IMPORTANT

13-FEB-23
T
Ponugupati Premanand Satya Paul Kumar
S/O Satyanandam,Flat No 403,NSR Plaza,Beside Ravindrabharati School
Mangalagiri( PO),Guntur Dt

Mangalagiri,Guntur,Andhra Pradesh -522503

Mobile : 9849376146.

Dear Customer,

Re: Health Insurance Policy - P/131214/01/2023/011789

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.

R Margabandhu CN=R Margabandhu,

SERIALNUMBER= 0 0 f 8 2 dcf7 6 fdf6 5 3 7 e 3 3 3 1 f 8 4 7 9 ef4 5 e 7 b 4 f 3 8 6 1 b 1 5 4
7 5 4 8 8 cdf3 b 2 c 3 c 2 6 c 3 c 9 , ST= TAMIL NADU, OID. 2 . 5 . 4 . 1 7 = 600034,
OID. 2. 5. 4. 20=513b7b33f 2 ce960f 2314 8ea208744690e09638750806c
a65f89e15179f5fe50a, OU=UNDERWRITING - Chief Risk Officer,
O=STAR HEALTH AND ALLIED INSURANCE COMPANY, C=IN.
Date : Mon Feb 13 10: 39: 12 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
 STAR COMPREHENSIVE INSURANCE POLICY
SCHEDULE (Floater)
UNIQUE ID:SHAHLIP22028V072122

In consideration of payment of Rs.42280/- towards renewal premium of Policy number: P/131214/01/2022/010275, the policy
stands renewed for a further period of 1 year as per the details given below.

Renewal Endorsement No : P/131214/01/2023/011789

Customer Code : AA0017435835 GSTIN : 37AAJCS4517L1ZX
Customer Name : Ponugupati Premanand Satya Paul SAC Code : 997133/Accident and Health Insurance Services
Kumar
Proposer's Code : 20503535 Issuing Office Code : 131214
Proposer's Name : Ponugupati Premanand Satya Paul Issuing Office Name : Branch Office - Guntur
Kumar
Address : S/O Satyanandam,Flat No Address : DO-NO-5-60-2/5, ASHOK
403,NSR Plaza,Beside NAGAR,
Ravindrabharati School 4/1 , MAIN ROAD
Mangalagiri( PO),Guntur Dt LAKSHMIPURAM BESIDE
ANDE SILKS LINE, GUNTUR-
Mangalagiri,Guntur,Andhra Pradesh 522007
- 522503
Phone No : 9849376146/ Phone No : 0863-2339294, 2339295
E-mail Id : [email protected] E-mail Id : [email protected]

Proposer GSTIN : - Place of Supply : -

Proposal date : 24/02/2021 Fulfiller Code : SH4279
Date of Inception of first policy : 24-FEB-2021
Intermediary Code : BA0000315944
Renewal Year : Second Year
Collection Number : 1123013655
Receipt Date : 13/02/2023
Name : Mr.NARSIMSETTI
SRINIVASA RAO
Premium :Rs 35,830 /-
Phone No : 9441130629/9441130629
CGST @9% : 3,225 /- SGST / UTGST @9% : 3,225 /-
Stamp Duty :Rs 1 /- Total Premium :Rs 42,280 /-
E-mail Id : [email protected]
Total Premium In Words : Rupees Forty Two Thousand Two Hundred Eighty Only Installment Facility Optn :No

Premium Payment Frequency :Annual Installment Amount : Rs. 0

Period of Insurance : FROM 24/02/2023 00:00 TO : Midnight Of 23/02/2024
Scheme Description (Family Size) : 2 ADULTS Basic Floater Sum Insured : Rs. 1000000 /-
Bonus : Rs. 1000000 /-
Sum Insured Under Section 1 (Health) Rs. 1000000 /- Policy Term : 1 Year
Capital Sum Insured Under Section 10 (For Accidental Death & Permanent Total Disablement) : Rs. 1000000 /-
For Mr / Ms. Ponugupati Premanand Satya Paul Kumar Only.

Entered by For Star Health and Allied Insurance Company Ltd.

: SH642
Aproved by
: 82
IRDAI Regn. No 129
Corporate Identity Number L66010TN2005PLC056649 Authorised Signatory
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/131214/01/2023/011789
Details of Insured Persons :
Sl. Name of the Insured Sex Date of Birth Age Relationship with ID Card No Co-Pay Buy Back Pre- Inception Date
no. in Proposer PED Existing
Yrs Opted Disease/s
1 Ponugupati Premanand M 01/07/1967 55 SELF 20503535-1 0 Yes 24/02/2021
Satya Paul Kumar
Pre Existing Disease : Diabetes & Hypertension and their complications
2 Kanaparthi Anitha F 30/11/1968 54 SPOUSE 20503535-2 0 No No PED 24/02/2021
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
"Consolidated Stamp duty paid vide Proceeding No : GSO5/E6063691/2022 DT:17/10/2022"

Nominee Details
Nominee Details for the proposer Appointee Details

Name Relationship Age Appointee Relationship

S.No. % Age
with proposer Name with Nominee

1 Kanaparthi Anitha Spouse 54 100

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 - Guntur on
13th Day of February 2023.

Permanent Exclusion Details

Insured Name ID Card Permanent Exclusion Disease

Entered by For Star Health and Allied Insurance Company Ltd.

: SH642
Aproved by
: SH64282

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. : 37K123Y23P000509 Customer ID : AA0017435835

Invoice Date : 13/02/23 Policy No : P/131214/01/2023/011789
Recipient Supplier

GSTIN : - GSTIN 37AAJCS4517L1ZX

:
Proposer's : Ponugupati Premanand Satya Paul NAME : Star Health and Allied Insurance Co
Name Kumar Ltd - Branch Office - Guntur
Address : S/O Satyanandam,Flat No 403,NSR Address : DO-NO-5-60-2/5, ASHOK NAGAR,
Plaza,Beside Ravindrabharati 4/1 , MAIN ROAD LAKSHMIPURAM
School BESIDE
Mangalagiri( PO),Guntur Dt ANDE SILKS LINE, GUNTUR-522007

City : City : GUNTUR

State : Andhra Pradesh State : Andhra Pradesh

Pincode : 522503 Pincode : 522007

Client Category : IND Place of Supply : 37 - Andhra Pradesh

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

997133 Insurance 35830 0 35830 3225 3225 Rs. 42280

Services
Total Invoice Value (in : Rs. 42280
Figures) Total Invoice Value
: Rupees: Forty-two thousand two
(in Words) hundred eighty 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 For Star Health and Allied Insurance Company Ltd.

: SH642
Aproved by
: SH64282

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