Star Health And Allied Insurance Company Limited

Date : 10-Nov-2023
To, IMPORTANT

MRS.SUNANDA ,
C/O. S J V MAHIPAL AMAR KRUPA UPSTAIRS, 3RD CROSS, GANDHI NAGAR
C/O. S J V MAHIPAL AMAR KRUPA UPSTAIRS, 3RD CROSS, GANDHI NAGAR

Ballari Taluk,Karnataka-583104
Mobile : 9448006897

Dear Customer,

Re: Health Insurance Policy - 11240501079910

We are extremely thankful to you for your renewal instructions and payment of premium. We enclose the
renewed policy based on our records. We would request you to kindly study the renewed policy carefully and
revert to us if there is any discrepancy to enable us to attend to the same.

Kindly note that the above request is very important and if we do not hear anything from you within
15 days, we would presume that the policy issued by us is in order and the contract is concluded.

We would like to mention that we have incorporated the name of the intermediary as indicated by you.

We wish you good health and we look forward to serve you in the days to come.

With kind regards,

Authorised Signatory

In case of a need for hospitalization, kindly prefer our network hospital (list is available in our website) for a
quick response to your claim request.
Please select the room as per your eligibility stipulated in your policy to avoid additional payment
from your pocket towards the proportionate increase which would invariably be charged by the
hospital for the higher room category occupied.
Sum Insured of this Policy is meant for utilization till its expiry.Bearing this aspect in mind,we have no
doubt,you will choose appropriate hospital,room rent and treatment charges etc.

Should you need any assistance, our customer care will be delighted to assist you ,whose toll free no. is
1800-425-2255/1800-102-4477.

However,the ultimate decision will be that of yours only.

Page 1 of 5

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
 Star Health And Allied Insurance Company Limited

Star Health Assure Insurance Policy

Unique Identification No. SHAHLIP23131V022223

In Consideration of payment of Rs. 58,021/- towards renewal premium of policy

number:P/141214/01/2023/004716, the policy stands renewed for a further period of 1 Year as per
the details given below

Renewal Endorsement No:11240501079910

Customer Code : 3210623 GSTIN : 29AAJCS4517L1ZU
Customer Name : MRS.SUNANDA SAC Code : 997133 / Accident and Health
Insurance Services
Proposer Code : 3210623 Issuing Office Code : 141214
Proposer Name : MRS.SUNANDA Issuing Office Name : Branch Office - Bellary
Proposer Address : C/O. S J V MAHIPAL AMAR KRUPA Issuing Office Address : No. 63
UPSTAIRS, 3RD CROSS, GANDHI 1st Floor
NAGAR Denta Care Building,Dr. Raj
C/O. S J V MAHIPAL AMAR KRUPA Kumar Road & Ananthpur
UPSTAIRS, 3RD CROSS, GANDHI Road
NAGAR Ballari Taluk Karnataka
583101
Ballari Taluk Karnataka 583104
Phone No : 9448006897 Phone No : 08392-278864/278865
E-mail Id : drsjvmahipal@hotmail.com E-mail Id : bellary@starhealth.in
Proposer GSTIN : NO Place of Supply : Karnataka
Proposal date : 18-Nov-2013 Fulfiller Code : SH4009
Date of Inception : 06-Dec-2013
of first policy
Renewal Year : Tenth Year Intermediary : BA0000072464
Collection No : 141214/RV/2024/0080596608
Code
Collection Date : 10-Nov-2023

Premium : Rs. 49,171/-

Name : D SUDHA REDDY

CGST @ 9% : Rs. 4,425/-

Phone No :9611307027/961130702
7
:
SGST @ 9% Rs. 4,425/-
E-mail Id : leohp1969@gmail.com
Total Premium : Rs. 58,021/-
Stamp Duty : Re. 1/-

Total Premium In Words : Rupees Fifty Eight thousand twenty one only
PERIOD OF INSURANCE : From : 06-Dec-2023 00:00 To : Midnight Of 05-Dec-2024 Policy Term :1 Year
Installment Facility Option:No Premium Payment Frequency :Annual Installment Amount Rs. : 0/-
Policy Type : INDIVIDUAL

Entered by : CUSTPORTAL For Star Health and Allied Insurance Company Ltd.
Approved by : PORTAL
IRDAI Regn.No.129

Corporate Identity Number L66010TN2005PLC056649

Authorised Signatory Page 2 of 5
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
 Star Health And Allied Insurance Company Limited

Attached to and forming part of Policy No: 11240501079910

Details of Insured Persons:

Age Relation Sum Optional
Sl Name of the ID Card No Claim Inception
Gender Date of Birth in with Insured Cover Deductible
No Insured No Bonus Date
Yrs Proposer Rs. (Deductible)
MRS.SUNANDA 321062 12,50,00
1 Female 01-Jun-1956 67 Self 50,00,000 No 0 06-Dec-2013
3-1 0
Pre Existing Disease : No PED Declared

Nominee Details:
Nominee Details for the Proposer Appointee Details
S.No Name Relationship Age % of the Appointee Name Appointee Relationship
with proposer claim Age with nominee

1 DR S J V Spouse 78 100
MAHIPAL
Sector Classification:
Urban

''CHALLAN NO IG0923003049515949 DT 30.09.2023 AND ESTAMPING - POLICY STAMPS"''

Please check whether the details given by you about the insured person(s) in the proposal form are incorporated
correctly in the policy schedule. If you find any discrepancy, please inform us within 15 days from the date of
receipt of the policy, failing which the details relating to the insured person given in the policy schedule are deemed
to have been accepted by you.
Warranted that in case of dishonor of premium cheque(s), the Company shall not be liable under the policy and the
policy shall be void abinitio (from inception).

Important
In the event of hospitalization of insured person, intimation should be given to the Company immediately,
however, within 24 hrs from the time of admission.
Toll Free No : 1800 425 2255 Email: support@starhealth.in, Fax No: 1800 425 5522.

It is hereby made clear that all terms, conditions, clauses, warranties, exclusions etc., as already issued, forming
part of the policy of insurance originally issued at the time of inception of this relationship, shall continue to be
operative and unaltered, forming part of this renewal insurance cover also.

Reference may be made to those terms, conditions etc., for identifying the scope/extent of coverage.

Other excluded expenses as detailed in our website www.starhealth.in

In witness whereof the undersigned being authorized by and on behalf of the company has set his hand at Branch
Office - Bellary on 10th Day of November 2023.

Entered by : CUSTPORTAL For Star Health and Allied Insurance Company Ltd.
Approved by : PORTAL

Authorised Signatory Page 3 of 5

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
 Star Health And Allied Insurance Company Limited

Hospitalisation Benefit Policy

Premium Certificate for the purpose of deduction under Section 80 D of Income Tax (Amendment) Act,1986

Policy No : 11240501079910 Type of Policy : Assure Insurance-2021

Issue Office : 141214-Branch Office - Bellary

Address : No. 63
1st Floor
Denta Care Building,Dr. Raj Kumar Road & Ananthpur Road
Ballari Taluk Karnataka 583101

Tel / Fax : 08392-278864/278865

Email : bellary@starhealth.in

This is to certify that MRS.SUNANDA has paid Rs 58,021/- (Total Premium : Indian Rupees Fifty Eight
thousand twenty one only ) towards Premium for Hospitalization Insurance vide Policy No: 11240501079910
for the Period 06-Dec-2023 To 05-Dec-2024 issued on 10-Nov-2023.

Payment received by Payment Gateway vide Receipt No: 141214/RV/2024/0080596608/1 Receipt

Date: 10-Nov-2023

Note :- This Certificate must be surrendered to the Insurance Company for issuance of fresh Certificate in
case of Cancellation of the Policy or any alteration in the Insurance affecting the Premium.

Date : 10-Nov-2023 For and on behalf of

Place : Branch Office - Bellary Star Health and Allied Insurance Company Ltd.

IRDA Regn.No.129

Corporate Identity Number L66010TN2005PLC056649 Authorised Signatory

Email ID: info@starhealth.in

Entered by : CUSTPORTAL For Star Health and Allied Insurance Company Ltd.
Approved by : PORTAL

Authorised Signatory Page 4 of 5

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
 Star Health And Allied Insurance Company Limited

Tax Invoice
Invoice No. : 292311I002216536 Customer ID : 3210623
Invoice Date : 10-Nov-2023 Policy No. : 11240501079910
Recipient Supplier
GSTIN : GSTIN : 29AAJCS4517L1ZU
Name : MRS.SUNANDA Name : Star Health and Allied Insurance Co Ltd -
Branch Office - Bellary
Address : C/O. S J V MAHIPAL AMAR KRUPA Address : No. 63
UPSTAIRS, 3RD CROSS, GANDHI
NAGAR
C/O. S J V MAHIPAL AMAR KRUPA 1st Floor
UPSTAIRS, 3RD CROSS, GANDHI
NAGAR
Denta Care Building,Dr. Raj Kumar Road &
Ananthpur Road
City : Ballari Taluk Pin Code : 583104 City : Ballari Taluk Pin Code : 583101

State : Karnataka Client : IND State : Karnataka Place of : Karnataka

Category supply

Taxable IGST @ UT/SGST @ CESS @ Total Invoice

Total Discount CGST @ 9%
Value 18% 9% 1% Value
HSN / SAC Description of
Code Service(s) F=C*
D=C* E=C* G= C * H=C+D+
A B C=A-B UTGST or
IGST CGST Cess E+ F + G
SGST

Insurance
997133 49,171.00 0 49,171.00 0 4,425.00 4,425.00 0 58,021.00
Services

Total Invoice Value (in Figures) : Rs. 58,021/-

Total Invoice Value (in Words) : Rupees Fifty Eight thousand twenty one only
Amount of Tax Subject to reverse Charge : No

Important Note:
The invoice is issued as per Section 31 of the CGST Act
In case no GSTIN or incorrect GSTIN is provided by the Proposer at Proposal stage, Star Health and Allied Insurance Co Ltd shall not be
responsible for any Input Tax Credit losses and no subsequent revision of invoice will be undertaken
"I/We hereby declare that though our aggregate turnover in any preceding financial year from 2017-18 onwards is more than the aggregate
turnover notified under sub-rule (4) of rule 48, we are not required to prepare an invoice in terms of the provisions of the said sub-rule."
E. & O.E
This is a digitally signed document and hence no physical signature is required

IRDAI Regn.No.129 Corporate Identity Number L66010TN2005PLC056649 Email ID: stargst@starhealth.in

Entered by : CUSTPORTAL For Star Health and Allied Insurance Company Ltd.
Approved by : PORTAL

Authorised Signatory Page 5 of 5

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