Tax Certificate

To
Policy Holder Name : Kunal Sheth
Address MIG 21 FIRST PHASE
: ADARSH NAGAR
Gulbarga (M Corp+OG)
585105

Subject: Premium Certificate for the purpose of deduction under Section 80 D of Income Tax Act 1961 and any amendments
made thereafter.

Dear Kunal Sheth

This is to certify that the company has received the premium for Health Insurance Coverage under "Health Insurance Policy"
with the following details.

Kunal Sheth
Policy Holder's Name : P/161130/01/2022/060114
Policy No. :

Policy Name : Star Comprehensive Insurance Total Premium : 19848

Policy
Policy End Date :
Policy Start Date : 16/08/2021 15/08/2022
Servicing Branch
Proposer GSTIN : GSTIN :
- 06AAJCS4517L1Z2

Servicing Branch Servicing Branch Ist Floor,, SCO 4, Sector 14 Market

161130 - Branch Office - Address :
Code & Name : Near Payal Cinema, Gurgaon
Gurgaon III
Branch Office - Gurgaon III Gurgaon-122001

IGST CGST SGST

Receipt Date Basic Premium Total Premium
% Rs. % Rs. % Rs.

16-AUG-21 4205 18 757 0 0 0 0 4962

Financial Year Amount

2021-2022 4962

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 :U66010TN2005PLC056649 Email :support@starthealth.in Website :www.starhealth.in IRDAI Regn.no: 129
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 Sep 17 11:54:07 IST 2021
The Product is eligible for deduction us 80D of the Income Tax Act 1961 and any amendments made there to.

Note:-
1) This certificate must be surrendered to the Insurance Company of insurance of fresh Certificate in case of Cancellation of the
Policy or any alternation in the Insurance affecting the Premium.
2) This Certificate is reflecting the Premium(s) Receipts cleared at the time of generating this certificate.
3) The Liability of any changes in the Premium Receipt's clearing status post generating the certificate shall be upon the
policy holder.

Date : 17/09/2021 For and On behalf of

Place : Gurgaon Star Health and Allied Insurance Company Ltd

IRDA Regn. No 129

Corporate Identity Number U66010TN2005PLC056649

Email ID : info@starhealth.in Authorised signatory.

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 :U66010TN2005PLC056649 Email :support@starthealth.in Website :www.starhealth.in IRDAI Regn.no: 129