IMPORTANT

To, 07-JUL-23

Naresh R Jadhav
978,Near bus stop,bhatsai, Vehloli
Thane,shahapur,

Vaghivali,Thane,Maharashtra -421301
Mobile : 8888943038.

Dear Customer,

Re: Health Insurance Policy - P/171142/01/2024/003168

We are extremely thankful for availing health insurance from us and we enclose the policy along with the terms and
conditions.

The said policy has been prepared based on the details furnished by you in the proposal form (copy enclosed) and
the medical reports, wherever applicable. We shall thank you if you can verify the policy to ensure that all the details
are incorporated correctly as per the proposal. In case of any discrepancy noticed, please communicate the same to
us immediately. You will appreciate that it is the primary duty of the proposer to fill the proposal form and also to
make sure that the proposal contains all the details correctly so also the policy has incorporated the details correctly.

This insurance policy is subject to various exclusions including exclusion for pre-existing diseases and conditions in
this policy. If there is suppression of any material fact in the proposal, the contract shall become null and void ab
initio.

We would like to mention that we have incorporated the name of the intermediary as indicated by you in the proposal
who will be of assistance to you.

The policy is subject to the condition of "free look period". As per this condition, a free look period of 15 days from
the date of receipt of the policy is available to you to review the terms and conditions of the policy. In case you are
not satisfied with the terms and conditions, you may seek cancellation of the policy and in such an event, we shall
allow refund of premium paid after adjusting the cost of pre-acceptance medical screening, if any, stamp duty
charges, and proportionate risk premium for the period on cover, provided no claim has been made until such
cancellation.

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

With kind regards,

Authorised Signatory
"Let Star Health help you to become healthier and happier. Star Wellness Benefits includes Mind Body healing and other
Condition management programmes (Weight management, Diabetes etc....) Visit www.starhealth.in / customer portal login and
start your journey with us to Better Health".

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.
CN=R Margabandhu,

R Margabandhu
SERIALNUMBER=00f82dcf76fdf6537e3331f8479ef45e7b4f3861b154
However, the ultimate decision will be that of yours only. 75488cdf3b2c3c26c3c9, ST=TAMIL NADU, OID.2.5.4.17=600034,
OID.2.5.4.20=513b7b33f2ce960f23148ea208744690e09638750806c
a65f89e15179f5fe50a, OU=UNDERWRITING - Chief Risk Officer,
O=STAR HEALTH AND ALLIED INSURANCE COMPANY, C=IN.
Date :Fri Jul 07 07:40:21 IST 2023

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@starthealth.in Website :www.starhealth.in IRDAI Regn.no: 129
 YOUNG STAR INSURANCE POLICY
SCHEDULE (Floater)
UNIQUE ID:SHAHLIP22036V042122

Policy No. : P/171142/01/2024/003168 Previous Policy No. :

Customer Code : AA0030071758 GSTIN : 27AAJCS4517L1ZY
Customer Name : Naresh R Jadhav SAC Code : 997133/Accident and Health Insurance Services
Proposer's Code : 33793178 Issuing Office Code : 171142
Proposer's Name : Naresh R Jadhav Issuing Office Name : Branch Office - Thane V
Address : 978,Near bus stop,bhatsai, Vehloli Address : 203, 2nd Floor, Panama Planet
Thane,shahapur, Above Bharat Bank, Gokhale
Road
Vaghivali,Thane,Maharashtra - Thane (West), Thane-400602
421301
Phone No : /8888943038/ Phone No : 022 - 67668500
E-mail Id : Poonamjadhav20211@gmail.com E-mail Id : thane.bo5@starhealth.in
Proposer GSTIN : - Place of Supply : -
Proposal date : 06/07/2023 Fulfiller Code : SH48114

Date of Inception of first policy : 07-JUL-2023 Intermediary Code : BA0000351532

Renewal Year : NEW
Receipt Date : 06/07/2023 Name : Mr.RAO SUBHASH
Premium :Rs 16,192 /- TUKARAM
CGST @9% : 1,458 /- SGST / UTGST @9% : 1,458 /- Phone No : 7350570797/7350570797
Stamp Duty :Rs 1 /- Total Premium :Rs 19,108 /-
E-mail Id : SUBHASHRAO127@GM
AIL.COM
Total Premium In Words : Rupees Nineteen Thousand One Hundred Eight Only Installment Facility Optn :Yes

Premium Payment Frequency :Semi - Annual Installment Amount Rs. : 9554 Collection No: 1660003381

Period of Insurance : FROM 07/07/2023 07:40 TO : Midnight Of 06/07/2024 Term : 1 Year

Scheme Description (Family Size) : 2 ADULTS + 2 CHILDREN Basic Floater Sum Insured : Rs. 1000000 /-
Bonus : Rs. 0 /-
Total Sum Insured In Words : Rupees Ten Lakhs Only Plan Type : SILVER
Details of Insured Persons :
Sl. Name of the Insured Sex Date of Birth Age in Relationship with ID Card No Pre Existing Disease Inception Date
no. Yrs Proposer
1 Naresh R Jadhav M 09/05/1990 33 SELF 33793178-1 No PED 07/07/2023
declared
2 Poonam Naresh Jadhav F 03/06/1990 33 SPOUSE 33793178-2 No PED 07/07/2023
declared
3 Aaryan Naresh Jadhav M 09/01/2014 9 DEPENDANT CHILD 33793178-3 No PED 07/07/2023
declared
4 Vihaan Naresh Jadhav M 09/05/2016 7 DEPENDANT CHILD 33793178-4 No PED 07/07/2023
declared

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

IRDAI Regn. No 129

Authorised Signatory
Corporate Identity Number L66010TN2005PLC056649
Email ID : info@starhealth.in
2 of 6

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@starthealth.in Website :www.starhealth.in IRDAI Regn.no: 129
Attached to and forming part of Policy No : P/171142/01/2024/003168

Please check whether the details given by you about the insured persons 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).

THE INSURANCE UNDER THIS POLICY IS SUBJECT TO CONDITIONS, CLAUSES, WARRANTIES, EXCLUSIONS ETC.,
ATTACHED.
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.
Sector Classification :

Rural

Toll Free No: 1800 425 2255/1800 102 4477 Email: support@starhealth.in, Fax No: 1800 425 5522
"CONSOLIDATED STAMP DUTY FOR POLICY STAMPS PAID VIDE NO. LOA/CSD/667/2023/1172 DT. 28/MAR/2023"

Nominee Details

Nominee Details for the proposer Appointee Details

S.No. Name Relationship Age % Appointee Relationship

Age
with proposer Name with Nominee

1 Poonam Naresh Jadhav Spouse 33 100

In witness whereof the undersigned being authorised by and on behalf of the company has set his hand at Branch Office - Thane V on 07th
Day of July 2023.

Permanent Exclusion Details

Insured Name ID Card Permanent Exclusion Disease

INSTALLMENT PREMIUM CLAUSE

Sr.No. Installment Due Dt. Premium Amount GST Amount Total Installment Premium Amount

1 07-JUL-23 8096 1458 9554

2 06-JAN-24 8096 1458 9554
Total : 16192 2916 19108

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

Authorised Signatory

3 of 6

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@starthealth.in Website :www.starhealth.in IRDAI Regn.no: 129
 Star Health and Allied Insurance
Company Limited
Emergency Help Line No. 1800 425 2255 / 1800 102 4477
e-mail : support@starhealth.in Website : www.starhealth.in Customer Identity Card

Please quote the Customer Id No. for assistance Customer ID No. : 33793178-4
This Card is valid until otherwise Cancelled. Name : Vihaan Naresh Jadhav
This ID Card is invalid, if the insurance cover is not in force Date Of Birth : 09-MAY-16 Age : 7 Years
Immediate intimation to 'Star' through above Tel Nos. is a must
Gender : Male Office Code : 171142
in case of Hospitalisation.
At the time of hospitalization, kindly submit any Government Valid From : 07-JUL-23 TA/SSM/SM Code : SH48114
approved photo ID Card. Agent/Broker/TE Code : BA0000351532
Corporate Identity Number: L66010TN2005PLC056649 IRDAI Regn. No:129

Star Health and Allied Insurance Star Health and Allied Insurance
Company Limited Company Limited
Customer Identity Card Customer Identity Card

Customer ID No. : 33793178-1 Customer ID No. : 33793178-2

Name : Naresh R Jadhav Name : Poonam Naresh Jadhav
Date Of Birth : 09-MAY-90 Age : 33 Years Date Of Birth : 03-JUN-90 Age : 33 Years
Gender : Male Office Code : 171142 Gender : Female Office Code : 171142
Valid From : 07-JUL-23 TA/SSM/SM Code : SH48114 Valid From : 07-JUL-23 TA/SSM/SM Code : SH48114
Agent/Broker/TE Code : BA0000351532 Agent/Broker/TE Code : BA0000351532
IRDAI Regn. No:129 IRDAI Regn. No:129

Star Health and Allied Insurance

Company Limited
Customer Identity Card

Customer ID No. : 33793178-3

Name : Aaryan Naresh Jadhav
Date Of Birth : 09-JAN-14 Age : 9 Years
Gender : Male Office Code : 171142
Valid From : 07-JUL-23 TA/SSM/SM Code : SH48114
Agent/Broker/TE Code : BA0000351532

IRDAIIRDAI
Regn. Regn.
No:129No:129

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

Authorised Signatory

4 of 6

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@starthealth.in Website :www.starhealth.in IRDAI Regn.no: 129
 TAX Invoice

Invoice No. : 27D660Y24P000227 Customer ID : AA0030071758

Invoice Date : 07/07/23 Policy No : P/171142/01/2024/003168
Recipient Supplier

GSTIN : - GSTIN : 27AAJCS4517L1ZY

Proposer's : Naresh R Jadhav NAME : Star Health and Allied Insurance Co Ltd
Name - Branch Office - Thane V
Address : 978,Near bus stop,bhatsai, Vehloli Address : 203, 2nd Floor, Panama Planet
Thane,shahapur, Above Bharat Bank, Gokhale Road
Thane (West), Thane-400602
City : City : THANE V
State : Maharashtra State : Maharashtra
Pincode : 421301 Pincode : 400602
Client Category : IND Place of Supply : 27 - Maharashtra

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

997133 Insurance 16192 0 16192 1458 1458 Rs. 19108

Services
Total Invoice Value (in Figures) : Rs. 19108
Total Invoice Value (in Words) : Rupees: Nineteen thousand one
hundred eight 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 : STAR_PORTAL For Star Health and Allied Insurance Company Ltd.
Approved by : PORTAL

Authorised Signatory

5 of 6

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@starthealth.in Website :www.starhealth.in IRDAI Regn.no: 129
 Name Of the Product YOUNG STAR INSURANCE POLICY
Product UIN No. SHAHLIP22036V042122
Summary of Important Benefits
Benefit Limits (in Rs.) Refer to Policy
Particulars of Coverage / clause No.
S.No
Benefits Individual and Floater
Individual
Sum Insured (in Rs.) 300000/- 500000/- 1000000/- 1500000/- 2000000/- 2500000/- 5000000/- 7500000/- 10000000/-
1 Plan Type Silver Plan

Room Rent (Per Day) - Up to

2 *Hospitalization expenses will be
considered in proportion to the eligible Single Private A/c Room II(A)
Room Rent
Surgeon, Anesthetist, Medical
3 Practitioner, Consultants, Specialist
Fees, Anesthesia, blood, oxygen,
operation theatre charges, Surgical Actual II(B & C)
Appliances, Medicines and Drugs

4 Road Ambulance charges(per policy

period) Actuals
II(D)

5 Pre-Hospitalization Expenses Up to 60 days prior to admission II(E)

6 Post-Hospitalization Expenses Up to 90 days from the date of discharge II(F)

7 Day Care Procedure All day care procedure covered. II(G)

8 Medical Opinion E -Medical Opinion" from the Company's expert panel. II(H)
Sum Insured/policy type Rs3,00,000/- Rs5,00,000/- Rs10,00,000/- Rs15,00,000/-and above
9. Health Check Individual 1,500/- 2,000/- 3,000/- 3,500/- II(I)
up
Floater N/A 3,000/- 4,000/- 5,000/-

10 Automatic Restoration of Basic Sum II(J)

Once during policy period by 100%
Insured
The insured person will be eligible for Cumulative bonus calculated at 20% of basic sum insured for each claim
11 Cumulative bonus free year subject to a maximum of 100% of the basic sum insured. II(K)

Additional Basic Sum Insured for Road 25% of the Sum Insured subject to a
12 II(L)
Traffic Accident (RTA) maximum of Rs10,00,000/-

13 Star Wellness Program Discount in the Renewal premium for healthy life style through wellness activities. II(M)

14 Special Features 10% Discount at the time of renewal after 40years of age. V(22 A)

15. Coverage for Modern Treatment Covered up to the limits II(N)

16. Instalment Facility (If Opted) Available V(13)

Note: The above information is only indicative. For complete details of the Terms & Conditions kindly read the policy wordings attached.

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

Authorised Signatory

6 of 6

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@starthealth.in Website :www.starhealth.in IRDAI Regn.no: 129