IMPORTANT

To, 12-MAY-23

SARANSH GARG
60, vyom prastha
GMS ROAD

Forest Research Institute & College Area (CT),Dehradun,Uttarakhand -248001

Mobile : 9650064402.

Dear Customer,

Re: Health Insurance Policy - P/161115/01/2024/002094

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
"Let Star Health help you to become healthier and happier. Star Wellness Benefits includes Mind Body healing and other
Condition management programmes (Weight management, Diabetes etc....) Visit www.starhealth.in / customer portal login and
start your journey with us to Better Health".

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,

R Margabandhu
SERIALNUMBER=00f82dcf76fdf6537e3331f8479ef45e7b4f3861b154
75488cdf3b2c3c26c3c9, ST=TAMIL NADU, OID.2.5.4.17=600034,
OID.2.5.4.20=513b7b33f2ce960f23148ea208744690e09638750806c
a65f89e15179f5fe50a, OU=UNDERWRITING - Chief Risk Officer,
O=STAR HEALTH AND ALLIED INSURANCE COMPANY, C=IN.
Date :Fri May 12 23:49:03 IST 2023

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 :[email protected] Website :www.starhealth.in IRDAI Regn.no: 129
 YOUNG STAR INSURANCE POLICY
SCHEDULE (Floater)
UNIQUE ID:SHAHLIP22036V042122

In consideration of payment of Rs.12638/- towards renewal premium of Policy number: P/161115/01/2023/000587, the policy stands
renewed for a further period of 1 year as per the details given below.

Renewal Endorsement No : P/161115/01/2024/002094

Customer Code : AA0018337175 GSTIN : 05AAJCS4517L1Z4
Customer Name : SARANSH GARG SAC Code : 997133/Accident and Health Insurance Services
Proposer's Code : 21463812 Issuing Office Code : 161115
Proposer's Name : SARANSH GARG Issuing Office Name : Branch Office - Dehradun
Address : 60, vyom prastha Address : As-5,6&7,2Ndfloor,
GMS ROAD Plsplaza,4B-Rajaroad
, Dehradun-248001
Forest Research Institute & College
Area (CT),Dehradun,Uttarakhand -
248001
Phone No : /9650064402/ Phone No : 0135-6455821, 2659875,
2659901,2659918
E-mail Id : [email protected] E-mail Id : [email protected]
Proposer GSTIN : - Place of Supply : Uttarakhand / State Code : 5
Proposal date : 20/04/2021 Fulfiller Code : SH29639

Date of Inception of first policy : 20-APR-2021 Intermediary Code : BA0000297376

Renewal Year : Second Year
Collection Number : 1117002390 Name : Ms.ANJU GUPTA
Receipt Date : 12/05/2023
Premium :Rs 10,710 /-
CGST @9% : 964 /- SGST / UTGST @9% : 964 /- Phone No : 8630113784/8630113784
Stamp Duty :Rs 1 /- Total Premium :Rs 12,638 /-
E-mail Id : GUPLAAMJU.2012@RED
IFFMAIL.COM
Total Premium In Words : Rupees Twelve Thousand Six Hundred Thirty Eight Only Installment Facility Optn :No

Premium Payment Frequency :Annual Installment Amount Rs. : 0

Period of Insurance : FROM 12/05/2023 23:44 TO : Midnight Of 11/05/2024 Term : 1 Year

Scheme Description (Family Size) : 2 ADULTS Basic Floater Sum Insured : Rs. 1000000 /-
Bonus : Rs. 0 /-
Total Sum Insured In Words : Rupees Ten Lakhs Only Plan Type : SILVER

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

IRDAI Regn. No 129

Authorised Signatory
Corporate Identity Number L66010TN2005PLC056649
Email ID : [email protected]
2 of 4

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 :[email protected] Website :www.starhealth.in IRDAI Regn.no: 129
Attached to and forming part of Policy No : P/161115/01/2024/002094
Details of Insured Persons :
Sl. Name of the Insured Sex Date of Birth Age in Relationship with ID Card No Pre Existing Disease Inception Date
no. Yrs Proposer
1 SARANSH GARG M 25/03/1989 34 SELF 21463812-1 No PED 20/04/2021
declared
2 ELISHA SARANSH F 22/06/1992 30 SPOUSE 21463812-2 No PED 20/04/2021
GARG declared

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.
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.
Sector Classification :

Urban

Toll Free No: 1800 425 2255/1800 102 4477 Email: [email protected], Fax No: 1800 425 5522

Nominee Details

Nominee Details for the proposer Appointee Details

S.No. Name Relationship Age % Appointee Relationship

Age
with proposer Name with Nominee

1 ELISHA GARG Spouse 30 100

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 authorised by and on behalf of the company has set his hand at Branch Office - Dehradun on
12th Day of May 2023.

Permanent Exclusion Details

Insured Name ID Card Permanent Exclusion Disease

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

Authorised Signatory

3 of 4

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 :[email protected] Website :www.starhealth.in IRDAI Regn.no: 129
 TAX Invoice

Invoice No. : 5B117Y24P0000635 Customer ID : AA0018337175

Invoice Date : 12/05/23 Policy No : P/161115/01/2024/002094
Recipient Supplier

GSTIN : - GSTIN : 05AAJCS4517L1Z4

Proposer's : SARANSH GARG NAME : Star Health and Allied Insurance Co Ltd
Name - Branch Office - Dehradun
Address : 60, vyom prastha Address : As-5,6&7,2Ndfloor,
GMS ROAD Plsplaza,4B-Rajaroad
, Dehradun-248001
City : City : DEHRADUN
State : Uttarakhand State : Uttarakhand
Pincode : 248001 Pincode : 248 001
Client Category : IND Place of Supply : 5 - Uttarakhand

HSN / Description of Total Discount TaxableValue IGST @ 18% CGST @9% UT/SGST@9% CESS@1% Total Invoice Value
SAC Service(s) G=C*Cess H =C+D+E +F+G
Code A B C=A-B D = C * IGST E=C F=C
*CGST *UTGST or
SGST

997133 Insurance 10710 0 10710 964 964 Rs. 12638

Services
Total Invoice Value (in Figures) : Rs. 12638
Total Invoice Value (in Words) : Rupees: Twelve thousand six
hundred thirty-eight 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 : PREMIA For Star Health and Allied Insurance Company Ltd.
Approved by : PORTAL

Authorised Signatory

4 of 4

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 :[email protected] Website :www.starhealth.in IRDAI Regn.no: 129