First Floor No. 10 Venkatesan Street (Above Heritage Fresh
Departmental Store)Tambaram West Tambaram Tamil Nadu-600045 Phone: 04449002850-49002899 Telefax:
Collection Receipt
Customer Code : 8571903 Collection No : 191033009460
Received From : MR.CHANDRAMOULI.V Collection Date : 09-Jan-2024 Customer Address : 003 PLOT NO 81 FOUNDATION Office Code : 111118 - Branch Office - PRAKRRUTI APARTMENT Tambaram INDUSTRIAL SUBURB GSTIN : 33AAJCS4517L1Z5 VISHWESHWARA NAGAR VTC Place of Supply : Tamil Nadu MYSORE SOUTH MYSORE Mysuru Taluk Karnataka 570008 Customer mobile : ./984XXXXX67 Type of proposal : Renewal number Customer GSTIN : NO State Code : 33 Amount Collected : Rs. 36,582/- Amount in words : INDIAN RUPEES Thirty Six thousand five hundred eighty two only Towards the Following : Amount Receipted towards Premium Sr. Proposal Fulfiller Intermediary Amount Mode of Bank CHQ/CC/DD CHQ/DD/BC No Ref. No Code Code Collected payment Name No Dt. (Rs) 1 61240890182 SH0487 BA0000019913 36,582/- Cheque Tamil Nadu 092413 08-Jan-2024 7 State Co- Op Bank Ltd
For Star Health and Allied Insurance Co. Ltd.
Authorised Signatory
Note : Receipt Subjected to realization of Cheque/DD
This is only an evidence of receipt of money by the company. Risk will commence once the proposal is examined and accepted. “Available modes of payments of Premium: Cash, Cheque, DD, Net Banking, RTGS/NEFT, Credit Card, Debit Card, UPI, Payment Gateway(PAYTM, PAYU, AIRPAY, BBPS, CSC, UBONA).”
Page 1 of 1 IRDA Regn.No.129 Corporate Identity Number L66010TN2005PLC056649 Email ID: info@starhealth.in
