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Renewal Notice 231026 185701

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Star Health And Allied Insurance Company Limited

RENEWAL NOTICE
Policy No: P/141141/01/2023/006633

Date :08-Aug-2023
MR.H RAMANJINAPPA Branch Office - Hebbal II-141141

KATHRIGUPPE (V) MARALU KUNTE (P) NO. 255, 2nd Floor


CHIKKABALLAPURA (T & D) 1st Main,1st Cross
. Ganganagar
Chikkaballapura Town,Karnataka-562101 Bengaluru City Karnataka 560032
96XXXXXX42/muXXXXXXXX@gmail.com Ph : 080-46131777
Email ID : hebbal2.bo@starhealth.in
Proposer/CustomerCode:5757369/5757369 Reference No : 612406096548 - Direct Receipt

Dear Customer,
We value your relationship with us and thank you for the same. We wish to bring to your kind notice that your Family Health Optima Insurance Plan is due for
renewal on 06-Nov-2023. The renewal premium, including Tax, works out to Rs. 30,245/- as per details given below.

Age as on Relationship with


S. No Name of the Insured DOB Sum Insured(Rs.) Premium (Rs.)
renewal proposer
1 MR. H. RAMANJINAPPA 04-Dec-1963 59 Self
2 MRS. PREMA .G 06-Nov-1970 53 Spouse 3,00,000 25,631
3 MAST. ADARSH .K.R 14-Nov-1997 25 Son
GST @ 18% 4,614
Total Renewal Premium 30,245
You can cover yourself with more Suminsured Coverages

MR. H. RAMANJINAPPA SI 4,00,000 SI 5,00,000 SI 10,00,000 SI 15,00,000 SI 20,00,000


Rs. 32,719/- Rs. 34,369/- Rs. 41,242/- Rs. 47,428/- Rs. 53,120/-
**Excess if any shall be refunded to proposer

We are pleased to inform you that we have revised the product terms and conditions in lieu of the product version purchased by you last year. This renewal notice is
prepared as per new terms and conditions. In case you wish to have more details of the revision, kindly approach your Agent/Broker/Our Office.
However, we require below mentioned additional information from you:-
Mobile Number and Package Amount has been added in the Product

If there is any change in the list of insured persons to be covered and/ or you desire any changes in the sum insured etc., please inform us
immediately so that we can work out the revised renewal premium and advise you. Otherwise, please arrange to remit the renewal premium of Rs.
30,245/- on or before 06-Nov-2023. Please note that the payment of premium by any mode other than by cash will be eligible for benefit under Sec. 80 D of the
Income Tax Act. If you pay by Cheque or DD, please make payment in favour of ''Star Health and Allied Insurance Company Limited.''

We request you to renew the policy before the renewal date to ensure continuity of cover and benefits.

''Please furnish your mobile number and email id in the space provided below to enable our company to communicate with you as our valued customer, whenever
required''.

Mobile Number : Email id :

You can also update your Address / Mobile No / E Mail ID, online by visiting our website www.starhealth.in
Please note that this policy can be renewed online or using your mobile. Kindly log on to our website www.starhealth.in to know the details.

Always at your service. Intermediary Name/Code : Mr.H.A.NARASIMHA MURTHY / BA0000190992


For Star Health and Allied Insurance Company Limited
Phone No : 9620316342
Fulfiller Name/Code : Ms.GAYATHRI MOHAN / SH22870

Authorised Signatory Phone No : 080-46131777/9980182538

This is an example of Promotional Message.

IRDA Regn.No.129 Corporate Identity Number L66010TN2005PLC056649 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

Sheet attached to and forming part of the Renewal notice


( for Health/Personal Accident)
Name of the Proposer : MR.H RAMANJINAPPA
Policy Number : P/141141/01/2023/006633
As per the Regulatory requirements ,we can effect payment of refund / claims only through Electronic Clearing System (ECS) / National Electronic Funds Transfer
(NEFT) / Real Time Gross Settlement (RTGS) / Interbank Mobile Payment Service (IMPS).
For this purpose please submit the following details

Name of the proposer

Name of the Bank & Branch

Type of Account SB Account / Current Account / Others (please specify)

Account Number

IFSC Code of Bank

Please attach a photo copy of a cheque leaf of the above Bank Account.

Date :
Place : Signature of the Proposer

IRDA Regn.No.129 Corporate Identity Number L66010TN2005PLC056649 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 Co.Ltd


Spot Acknowledgement
Acknowledged hereby receipt of Cash / Cheque / DD No. Dt for Rs.
drawn on from Mr./Mrs/Ms. towards premium for the renewal of Policy No.
. A system generated "Advance Premium Receipt" for this payment will follow from our office, which is subject to
realization of the cheque.

Name & Code of the Authorised Person Signature of Authorised Person


Place:
Date:

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