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    Mediclaim

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    sockalingam.m
    This is a receipt from Star Health And Allied Insurance Company Limited for Rs. 21,772 collected from Mrs. T. Usha towards the renewal of an insurance proposal. The receipt provides details of the customer, proposal reference number, intermediary codes, amount collected and mode of payment.

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    © All Rights Reserved
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    Mediclaim

    Uploaded by

    sockalingam.m
    9 views1 page
    This is a receipt from Star Health And Allied Insurance Company Limited for Rs. 21,772 collected from Mrs. T. Usha towards the renewal of an insurance proposal. The receipt provides details of the customer, proposal reference number, intermediary codes, amount collected and mode of payment.

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    © © All Rights Reserved

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    This is a receipt from Star Health And Allied Insurance Company Limited for Rs. 21,772 collected from Mrs. T. Usha towards the renewal of an insurance proposal. The receipt provides details of the customer, proposal reference number, intermediary codes, amount collected and mode of payment.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    9 views1 page

    Mediclaim

    Uploaded by

    sockalingam.m
    This is a receipt from Star Health And Allied Insurance Company Limited for Rs. 21,772 collected from Mrs. T. Usha towards the renewal of an insurance proposal. The receipt provides details of the customer, proposal reference number, intermediary codes, amount collected and mode of payment.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    Star Health And Allied Insurance Company Limited

    No. 95,Vaigarai Block, I Floor St. Paul's Complex,(Opp. to Head


    Post Office) Bharathiyar Salai
    Tiruchirappalli Town Tamil Nadu-620001
    Phone: 0431-2461324 Telefax:

    Collection Receipt

    Customer Code : 12788868 Collection No : 191016009503


    Received From : MRS.T.USHA Collection Date : 10-Nov-2023
    Customer Address : No: 1-4, 5th crossThiru Nagar . Office Code : 121200 - Zonal Office - Trichy
    Edumalai Road, GSTIN : 33AAJCS4517L1Z5
    Mannachanallur .Trichy. Place of Supply : Tamil Nadu
    Manachanallur Taluka Tamil
    Nadu 621005
    Customer mobile : ./890XXXXX73 Type of proposal
    : Renewal
    number
    Customer GSTIN : NO State Code : 33
    Amount Collected : Rs. 21,772/-
    Amount in words : INDIAN RUPEES Twenty One thousand seven hundred seventy two only
    Towards the Following : Amount Receipted towards Premium
    Sr. Proposal Fulfiller Intermediary Amount Mode of Bank CHQ/CC/DD CHQ/DD/BC
    No Ref. No Code Code Collected payment Name No Dt.
    (Rs)
    1 61240617374 SH0253 BA0000010875 21,772/- Cash
    4

    For Star Health and Allied Insurance Co. Ltd.

    Authorised Signatory

    Note : Receipt Subjected to realization of Cheque/DD


    This is only an evidence of receipt of money by the company.
    Risk will commence once the proposal is examined and accepted.
    “Available modes of payments of Premium: Cash, Cheque, DD, Net Banking, RTGS/NEFT, Credit Card, Debit
    Card, UPI, Payment Gateway(PAYTM, PAYU, AIRPAY, BBPS, CSC, UBONA).”

    Page 1 of 1
    IRDA Regn.No.129 Corporate Identity Number L66010TN2005PLC056649 Email ID: info@starhealth.in

    Regd.&Corporate Office:1,New Tank Street,Valluvar Kottam High Road,Nungambakkam,Chennai - 600034,Phone : 044 -28302700 / 28288800 Toll
    Free Fax No: 1800-425-5522 Toll Free No:1800-425-2255 / 1800-102-4477,CIN : L66010TN2005PLC056649 Email :support@starhealth.in
    Website :www.starhealth.in IRDAI Regn.no: 129

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