Hospitalisation Benefit Policy

Premium Certificate for the purpose of deduction under Section 80 D of Income Tax (Amendment) Act,1986

Policy No : P/211114/01/2019/011361 Type of Policy : Family Health Optima Insurance

Issue Office : 211114 - Branch Office-Karnal - 2017
Address : 2nd Floor, SCF-137, Sector-13
Urban Estate, Near ICICI Bank
Karnal-132001 (Haryana)
Tel / Fax : 0184 - 4022764 / 67 68 / 69 /
Email : karnal@starhealth.in

This is to certify that Mr.SATVINDER SINGH has paid Rs 11889(Total Premium : Indian Rupees Eleven Thousand Eight
Hundred Eighty-Nine Only ) towards Premium for Hospitalization Insurance vide Policy No: P/211114/01/2019/011361 for the
Period 06/03/2019 To 05/03/2020 issued on 04-MAR-19.
Payment received by Cheque/Credit/Debit Card vide Receipt No: 1237012770 Receipt Date: 04-MAR-19
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 : 04/03/2019 For and On behalf of

Place : Star Health and Allied Insurance Company Ltd

IRDA Regn. No 129

Corporate Identity Number U66010TN2005PLC056649

Email ID : info@starhealth.in Authorised signatory.

CN=PVS Lakshmiprasad,

PVS SERIALNUMBER=9e461d073974cff564ee9ba39dcb9f6c1b1fe484d
e3bff77fe99ff653e852cf9, ST=TAMIL NADU, OID.2.5.4.17=600034,
OID.2.5.4.20=3fbc716070e67ba3c9fed3530e1e3d7e9732722433b0
b08c8ac802f047aae330, OU=Technical, O=STAR HEALTH AND

Lakshmiprasad
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
ALLIED INSURANCE COMPANY LIMITED, C=IN. Date :Mon Mar
04 20:09:02 IST 2019
Free No:1800-425-2255 / 1800-102-4477,CIN :U66010TN2005PLC056649 Email :support@starthealth.in Website :www.starhealth.in IRDAI Regn.no: 129