Star Health And Allied Insurance Company Limited

Date : 08-Aug-2022
To, IMPORTANT

Ms. ARUNTHAVAM V ,
No.105,1 st Floor,Balaji Nagar
2 nd Street,Alwarthirunagar

Chennai,Tamil Nadu-600087
Mobile : 9444602892

Dear Customer,

Re: Health Insurance Policy - 11230074563901

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,
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 :Mon Aug 08 10:53:48 IST 2022
Page 1 of 5

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

Medi Classic Insurance Policy (Individual)

Unique Identification No. SHAHLIP22037V062122

In Consideration of payment of Rs. 15,065/- towards renewal premium of policy

number:P/111121/01/2022/008543, the policy stands renewed for a further period of 1 Year as per
the details given below

Renewal Endorsement No:11230074563901

Customer Code : 23308190 GSTIN : 33AAJCS4517L1Z5
Customer Name : Ms. ARUNTHAVAM V SAC Code : 997133 / Accident and Health
Insurance Services
Proposer Code : 23308190 Issuing Office Code : 111121
Proposer Name : Ms. ARUNTHAVAM V Issuing Office Name : AREA OFFICE - PARRYS
Proposer Address : No.105,1 st Floor,Balaji Nagar Issuing Office Address : P T Lee Chengalvaraya
2 nd Street,Alwarthirunagar Naicker Trust building
No:23 , 2nd floor, Rajaji salai
Chennai Tamil Nadu 600087 George Town
Chennai Tamil Nadu 600001
Phone No : 9444602892 Phone No : 044-42627776/044-42221512

E-mail Id : raj.arokia88@gmail.com E-mail Id : chennai.parrys@starhealth.in

Proposer GSTIN : NO Place of Supply : Tamil Nadu
Proposal date : 10-Aug-2021 Fulfiller Code : SH0631
Date of Inception : 10-Aug-2021
of first policy
Renewal Year : First Year Intermediary :BA0000567342
Collection No : 181184009225
Code
Collection Date : 08-Aug-2022 Name :S LEKHA
Premium : Rs. 12,767/-

CGST @ 9% : Rs. 1,149/-

Phone No :7299335570/729933557
0
:
SGST @ 9% Rs. 1,149/-
E-mail Id : somurevanth2008@gm
ail.com
Total Premium : Rs. 15,065/-
Stamp Duty : Re. 1/-

Total Premium In Words : Rupees Fifteen thousand sixty five only

PERIOD OF INSURANCE : From : 10-Aug-2022 00:00 To : Midnight Of 09-Aug-2023 Policy Term :1 Year
Installment Facility Option:No Premium Payment Frequency :Annual Installment Amount Rs. : 0/-
Details of Insured Persons : No. of Persons Insured : 1
Optional Covers Opted
Age Relationshi Sum Cumu. ID
Sl. Date of Inception
Name Gender in p with Insured Bonus Card Gold Hospital Patient
no. Birth date
Yrs Proposer (Rs.) (Rs.) No Plan Cash Care

Mrs.
ARUNTHAVAM 09-Dec- 233081 10-Aug-
1 Female 60 Self 3,00,000 75,000 Yes No No
V 1961 90-1 2021

Pre Existing Disease : All complications related to the surgeries or procedures performed previously
Diabetes Mellitus and its complications

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

Corporate Identity Number L66010TN2005PLC056649

Authorised Signatory Page 2 of 5
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@starthealth.in
Website :www.starhealth.in IRDAI Regn.no: 129
 Star Health And Allied Insurance Company Limited

Attached to and forming part of Policy No: 11230074563901

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 AROKIARAJ A Son In Law 34 100

Sector Classification:
Urban No

''CONSOLIDATED STAMP DUTY PAID VIDE G.O.(RT) NO.173 DATED.10TH MAY 2022''

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.
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.
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 AREA
OFFICE - PARRYS on 08th Day of August 2022.

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

Authorised Signatory Page 3 of 5

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

Hospitalisation Benefit Policy

Premium Certificate for the purpose of deduction under Section 80 D of Income Tax (Amendment) Act,1986

Policy No : 11230074563901 Type of Policy : Mediclassic Individual Revised

2019
Issue Office : 111121-AREA OFFICE - PARRYS

Address : P T Lee Chengalvaraya Naicker Trust building

No:23 , 2nd floor, Rajaji salai
George Town
Chennai Tamil Nadu 600001

Tel / Fax : 044-42627776/044-42221512

Email : chennai.parrys@starhealth.in

This is to certify that Ms. ARUNTHAVAM V has paid Rs 15,065/- (Total Premium : Indian Rupees Fifteen
thousand sixty five only ) towards Premium for Hospitalization Insurance vide Policy No: 11230074563901 for
the Period 10-Aug-2022 To 09-Aug-2023 issued on 08-Aug-2022.

Payment received by Payment Gateway vide Receipt No: 181184009225/1 Receipt Date: 08-Aug-2022

Note :- This Certificate must be surrendered to the Insurance Company for issuance of fresh Certificate in
case of Cancellation of the Policy or any alteration in the Insurance affecting the Premium.

Date : 08-Aug-2022 For and on behalf of

Place : AREA OFFICE - PARRYS Star Health and Allied Insurance Company Ltd.

IRDA Regn.No.129

Corporate Identity Number L66010TN2005PLC056649 Authorised Signatory

Email ID: info@starhealth.in

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

Authorised Signatory Page 4 of 5

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

Tax Invoice
Invoice No. : 332208I002864430 Customer ID : 23308190
Invoice Date : 08-Aug-2022 Policy No. : 11230074563901
Recipient Supplier
GSTIN : NO GSTIN : 33AAJCS4517L1Z5
Name : Ms. ARUNTHAVAM V Name : Star Health and Allied Insurance Co Ltd - AREA
OFFICE - PARRYS
Address : No.105,1 st Floor,Balaji Nagar Address : P T Lee Chengalvaraya Naicker Trust building
2 nd Street,Alwarthirunagar No:23 , 2nd floor, Rajaji salai
George Town
City : Chennai Pin Code : 600087 City : Chennai Pin Code : 600001

State : Tamil Nadu Client : IND State : Tamil Nadu Place of : Tamil Nadu
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 12,767.00 0 12,767.00 0 1,149.00 1,149.00 0 15,065.00
Services

Total Invoice Value (in Figures) : Rs. 15,065/-

Total Invoice Value (in Words) : Rupees Fifteen thousand sixty five 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

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

Authorised Signatory Page 5 of 5

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