Star Health And Allied Insurance Company Limited

Date : 07-Feb-2023
To, IMPORTANT

BARSALI BANERJEE ,
A-23, MOULANA AZAD SARANI, CITY CENTRE, DURGAPUR, DIST-BURDWAN,
WB,
PIN-713216
Kanksa,West Bengal-713216
Mobile : 8388965018/9126757003

Dear Customer,

Re: Health Insurance Policy - 11230242149104

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,
SERIALNUMBER=00f82dcf76fdf6537e3331f8479ef45e7b4f3861b15475488cdf

R Margabandhu 3b2c3c26c3c9, ST=TAMIL NADU, OID.2.5.4.17=600034,

OID.2.5.4.20=513b7b33f2ce960f23148ea208744690e09638750806ca65f89e15
179f5fe50a, OU=UNDERWRITING - Chief Risk Officer, O=STAR HEALTH AND
ALLIED INSURANCE COMPANY, C=IN. Date :Tue Feb 07 19:16:49 IST 2023
Page 1 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@starhealth.in
Website :www.starhealth.in IRDAI Regn.no: 129
 Star Health And Allied Insurance Company Limited

Star Comprehensive Insurance Policy Schedule(Floater)

Unique Identification No. SHAHLIP22028V072122

In Consideration of payment of Rs. 15,706/- towards renewal premium of policy

number:P/191114/01/2022/019890, the policy stands renewed for a further period of 1 Year as per
the details given below

Renewal Endorsement No:11230242149104

Customer Code : 13747369 GSTIN : 19AAJCS4517L1ZV
Customer Name : BARSALI BANERJEE SAC Code : 997133 / Accident and Health
Insurance Services
Proposer Code : 13747369 Issuing Office Code : 191114
Proposer Name : BARSALI BANERJEE Issuing Office Name : Branch Office - Durgapur
Proposer Address : A-23, MOULANA AZAD SARANI, Issuing Office Address : SN-10, AMBEDKAR SARANI,
CITY CENTRE, DURGAPUR, DIST- CITY CENTRE, DURGAPUR,
BURDWAN, 713216
WB,
PIN-713216
Kanksa West Bengal 713216 Kanksa West Bengal 713216
Phone No : 8388965018/9126757003 Phone No : 0343-2546041/42/44
E-mail Id : avi.kumar.mishra2012@gmail.co E-mail Id : durgapur@starhealth.in
m
Proposer GSTIN : NO Place of Supply : West Bengal
Proposal date : 10-Feb-2020 Fulfiller Code : SH24346
Date of Inception : 12-Feb-2019
of first policy
Renewal Year : Third Year Intermediary :BA0000274629
Collection No : 181146022240
Code
Collection Date : 07-Feb-2023

Premium : Rs. 13,310/-

Name : MR.SHYAMAL DAS

CGST @ 9% : Rs. 1,198/-

Phone No :8250904630/843659262
4
:
SGST @ 9% Rs. 1,198/-
E-mail Id : shyamaldas472@gmail
.com
Total Premium : Rs. 15,706/-
Stamp Duty : Re. 1/-

Total Premium In Words : Rupees Fifteen thousand seven hundred six only
PERIOD OF INSURANCE : From : 12-Feb-2023 00:00 To : Midnight Of 11-Feb-2024 Policy Term :1 Year
Installment Facility Option:No Premium Payment Frequency :Annual Installment Amount Rs. : 0/-
Scheme Description (Family Size) : 2A Basic Floater Sum Insured : Rs. 7,50,000/-
Bonus : Rs. 7,50,000/-
Sum Insured Under Section 1 (Health) Rs. 7,50,000/-
Capital Sum Insured Under Section 10 (For Accidental Death & Permanent Total Disablement) : Rs. 7,50,000/-
For BARSALI BANERJEE Only.

Entered by : SH40475 For Star Health and Allied Insurance Company Ltd.
Approved by : SH40475
IRDA Regn.No.129

Corporate Identity Number L66010TN2005PLC056649

Authorised Signatory Page 2 of 4
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: 11230242149104

Details of Insured Persons :

Sl. Age in Relationship Buy Back PED

Name of the Insured Gender Date of Birth ID Card No Inception date
no. Yrs with Proposer Opted
BARSALI BANERJEE
1 Female 27-Jun-1991 31 Self 13747369-3 No 12-Feb-2019

Pre Existing Disease : No PED Declared

AVIJIT KUMAR MISHRA
2 Male 05-Apr-1989 33 Spouse 13747369-4 No 12-Feb-2019

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 AVIJIT KUMAR Spouse 33 100

MISHRA
Sector Classification:
Rural No

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.
Toll Free No: 1800 425 2255/1800 102 4477 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 - Durgapur on 07th Day of February 2023.

Entered by : SH40475 For Star Health and Allied Insurance Company Ltd.
Approved by : SH40475

Authorised Signatory Page 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@starhealth.in
Website :www.starhealth.in IRDAI Regn.no: 129
 Star Health And Allied Insurance Company Limited

Tax Invoice
Invoice No. : 192302I001789196 Customer ID : 13747369
Invoice Date : 07-Feb-2023 Policy No. : 11230242149104
Recipient Supplier
GSTIN : GSTIN : 19AAJCS4517L1ZV
Name : BARSALI BANERJEE Name : Star Health and Allied Insurance Co Ltd -
Branch Office - Durgapur
Address : A-23, MOULANA AZAD SARANI, CITY Address : SN-10, AMBEDKAR SARANI, CITY CENTRE,
CENTRE, DURGAPUR, DIST-BURDWAN, DURGAPUR, 713216
WB,
PIN-713216
City : Kanksa Pin Code : 713216 City : Kanksa Pin Code : 713216

State : West Bengal Client : IND State : West Bengal Place of : West Bengal
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 13,310.00 0 13,310.00 0 1,198.00 1,198.00 0 15,706.00
Services

Total Invoice Value (in Figures) : Rs. 15,706/-

Total Invoice Value (in Words) : Rupees Fifteen thousand seven hundred six 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

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

Entered by : SH40475 For Star Health and Allied Insurance Company Ltd.
Approved by : SH40475

Authorised Signatory Page 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@starhealth.in
Website :www.starhealth.in IRDAI Regn.no: 129