Star Health And Allied Insurance Company Limited

Date : 17-Dec-2023
To, IMPORTANT

MR.S.MUTHU KRISHNAN ,
No: 2/7B
VALLAL PERUMAL STREET, RADHA NAGAR
CHROMEPET, CHENNAI
Chennai,Tamil Nadu-600044
Mobile : 96XXXXXX77

Dear Customer,

Re: Health Insurance Policy - 11240572597412

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.

Page 1 of 5

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

Family Health Optima Insurance Plan

Unique Identification No. SHAHLIP23164V072223
POLICY SCHEDULE
Policy No. : 11240572597412 Previous Policy No : P/121128/01/2023/005835
Customer Code : 2091743 GSTIN : 33AAJCS4517L1Z5
Customer Name : MR.S.MUTHU KRISHNAN SAC Code : 997133 / Accident and Health
Insurance Services
Proposer Code : 2091743 Issuing Office Code : 121128
Proposer Name : MR.S.MUTHU KRISHNAN Issuing Office Name : Branch Office - Sulur
Proposer Address : No: 2/7B Issuing Office Address : Venkatraman Iyer Layout
VALLAL PERUMAL STREET, RADHA 3rd Flr
NAGAR 15th Ward,Trichy Road
CHROMEPET, CHENNAI Sulur Taluka Tamil Nadu
Chennai Tamil Nadu 600044 641402
Phone No : 96XXXXXX77 Phone No : 0422-2961128
E-mail Id : [email protected] E-mail Id : [email protected]
Proposer GSTIN : NO Place of Supply : Tamil Nadu
Proposal date : 19-Dec-2011 Fulfiller Code : SH56372
Date of Inception : 19-Dec-2011
of first policy
Policy Category : Twelveth Year Intermediary : BA0000626939
Collection No : 121128/RV/2024/0087115057
Code
Collection Date : 17-Dec-2023

Premium : Rs. 32,124/-

Name : SAGUNTHALA V

CGST @ 9% : Rs. 2,891/-

Phone No :9342201740/934220174
0
:
SGST @ 9% Rs. 2,891/-
E-mail Id : boovanvs2004@gmail.
com
Total Premium : Rs. 37,906/-
Stamp Duty : Re. 1/-

Total Premium In Words : Rupees Thirty Seven thousand nine hundred six
only
PERIOD OF INSURANCE : From : 19-Dec-2023 00:00 To : Midnight Of 18-Dec-2024 Policy Term :1 Year
Installment Facility Option:No Premium Payment Frequency :Annual Installment Amount Rs. : 0/-
Scheme Description (Family Size) :2A Basic Floater Sum Insured :Rs. 3,00,000/-
Bonus : Rs. 1,50,000/- Limit of Coverage : Rs. 4,50,000/- Recharge Benefit : Rs. 75,000/-
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
S.MUTHU KRISHNAN
1 Male 29-Apr-1965 58 Self 2091743-1 19-Dec-2011

Pre Existing Disease : No PED Declared

M.BALAMANI
2 Female 11-Mar-1975 48 Spouse 2091743-2 19-Dec-2011

Pre Existing Disease : No PED Declared

Entered by : CUSTPORTAL For Star Health and Allied Insurance Company Ltd.
Approved by : PORTAL
IRDAI Regn.No.129

Corporate Identity Number L66010TN2005PLC056649

Authorised Signatory Page 2 of 5
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: 11240572597412

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 SARATHI RAJAN Son 30 100

Sector Classification:
Urban Social

''CONSOLIDATED STAMP DUTY PAID VIDE G.O.(RT) NO.244 DATED.2ND JUNE 2023''

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).
THE INSURANCE UNDER THIS POLICY IS SUBJECT TO CONDITIONS, CLAUSES, WARRANTIES,
EXCLUSIONS ETC., ATTACHED.
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 / 1800 102 4477 Email: [email protected], Fax No: 1800 425 5522.
In witness whereof the undersigned being authorized by and on behalf of the company has set his hand at Branch
Office - Sulur on 17th Day of December 2023.

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

Authorised Signatory Page 3 of 5

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 : 11240572597412 Type of Policy : Family Health Optima Insurance

- 2022
Issue Office : 121128-Branch Office - Sulur

Address : Venkatraman Iyer Layout

3rd Flr
15th Ward,Trichy Road
Sulur Taluka Tamil Nadu 641402

Tel / Fax : 0422-2961128

Email : [email protected]

This is to certify that MR.S.MUTHU KRISHNAN has paid Rs 37,906/- (Total Premium : Indian Rupees
Thirty Seven thousand nine hundred six only ) towards Premium for Hospitalization Insurance vide Policy No:
11240572597412 for the Period 19-Dec-2023 To 18-Dec-2024 issued on 17-Dec-2023.

Payment received by Payment Gateway vide Receipt No: 121128/RV/2024/0087115057/1 Receipt

Date: 17-Dec-2023

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 : 17-Dec-2023 For and on behalf of

Place : Branch Office - Sulur Star Health and Allied Insurance Company Ltd.

IRDA Regn.No.129

Corporate Identity Number L66010TN2005PLC056649 Authorised Signatory

Email ID: [email protected]

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

Authorised Signatory Page 4 of 5

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. : 332312I011225464 Customer ID : 2091743
Invoice Date : 17-Dec-2023 Policy No. : 11240572597412
Recipient Supplier
GSTIN : GSTIN : 33AAJCS4517L1Z5
Name : MR.S.MUTHU KRISHNAN Name : Star Health and Allied Insurance Co Ltd -
Branch Office - Sulur
Address : No: 2/7B Address : Venkatraman Iyer Layout
VALLAL PERUMAL STREET, RADHA 3rd Flr
NAGAR
CHROMEPET, CHENNAI 15th Ward,Trichy Road
City : Chennai Pin Code : 600044 City : Sulur Taluka Pin Code : 641402

State : Tamil Nadu Client : IND State : Tamil Nadu Place of : Tamil Nadu
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 32,124.00 0 32,124.00 0 2,891.00 2,891.00 0 37,906.00
Services

Total Invoice Value (in Figures) : Rs. 37,906/-

Total Invoice Value (in Words) : Rupees Thirty Seven thousand nine hundred six 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 : CUSTPORTAL For Star Health and Allied Insurance Company Ltd.
Approved by : PORTAL

Authorised Signatory Page 5 of 5

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