Star Health And Allied Insurance Company Limited
Date : 22-Mar-2024
To, IMPORTANT
MR.SHRIKANT BHIMRAO PATIL ,
Akshay Bangla, Kalanagar,
Madhavanagar road, Sangli
-
Miraj Tehsil,Maharashtra-416416
Mobile : -/9421222299
Dear Customer,
Re: Health Insurance Policy - 11240796646701
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.
This is an electronically generated document(Policy
Schedule). CONSOLIDATED STAMP DUTY FOR POLICY
STAMPS PAID VIDE NO. LOA/CSD/667/2023/1172 DT.
28/MAR/2023
Page 1 of 7
Regd.&Corporate Office:1,New Tank Street,Valluvar Kottam High Road,Nungambakkam,Chennai - 600034,Phone : 044 -28302700 / 28288800
Toll Free No:1800-425-2255 / 1800-102-4477,CIN : L66010TN2005PLC056649 Email :[email protected] Website :www.starhealth.in
IRDAI Regn.no: 129
Star Health And Allied Insurance Company Limited
Star Health Assure Insurance Policy
Unique Identification No. SHAHLIP23131V022223
In Consideration of payment of Rs. 32,407/- towards renewal premium of policy
number:P/151117/01/2023/031901, the policy stands renewed for a further period of 1 Year as per
the details given below
Renewal Endorsement No:11240796646701
Customer Code : 33001008 GSTIN : 27AAJCS4517L1ZY
Customer Name : MR.SHRIKANT BHIMRAO PATIL SAC Code : 997133 / Accident and Health
Insurance Services
Cust CKYC No : -
Proposer Code : 33001008 Issuing Office Code : 151137
Proposer Name : MR.SHRIKANT BHIMRAO PATIL Issuing Office Name : Branch Office - Sangli
Proposer Address : Akshay Bangla, Kalanagar, Issuing Office Address : 1047/B 1st Floor
Madhavanagar road, Sangli Flat No-F 3
- Shivratna Complex College
Miraj Tehsil Maharashtra 416416 Corner
Miraj Tehsil Maharashtra
416416
Phone No : -/9421222299 Phone No :
E-mail Id :
[email protected] E-mail Id :
[email protected] Proposer GSTIN : NO Place of Supply : Maharashtra
Proposal date : 23-Mar-2023 Fulfiller Code : SO151137
Date of Inception : 23-Mar-2023
of first policy
Renewal Year : First Year Intermediary : BA0000406235
Collection No : 191755003433
Code
Collection Date : 22-Mar-2024
Premium : Rs. 27,463/-
Name : PRATIBHA AVINASH
TARLEKAR
CGST @ 9% : Rs. 2,472/-
Phone No :7588240088/758824008
8
:
SGST @ 9% Rs. 2,472/-
E-mail Id : pratibha21276@gmail.
com
Total Premium : Rs. 32,407/-
Stamp Duty : Re. 1/-
Total Premium In Words : Rupees Thirty Two thousand four hundred seven
only
PERIOD OF INSURANCE : From : 23-Mar-2024 00:00 To : Midnight Of 22-Mar-2025 Policy Term :1 Year
Installment Facility Option:No Premium Payment Frequency :Annual Installment Amount Rs. : 0/-
Policy Type : FLOATER Scheme Description : 2A+1C
Basic Floater Sum Insured : Rs. 10,00,000/- Bonus : Rs. 2,50,000/-
Sum Insured In Words : Rupees Ten lakhs only
Optional Cover (Deductible) : No Deductible : Rs. 0/-
Entered by : SH59026 This is an electronically generated document(Policy For Star Health and Allied Insurance Company Ltd.
Approved by : SH59026 Schedule). CONSOLIDATED STAMP DUTY FOR POLICY
STAMPS PAID VIDE NO. LOA/CSD/667/2023/1172 DT.
IRDAI Regn.No.129 28/MAR/2023
Corporate Identity Number L66010TN2005PLC056649
Authorised Signatory Page 2 of 7
Email ID: [email protected]
Regd.&Corporate Office:1,New Tank Street,Valluvar Kottam High Road,Nungambakkam,Chennai - 600034,Phone : 044 -28302700 / 28288800
Toll Free No:1800-425-2255 / 1800-102-4477,CIN : L66010TN2005PLC056649 Email :[email protected] Website :www.starhealth.in
IRDAI Regn.no: 129
Star Health And Allied Insurance Company Limited
Attached to and forming part of Policy No: 11240796646701
Details of Insured Persons :
Sl. Age in Relationship Inception
Name of the Insured Gender Date of Birth ID Card No
no. Yrs with Proposer date
SHRIKANT BHIMRAO . PATIL
1 Male 16-Sep-1969 54 Self 33001008-1 23-Mar-2023
Pre Existing Disease : Hypertension and its complications
SWATI SHRIKANT PATIL
2 Female 21-Jan-1975 49 Spouse 33001008-2 23-Mar-2023
Pre Existing Disease : No PED Declared
JASRAJ SHRIKANT PATIL
3 Male 27-Jul-2010 13 Son 33001008-3 23-Mar-2023
Pre Existing Disease : No PED Declared
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 SWATI Spouse 49 100
SHRIKANT PATIL
Sector Classification:
Urban
''CONSOLIDATED STAMP DUTY FOR POLICY STAMPS PAID VIDE NO. LOA/CSD/667/2023/1172 DT. 28/MAR/2023''
Please check whether the details given by you about the insured person(s) 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).
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: [email protected], Fax No: 1800 425 5522.
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 Branch
Office - Sangli on 22nd Day of March 2024.
Entered by : SH59026 This is an electronically generated document(Policy For Star Health and Allied Insurance Company Ltd.
Approved by : SH59026 Schedule). CONSOLIDATED STAMP DUTY FOR POLICY
STAMPS PAID VIDE NO. LOA/CSD/667/2023/1172 DT.
28/MAR/2023
Authorised Signatory Page 3 of 7
Regd.&Corporate Office:1,New Tank Street,Valluvar Kottam High Road,Nungambakkam,Chennai - 600034,Phone : 044 -28302700 / 28288800
Toll Free No:1800-425-2255 / 1800-102-4477,CIN : L66010TN2005PLC056649 Email :[email protected] Website :www.starhealth.in
IRDAI Regn.no: 129
Star Health And Allied Insurance Company Limited
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 : SH59026 This is an electronically generated document(Policy For Star Health and Allied Insurance Company Ltd.
Approved by : SH59026 Schedule). CONSOLIDATED STAMP DUTY FOR POLICY
STAMPS PAID VIDE NO. LOA/CSD/667/2023/1172 DT.
28/MAR/2023
Authorised Signatory Page 4 of 7
Regd.&Corporate Office:1,New Tank Street,Valluvar Kottam High Road,Nungambakkam,Chennai - 600034,Phone : 044 -28302700 / 28288800
Toll Free No:1800-425-2255 / 1800-102-4477,CIN : L66010TN2005PLC056649 Email :[email protected] 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 : 11240796646701 Type of Policy : Assure Insurance-2021
Issue Office : 151137-Branch Office - Sangli
Address : 1047/B 1st Floor
Flat No-F 3
Shivratna Complex College Corner
Miraj Tehsil Maharashtra 416416
Tel / Fax :
Email : [email protected]
This is to certify that MR.SHRIKANT BHIMRAO PATIL has paid Rs 32,406/- (Total Premium : Indian Rupees
Thirty Two thousand four hundred six only ) towards Premium for Hospitalization Insurance vide Policy No:
11240796646701 for the Period 23-Mar-2024 To 22-Mar-2025 issued on 22-Mar-2024.
Payment received by Cheque vide Receipt No: 191755003433/1 Receipt Date: 22-Mar-2024
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 : 22-Mar-2024 For and on behalf of
Place : Branch Office - Sangli Star Health and Allied Insurance Company Ltd.
IRDA Regn.No.129
Corporate Identity Number L66010TN2005PLC056649 Authorised Signatory
Entered by : SH59026 This is an electronically generated document(Policy For Star Health and Allied Insurance Company Ltd.
Approved by : SH59026 Schedule). CONSOLIDATED STAMP DUTY FOR POLICY
STAMPS PAID VIDE NO. LOA/CSD/667/2023/1172 DT.
28/MAR/2023
Authorised Signatory Page 5 of 7
Regd.&Corporate Office:1,New Tank Street,Valluvar Kottam High Road,Nungambakkam,Chennai - 600034,Phone : 044 -28302700 / 28288800
Toll Free No:1800-425-2255 / 1800-102-4477,CIN : L66010TN2005PLC056649 Email :[email protected] Website :www.starhealth.in
IRDAI Regn.no: 129
Star Health And Allied Insurance Company Limited
Tax Invoice
Invoice No. : 272403I008505589 Customer ID : 33001008
Invoice Date : 22-Mar-2024 Policy No. : 11240796646701
Recipient Supplier
GSTIN : GSTIN : 27AAJCS4517L1ZY
Name : MR.SHRIKANT BHIMRAO PATIL Name : Star Health and Allied Insurance Co Ltd -
Branch Office - Sangli
Address : Akshay Bangla, Kalanagar, Address : 1047/B 1st Floor
Madhavanagar road, Sangli Flat No-F 3
- Shivratna Complex College Corner
City : Miraj Tehsil Pin Code : 416416 City : Miraj Tehsil Pin Code : 416416
State : Maharashtra Client : IND State : Maharashtra Place of : Maharashtra
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 27,463.00 0 27,463.00 0 2,472.00 2,472.00 0 32,407.00
Services
Total Invoice Value (in Figures) : Rs. 32,407/-
Total Invoice Value (in Words) : Rupees Thirty Two thousand four hundred seven 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
IRDAI Regn.No.129 Corporate Identity Number L66010TN2005PLC056649 Email ID: [email protected]
Entered by : SH59026 This is an electronically generated document(Policy For Star Health and Allied Insurance Company Ltd.
Approved by : SH59026 Schedule). CONSOLIDATED STAMP DUTY FOR POLICY
STAMPS PAID VIDE NO. LOA/CSD/667/2023/1172 DT.
28/MAR/2023
Authorised Signatory Page 6 of 7
Regd.&Corporate Office:1,New Tank Street,Valluvar Kottam High Road,Nungambakkam,Chennai - 600034,Phone : 044 -28302700 / 28288800
Toll Free No:1800-425-2255 / 1800-102-4477,CIN : L66010TN2005PLC056649 Email :[email protected] Website :www.starhealth.in
IRDAI Regn.no: 129
Star Health And Allied Insurance Company Limited
Annexure 3A
Forming part of Policy Number : 11240796646701
Covering Flu Vaccination Approved by ICMR under Health Check Up benefit
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 cover without charging additional premium till 31.03.2024:
Cover for Flu Vaccine Approved by ICMR under Health check up benefit as per relevant clause with the same limits
and conditions provided therein.
Entered by : SH59026 This is an electronically generated document(Policy For Star Health and Allied Insurance Company Ltd.
Approved by : SH59026 Schedule). CONSOLIDATED STAMP DUTY FOR POLICY
STAMPS PAID VIDE NO. LOA/CSD/667/2023/1172 DT.
28/MAR/2023
Authorised Signatory Page 7 of 7
Regd.&Corporate Office:1,New Tank Street,Valluvar Kottam High Road,Nungambakkam,Chennai - 600034,Phone : 044 -28302700 / 28288800
Toll Free No:1800-425-2255 / 1800-102-4477,CIN : L66010TN2005PLC056649 Email :[email protected] Website :www.starhealth.in
IRDAI Regn.no: 129
