IMPORTANT

To, 31-JUL-23

SMARAJIT CHOWDHRY
BLOCK-D(3),R.K.MISSION
KANKHAL
HARIDWAR
Haridwar,Hardwar,Uttarakhand -249408
Mobile : 9412941666.

Dear Customer,

Re: Health Insurance Policy - P/161311/01/2024/003052

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
"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.

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

CN=R Margabandhu,

R Margabandhu
SERIALNUMBER=00f82dcf76fdf6537e3331f8479ef45e7b4f3861b154
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 :Mon Jul 31 14:35:57 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
 STAR COMPREHENSIVE INSURANCE POLICY
SCHEDULE (INDIVIDUAL)
UNIQUE ID:SHAHLIP22028V072122

In consideration of payment of Rs.30880/- towards renewal premium of Policy number: P/161311/01/2023/002903, the policy stands
renewed for a further period of 1 year as per the details given below.

Renewal Endorsement No : P/161311/01/2024/003052

Customer Code : AA0027158068 GSTIN : 05AAJCS4517L1Z4
Customer Name : Mr.SMARAJIT CHOWDHRY SAC Code : 997133/Accident and Health Insurance Services
Proposer's Code : 30571294 Issuing Office Code : 161311
Proposer's Name : SMARAJIT CHOWDHRY Issuing Office Name : Branch Office - Haridwar
Address : BLOCK-D(3),R.K.MISSION Address : 2ND FLOOR,KUMAR TOWER,
KANKHAL RANIPUR MORE,HARIDWAR
HARIDWAR , Haridwar-249407
Haridwar,Hardwar,Uttarakhand -
249408
Phone No : 0/9412941666/ Phone No : 01334220202
E-mail Id : smarajitc@gmail.com E-mail Id : Haridhwar@starhealth.in
Proposer GSTIN : - Place of Supply : -
Proposal date : 04/08/2022 Fulfiller Code : SH39175

Date of Inception of first policy : 04-AUG-2022

Renewal Year : First Year
Collection Number : 1258003407 Intermediary Code : BA0000462186
Receipt Date : 31/07/2023 Name : Mr.SUROJIT KUMAR
Premium :Rs 26170 /-
SARKAR
CGST @9% : 2,355 /- SGST / UTGST @9% : 2,355 /- Phone No : 9760180137/9760180137
Stamp Duty :Rs 1 /- Total Premium :Rs 30,880 /-
E-mail Id : ksarkar78@gmail.com
Total Premium In Words : Rupees Thirty Thousand Eight Hundred Eighty Only Installment Facility Optn :No

Premium Payment Frequency :Annual Installment Amount : Rs. 0

Period of Insurance : FROM 04/08/2023 00:00 TO : Midnight Of 03/08/2024 Policy Term: 1 Year
Details of Insured Persons :

Section 1 Section 10 Pre- Inception

Basic Sum Existing Date
Age in ID Card Co-Pay Cumulative Capital Sum Disease
Sl. Name of the Insured Sex Date of Relationshi Insured Bonus Rs Insured (Rs.)
Yrs p with No (Health) (Rs.)
no. Birth
Proposer
1 SMARAJIT CHOWDHRY M 24/11/1964 58 SELF 30571294-1 0 1000000 1000000 1000000 No PED 04/08/2022
declared

Buy Back Pre Existing Disease Opted: No

For Star Health and Allied Insurance Company Ltd.

Entered by : SH34474
Aproved by : SH34474

IRDAI Regn. No 129

Authorised Signatory
Corporate Identity Number L66010TN2005PLC056649
Email ID : info@starhealth.in
2 of 4

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/161311/01/2024/003052

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).

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 :

Urban Social Informal Informal Sector includes small scale, self-employed workers typically at a low level of organisation and technology, with the
Sector primary objective of generating employment and income, with heterogeneous activities like retail trade, transport, repair and
maintenance, construction, personal and domestic services and manufacturing, with the work mostly labour intensive, having
often unwritten and informal employer-employee relationship
Toll Free No: 1800 425 2255/1800 102 4477 Email: support@starhealth.in, Fax No: 1800 425 5522
Nominee Details
Nominee Details for the proposer Appointee Details

S.No. Name Relationship Age % Appointee Relationship

Age
with proposer Name with Nominee

1 LALIT UNIYAL Brother 78 100

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 authorised by and on behalf of the company has set his hand at Branch Office - Haridwar on 31st
Day of July 2023.
Permanent Exclusion Details

Insured Name ID Card Permanent Exclusion Disease

For Star Health and Allied Insurance Company Ltd.

Entered by : SH34474
Aproved by : SH34474

Authorised Signatory

3 of 4

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. : 5D258Y24P0001038 Customer ID : AA0027158068

Invoice Date : 31/07/23 Policy No : P/161311/01/2024/003052
Recipient Supplier

GSTIN : - GSTIN : 05AAJCS4517L1Z4

Proposer's : SMARAJIT CHOWDHRY NAME : Star Health and Allied Insurance Co Ltd
Name - Branch Office - Haridwar
Address : BLOCK-D(3),R.K.MISSION Address : 2ND FLOOR,KUMAR TOWER,
KANKHAL RANIPUR MORE,HARIDWAR
HARIDWAR , Haridwar-249407
City : City : HARIDWAR
State : Uttarakhand State : Uttarakhand
Pincode : 249408 Pincode : 249407
Client Category : IND Place of Supply : 5 - Uttarakhand

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 26170 0 26170 2355 2355 Rs. 30880

Services
Total Invoice Value (in Figures) : Rs. 30880
Total Invoice Value (in Words) : Rupees: Thirty thousand eight
hundred eighty 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

For Star Health and Allied Insurance Company Ltd.

Entered by : SH34474
Aproved by : SH34474

Authorised Signatory

4 of 4

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