IMPORTANT

06/10/2023
To,

NAFEES AHMED,
S/O ROZUDIN , KHASRA NO.-7/3/3 , BIJWASAN ROAD , KAPASHEDA
SOUTH DELHI NEAR PALAM AIRPORT DELHI

New Delhi,South West,Delhi -110037

Mobile : 9810486341.

Dear Customer,

Re: Health Insurance Policy - P/161211/01/2024/010052

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.

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 :Fri Oct 06 22:37:21 IST 2023

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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
 Family Health Optima Insurance Plan
Policy Schedule
Unique Identification No. SHAHLIP23164V072223
Policy No. : P/161211/01/2024/010052 Previous Policy No. : P/161211/01/2023/009271
Customer Code : AA0019942405 GSTIN : 07AAJCS4517L1Z0
Customer Name : NAFEES AHMED SAC Code : 997133/Accident and Health Insurance Services
Proposer Code : 23133227 Issuing Office Code : 161211
Proposer Name : NAFEES AHMED Issuing Office Name : Branch Ofifce - Pitampura
Address : S/O ROZUDIN , KHASRA NO.-7/3/3 , Address : Unit No:709, 710,7th Floor,
BIJWASAN ROAD , KAPASHEDA GDITL North Ex Towers,Plot No:A-09,Netaji
SOUTH DELHI NEAR PALAM Subhash Palace
AIRPORT DELHI Pitampura,new Delhi, New Delhi-110034

New Delhi,South West,Delhi -110037

Tel/Mobile : /9810486341/ Tel/Mobile : 011- 45261811 / 011-45261816
E-mail id : licmanya2010@gmail.com E-mail id : pitampura@starhealth.in
Proposer GSTIN : - Place of Supply : -
Proposal date : 30/07/2021 Fulfiller Code : SH21323
Date of Inception of first policy : 10-SEP-2021
Intermediary Code : BA0000450128
Renewal Year : Second Year
Collection Number & : 1214010755 & 06/10/2023 Name : Mr.ASHOK KUMAR
Date
Base Product Premium : Rs 30352 /- Tel/Mobile : 9212571334/9212571334
Premium : Rs 30352 /-
CGST @9% : Rs 2,732 /- SGST / UTGST @9% : Rs 2,732 /- E-mail id : ashoklic2013@gmail.com
Total Premium : Rs 35816 /- Stamp Duty : Re 1 /-
Total Premium In Words : Rupees Thirty Five Thousand Eight Hundred Sixteen Only
Installment Facility Optn :No Premium Payment Frequency :Annual Installment Amount Rs. : 0

Period of insurance : From : 06/10/2023 20:07 To : Midnight of 05/10/2024

Basic Floater Sum Insured : 300000
In words : Rupees: Three Lakhs Only
Bonus: Rs. 105000 Limit of Coverage : Rs. 405000 Recharge Benefit : Rs. 75000
Scheme Description : 2ADULT+3CHILD Policy Term : 1 Year

Details of Insured Persons :

Sl. Name of the Insured Gender Date of Birth Age in Relationship ID Card No Pre Existing Disease Co pay Inception Date
No. Yrs with Proposer
1 NAFEES AHMED M 20/06/1976 47 Self 23133227-1 No PED declared 0 14/08/2018
2 RAHISHA AHMED F 20/07/1978 45 Spouse 23133227-2 No PED declared 0 14/08/2018
3 ATHASAM AHMED M 28/02/2003 20 Dependant 23133227-3 No PED declared 0 14/08/2018
Child
4 AASIM AHMED M 15/02/1998 25 Dependant 23133227-4 0 14/08/2018
Child
Pre Existing Disease : TREATMENT RELATED TO PREVIOUS FRACTURES AND THEIR SEQUELAE.
5 NAZIYA F 22/07/2000 23 Dependant 23133227-5 No PED declared 0 14/08/2018
Child

Entered By : PREMIA For Star Health and Allied Insurance Company Ltd.
Approved By : SH46034

Corporate Identity Number L66010TN2005PLC056649 Authorised Signatory

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

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 Attached to and forming part of Policy No. P/161211/01/2024/010052
Nominee Details

Nominee Details for the proposer Appointee Details

Relationship Age % of Appointee Relationship

S.No. Name Age
with proposer the Name with Nominee
claim

1 RAHISHA AHMED Spouse 45 100

Sector Classification

Urban

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.
Toll Free No : 1800 425 2255 / 1800 102 4477 Email: support@starhealth.in, Fax No: 1800 425 5522 .
In witness whereof the undersigned being authorized by and on behalf of the company has set his hand at Branch Ofifce - Pitampura on 06th
Day of October 2023.

Permanent Exclusion Details

Insured Name ID Card Permanent Exclusion Disease

Entered By : PREMIA For Star Health and Allied Insurance Company Ltd.
Approved By : SH46034

Authorised Signatory

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

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 TAX Invoice

Invoice No. : 7G214Y24P0000231 Customer ID : AA0019942405

Invoice Date : 06/10/23 Policy No : P/161211/01/2024/010052
Recipient Supplier

GSTIN : - GSTIN : 07AAJCS4517L1Z0

Proposer Name : NAFEES AHMED NAME : Star Health and Allied Insurance Co Ltd
- Branch Ofifce - Pitampura
Address : S/O ROZUDIN , KHASRA NO.-7/3/3 Tel/Mobile : Unit No:709, 710,7th Floor,
, BIJWASAN ROAD , KAPASHEDA GDITL North Ex Towers,Plot No:A-
SOUTH DELHI NEAR PALAM 09,Netaji Subhash Palace
AIRPORT DELHI Pitampura,new Delhi, New Delhi-110034

City : City : PITAMPURA

State : Delhi State : Delhi
Pincode : 110037 Pincode : 110034
Client Category : IND Place of Supply : 7 - Delhi

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

997133 Insurance Services 30352 0 30352 2732 2732 Rs. 35816

Total Invoice Value (in Figures) : Rs. 35816
Total Invoice Value (in Words) : Rupees: Thirty-five thousand eight
hundred sixteen 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

Corporate Identity Number L66010TN2005PLC056649 Email ID : stargst@starhealth.in

Entered By : PREMIA For Star Health and Allied Insurance Company Ltd.
Approved By : SH46034

Authorised Signatory

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

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Forming part of Policy Number : P/161211/01/2024/010052

Covering Flu Vaccination Approved by ICMR under Health Check Up benefit and Home Care Treatment

Notwithstanding anything stated to the contrary in the within mentioned policy it is hereby agreed and declared that this Policy would hereinafter provide
the following covers without charging additional premium till 31.03.2024:

1.Cover for Flu Vaccine Approved by ICMR under Health check up benefit as per relevant clause with the same limits and conditions provided therein.

2.Cover for Home Care Treatment as per the details provided herein.
Home care treatment : Payable up to 10% of the sum insured subject to maximum of Rs.5 lakhs in a policy year, for treatment availed by the Insured
Person at home, only for the specified conditions mentioned below, which in normal course would require care and treatment at a hospital but is actually
taken at home provided that:

a. The Medical practitioner advises the Insured person to undergo treatment at home

b. There is a continuous active line of treatment with monitoring of the health status by a medical practitioner for each day through the duration of the
home care treatment

c. Daily monitoring chart including records of treatment administered duly signed by the treating doctor is maintained

d. Insured can avail "Home Care Treatment" service on cashless basis, if availed from the list of our Home Health Care Network service providers
given in our website "www.starhealth.in"

List of Conditions covered under Home care treatment

1. Fever and Infectious diseases which can be managed as Inpatient

2. Uncomplicated Urinary tract infections but needing Parenteral Antibiotics
3. Asthma and COPD -Mild Exacerbations needing Home Nebulization
4. Acute Gastritis/Gastroenteritis
5. I.V. Chemotherapy [Where advised by the doctor]
6. Palliative Cancer care requiring medical assistance
7. Acute Vertigo
8. Diabetic foot and Cellulitis
9. IVDP[Cervical and Lumbar disc diseases]
10. Major Surgeries/Arthroplasties needing IV Antibiotics Post Discharge
11. Care for Brain and Spinal Injury Cases Post Discharge
12. Post CVACare at Home after Discharge
13. Chronic Severe Refractory Asthma"

Entered By : PREMIA For Star Health and Allied Insurance Company Ltd.
Approved By : SH46034

Authorised Signatory

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

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