Star Health And Allied Insurance Company Limited

Arogya Sanjeevani Policy, Star Health and Allied Insurance Co. Ltd.
Unique Identification No. SHAHLIP22027V032122
Certificate of Insurance
Previous Certificate
Certificate No : 11240328849401 : 11240328849400
No
Customer Code : PI0003754166 GSTIN : 27AAJCS4517L1ZY
Customer Name : SHAILA MAHADEV MORE SAC Code : 997133 / Accident and Health
Insurance Services
Cust CKYC No : 40039016302119
Proposer Code : PI0003754166 Issuing Office Code : 171122
Proposer Name : SHAILA MAHADEV MORE Issuing Office Name : Branch Office Thane II
Proposer Address : Flat no.1602, 16th floor, Jai Issuing Office Address : 1st Floor, Panama Planet,
Hanuman SRS ch Above Bharat Bank,Gokhale
Tembipada Road, Bhandup West Road
Naupada, THANE (W)
Mumbai City Maharashtra 400078 Thane Town Maharashtra
400602
Phone No : 9967422970 Phone No : 022-67668500/502/520
E-mail Id : shailamoresh2@gmail.com E-mail Id : ThaneII.mumbai@starhealth.i
n
Proposer GSTIN : NO Place of Supply : Maharashtra
Proposal date : 19-Jul-2023 Fulfiller Code : SH3862
Date of Inception : 19-Jul-2023
of first policy
Policy Category : First Year Intermediary : BA0000321825
Collection No : 171122/RV/2025/0146375540
Code
Collection Date : 18-Jul-2024 Name : MS.MAYA NANA
:
Premium Rs. 10,620/- CHAWANDGIR
Phone No :7738483278/773848327
8
CGST @ 9% : Rs. 956/- E-mail Id : maya.chawandgir@ya
SGST @ 9% : Rs. 956/-
hoo.com
Total Premium : Rs. 12,532/-
Stamp Duty : Re. 1/-

Total Premium In Words : Rupees Twelve thousand five hundred thirty two
only
PERIOD OF INSURANCE : From : 19-Jul-2024 00:00 To : Midnight Of 18-Jul-2025
Installment Facility Option:No Premium Payment Frequency :Annual Installment Amount Rs. : 0/-

Details of Insured Persons :

Sl. Name of the Age in Relationship Sum Insured

Gender Date of Birth Bonus Rs ID Card No Inception Date
no Insured Yrs with Proposer (Rs.)

Mahadev More ME04051444

1 Male 02-Jun-1968 56 Father 3,00,000 15,000 19-Jul-2023
82
Pre Existing Disease : No PED Declared

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 1 of 2
Email ID: info@starhealth.in
 Star Health And Allied Insurance Company Limited

Attached to and forming part of certificate No. 11240328849401

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 Reena More Mother 46 100

Sector Classification:
Urban Social Informal Sector Informal Sector includes small scale, self-employed workers typically
at a low level of organisation and technology, with the primary
objective of generating employment and income, with
heterogeneous activities like retail trade, transport, repair and
maintenance, construction, personal and domestic services and
manufacturing, with the work mostly labour intensive, having often
unwritten and informal employer-employee relationship.

''ENF-2/LOA/ENF-2/CSD/26/2024 -20.03.24 TO 31.12.25 DT.27.03.24''

For detailed coverage, terms & Conditions and exclusions, kindly visit website : www.starhealth.in
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 Email: support@starhealth.in, Fax No: 1800 425 5522.

As per Section 34 of CGST Act of 2017, Policy Issued in one Financial Year and Cancelled in another Financial Year
on or after 01st of December, then Only Premium Amount will be Refunded to the Customer and GST Amount will
Not be Refunded. Customer has to Claim the Refund of GST Amount from the GST Portal.

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

Authorised Signatory Page 2 of 2