IMPORTANT

To, 07-APR-23

Amit Kumar Yadav

S/o Rakesh Kumar, Village - Meewa
Mawana, Meerut

Phalauda,Meerut,Uttar Pradesh -250401

Mobile : 8825713065.

Dear Customer,

Re: Health Insurance Policy - P/161212/01/2024/000381

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 Apr 07 07:26:53 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.18160/- towards renewal premium of Policy number: P/161212/01/2023/000010, the policy stands
renewed for a further period of 1 year as per the details given below.

Renewal Endorsement No : P/161212/01/2024/000381

Customer Code : AA0024316479 GSTIN : 09AAJCS4517L1ZW
Customer Name : Amit Kumar Yadav SAC Code : 997133/Accident and Health Insurance Services
Proposer's Code : 27639629 Issuing Office Code : 161212
Proposer's Name : Amit Kumar Yadav Issuing Office Name : Branch Office - Meerut
Address : S/o Rakesh Kumar, Village - Address : 2nd floor,
Meewa PP Plaza,
Mawana, Meerut Mangal Pandey Nagar,

Phalauda,Meerut,Uttar Pradesh -
250401
Phone No : /8825713065/ Phone No : 0121- 4059940 / 41
E-mail Id : [email protected] E-mail Id : [email protected]
Proposer GSTIN : - Place of Supply : -
Proposal date : 05/03/2022 Fulfiller Code : SH13830

Date of Inception of first policy : 20-APR-2022 Intermediary Code : BA0000445983

Renewal Year : First Year
Collection Number : 1271000477 Name : Mrs.SITA
Receipt Date : 07/04/2023
Premium :Rs 15,390 /-
CGST @9% : 1,385 /- SGST / UTGST @9% : 1,385 /- Phone No : 9997670236/9997670236
Stamp Duty :Rs 1 /- Total Premium :Rs 18,160 /-
E-mail Id : pawanyadav70130@gmail.
com
Total Premium In Words : Rupees Eighteen Thousand One Hundred Sixty Only Installment Facility Optn :No

Premium Payment Frequency :Annual Installment Amount Rs. : 0

Period of Insurance : FROM 20/04/2023 00:00 TO : Midnight Of 19/04/2024 Term : 1 Year

Scheme Description (Family Size) : 2 ADULTS + 1 CHILD Basic Floater Sum Insured : Rs. 1000000 /-
Bonus : Rs. 200000 /-
Total Sum Insured In Words : Rupees Ten Lakhs Only Plan Type : GOLD

Entered by : SH59585 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/161212/01/2024/000381
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 Amit Kumar Yadav M 02/01/1992 31 SELF 27639629-1 No PED 20/04/2020
declared
2 ARJU YADAV F 16/09/1993 29 SPOUSE 27639629-2 No PED 20/04/2022
declared
3 NEW BORN BABY F 19/10/2022 0 DEPENDANT CHILD 27639629-3 No PED 20/04/2023
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 ARJU YADAV Spouse 29 100

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 - Meerut on 07th
Day of April 2023.

Permanent Exclusion Details

Insured Name ID Card Permanent Exclusion Disease

Entered by : SH59585 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. : 9A271Y24P0000473 Customer ID : AA0024316479

Invoice Date : 07/04/23 Policy No : P/161212/01/2024/000381
Recipient Supplier

GSTIN : - GSTIN : 09AAJCS4517L1ZW

Proposer's : Amit Kumar Yadav NAME : Star Health and Allied Insurance Co Ltd
Name - Branch Office - Meerut
Address : S/o Rakesh Kumar, Village - Meewa Address : 2nd floor,
Mawana, Meerut PP Plaza,
Mangal Pandey Nagar,
City : City : MEERUT
State : Uttar Pradesh State : Uttar Pradesh
Pincode : 250401 Pincode : 250001
Client Category : IND Place of Supply : 9 - Uttar Pradesh

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 15390 0 15390 1385 1385 Rs. 18160

Services
Total Invoice Value (in Figures) : Rs. 18160
Total Invoice Value (in Words) : Rupees: Eighteen thousand one
hundred sixty 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 : SH59585 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