill out thoroughly!

Please describe the respective

products (including

packaging) and attach sales

brochures or other information

material. For which

components will the products

be further used?

(for each single product one

line)

Turnover

in Mio

Euro and

year

(for each

single

product

one line)

First customer and

country

(for each single product

one line)

Second customer and any

other customers and

country

(for each single product

one line)

Bajaj Allianz General Insurance Co Ltd

e.g. injector for fuel-injection

pump

e.g. 0,2

Mio Euro

(2004)

e.g. Bosch in Germany

will first assemble the

injector to a complete

fuel-injection pump

e.g. Porsche will assemble

the fuel-injection pump into

the motor of the car type xy

(final assembly)

2.2 What is your sales price per product?

2.3 What quantity is produced within one series / batch, per day?

2.4 How many items of each product (group) are manufactured and sold each year?

2.5 Do you manufacture:

- to your own design % of total production

- to purchaser’s documents % of total production

- on unit labour cost basis % of total production

- to licence % of total production

2.6 Which products reach the end user without further processing by another party?

2.7 Do you produce and deliver “Just in time”? For which clients, which products, sales achieved?

2.8 In case your product is defective: how can the end product be repaired?

2.9 Do you sell products for which you only act as a retailer / wholesaler?

Can you always identify the manufacturer of these products?

2.10 What is the life time (for non-perishable products) or shelf life (for perishable products) of

your products?

3. Raw materials / purchased goods

3.1 What share of semi-finished products are incorporated into your products?

3.2 What percentage of purchased goods is bought from countries outside the European Union /

Switzerland / Norway?

3.3 How do you assess your suppliers' capability to produce a product according to the required

quality standards and his quality system?

3.4 Do you require your suppliers to buy product recall insurance cover? If so, what indemnity

limit do you specify?

4. Quality Control

4.1 Please give a description of your quality system

4.2 Is your quality system subject to audits by your customers?

4.3 Is your company ISO 9000 ff. certified? If so, please attach a copy of the certificate.

4.4 What processes are used to test your product before delivery?

Bajaj Allianz General Insurance Co Ltd

5. Product Surveillance

5.1 Please describe your system of monitoring the quality of your products during use.

5.2 If your customers advise you of defects or problems (including complaints and the

rejection) with your products, how do you incorporate this information within your

business?

5.3 Do you analyze the information obtained from 5.1. and 5.2. regularly?

5.4 Have any notification of defects, warranty claims or other indications of product

defects become known to you, which indicate a quality problem or the possibility of a

recall?

5.5 Do you keep records of all shipments to your customers? How long?

Can you clearly identify the buyers of all goods that you supply? If so, please briefly

describe this process.

5.6 Do you keep specimen of all the batches of goods that you supply to your customers?

5.7 How high is the rejection rate of your products by your customers?

6. Recall program

6.1 Do you have a documented recall plan (including written rules and procedures)? Please

provide a description or a summary of the recall plan.

6.2 Apart from the Chairman / Executive Officer, who has overall responsibility for a

product recall within your company? Please name this person.

Who are the members of your product recall crisis team?

Please specify names, job titles and roles within your crisis team. Person to report to?

6.3 When was your recall action plan last reviewed?

How often do you review your recall action plan?

6.4 Please describe the traceability of you products, including

• the identification of a particular batch or an individual product

• the system of identification of your customer (or the ultimate consumer/ customer)

6.5 What costs do you expect in case of a recall? Please list the types of cost and estimated

maximum cost.

6.6 How is your recall plan integrated into your quality system?

7. Prior losses

7.1 Please list any product recall that your company has been involved in within the last 10

years. Please specify the year, the product type, the number of products recalled, the

total cost of the recall and the cause of the recall.

7.2 Please list your product liability losses of the last ten years.

Bajaj Allianz General Insurance Co Ltd

8. Previous product recall insurance

8.1 Have you bought product recall insurance previously? If so, please specify the insurer,

policy period, indemnity limit and deductibles. List claims paid under the policy.

9. Indemnity Limit

9.1

Please specify the requested limit of indemnity per occurrence and once in the annual

aggregate.

9.2 Please also specify the current limit of indemnity (per occurrence / in the annual

aggregate) of your Public and Products Liability policy.

Name of the insurer:

10. Additional information Pls Attach Product Recall Plan

DECLARATION

I / we desire to effect an insurance in terms of the public Liability Policy of the company against the limits of indemnity specified above. I/we hereby declare that all statutory provisions relating to my / our business proposed for insurance are complied with. I/we further declare that the above statements and particulars are true, and I / we have not omitted, suppressed, misrepresented or misstated any material fact and I / we agree that this declaration shall be the basis of the contract between me / us and the company , and be incorporated therein. I/We have read and understood the Privacy Policy of your Company and I hereby unconditionally agree and bind myself to all terms and conditions of your Privacy Policy, as amended, from time to time. Place : Date : Signature of the proposer ------ - - - - - - - - - - - - - - - - - - -- - - - - - - - - -- - - -- - - - - - - - - -- - - -- -- -- - -- -- - -- -- - SECTION - 41 OF INSURANCE ACT 1938 PROHIBITION OF REBATES (1) The person shall allow or offer to allow either directly or indirectly as in inducement to any

person to take out or renew or continue an insurance in respect of any kind of risk relating to lives or property in India any rebate of the whole or part of the commission payable or any rebate except such rebate as may be allowed in accordance with the prospectus in tables of the Insurer.

(2) Any person making default in complying with the provisions of this section shall be with

fine which may extend to five hundred rupees.