Branch Office Dadar II No.201, 2nd Floor, Laxmi Commercial Complex, , Near Flower Market,Dadar (W), Mumbai - 400028.

, ,
MUMBAI , 400028
Collection Receipt
Customer Code : AA0004560857

Received from : AMEEN ABDUL MUTALIB SHAH

Customer Address : B/4, SAIALYA CHS., PLOT NO-20, RSC NO-8, Collection No : 11-01/1358006322

MHADA MALWANI MALAD (WEST ), Collection Date : 11/01/2022

MUMBAI Office Code : 171123 - Branch Office Dadar II

Supplier GSTIN : 27AAJCS4517L1ZY

Customer GSTIN : - Place of Supply : - State Code: -

Amount Collected : Rs. 12296 /- Inclusive of tax :

Amount in words : Indian Rupees Twelve Thousand Two Hundred Ninety-Six Only

Towards the Following : PREMIUM RECEIPT ONLINE POLICY

S. No. Proposal Ref. No Fulfiller Code Intermediary Code Amount Collected Mode of Pay Bank Name CHQ/CC/DD No CHQ/DD/BC Dt

1 R/171123/01/2022/035368 SO171123 BA0000154854 12296 CC MAST 14541607433 11/01/2022

For Star Health and Allied Insurance Co. Ltd

Note : Receipt Subject to realization of Cheque / DD

This is only an evidence of receipt of money by the company
Risk will commence once the proposal is examined and accepted Authorised Signatory

IRDA Regn. No 129 Corporate Identity Number U66010TN2005PLC056649 Email id : info@starhealth.in

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@starhealth.in Website :www.starhealth.in IRDAI Regn.no: 129