Policy Doc

IMPORTANT
To, 03/11/2021
Mr.GOPI NAIK MEGAVATH,

FLAT NO: 'A', 307, TRIFECTA JOLA APPARTMENT,
KODATHI VILLAGE, CARMELARAM POST,
NEAR HADOSIDDAPURA, RAILWAY CROSS, BANGALORE
Bangalore,Bangalore,Karnataka -560035
Mobile : 9449025084.
Dear Customer,
Re: Health Insurance Policy - P/140000/01/2022/004639

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.
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 :Wed Nov 03 17:30:10 IST 2021
1 of 5
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
Medi classic Insurance Policy (Individual)
SCHEDULE
Unique Identification No. SHAHLIP22037V062122
Policy No. : P/140000/01/2022/004639 Previous Policy No. : P/140000/01/2021/004792
Customer Code : AA0015804311 GSTIN : 29AAJCS4517L1ZU
Customer Name : Mr.GOPI NAIK MEGAVATH SAC Code : 997133/Accident and Health Insurance Services
Proposer's Code : 18794797 Issuing Office Code : 140000
Proposer's Name : Mr.GOPI NAIK MEGAVATH Issuing Office Name : Zonal office - Bangalore
Address : FLAT NO: 'A', 307, TRIFECTA Issuing Office Address : 1st Floor, No.2 Venkatasamy
JOLA APPARTMENT, Road
KODATHI VILLAGE, Kumara Park West ,Bangalore -
CARMELARAM POST, 560 020.
NEAR HADOSIDDAPURA,
RAILWAY CROSS, BANGALORE Phone No : 080- 40874040 DIR 41636311/17
Bangalore,Bangalore,Karnataka- E-mail Id : bzo.uw@starhealth.in
560035
Place of Supply : -
Phone No : ./9449025084/.
Fulfiller Code : SH20384
E-mail Id : gopiheart@gmail.com
Proposer GSTIN : - Intermediary Code : BA0000533748
Proposal date : 07-NOV-21
Name : SATYA NARAYAN DAS
Date of Inception of first policy : 07-NOV-2020
Renewal Year : First Year Phone No : 9945087234/9945087234
Collection Number : 1026004856
: 03/11/2021 E-mail Id : satyadas2003@gmail.com
Collection Date
Premium :Rs 13,964 /-
CGST @9% :Rs 1,257 /- SGST / UTGST @9% :Rs 1,257 /-
Stamp Duty :Rs 1 /- Total Premium :Rs 16478 /-
Total Premium In Words : Rupees Sixteen Thousand Four Hundred Seventy Eight Installment Facility Optn :No
Only
Premium Payment Frequency :Annual Installment Amount : Rs. 0
PERIOD OF INSURANCE : FROM : 07/11/2021 00:00 TO : Midnight Of 06/11/2022 Policy Term : 1 Year
Details of Insured Persons : No. of Persons Insured: 1
Sl. Name Sex Date of Birth Age in Relationship Sum Insured Cumu.Bon ID Card No Pre Existing Inception
no. Yrs with Proposer (Rs.) us (Rs.) Disease Date
1 MEGAVATH F 21/11/1970 50 DEPENDANT 1000000 50000 18794797-1 07/11/2020

GANGULAMMA PARENT
Pre Existing Disease : Diabetes & Hypertension and their complications
Optional Covers Opted : Gold Plan: Yes Hospital Cash:No Patient Care: No
Entered by : PREMIA For Star Health and Allied Insurance Company Ltd.
Approved by : PORTAL
IRDAI Regn. No 129
Corporate Identity Number U66010TN2005PLC056649
Email ID : support@starhealth.in Please see overleaf 2 of 5
Attached to and forming part of Policy No : P/140000/01/2022/004639
IMPORTANT
THE INSURANCE UNDER THIS POLICY IS SUBJECT TO CONDITIONS, CLAUSES, WARRANTIES, EXCLUSIONS ETC. ATTACHED.
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: support@starhealth.in Fax No: 1800 425 5522.
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.
"Consolidated Policy stamp duty paid vide no. CR0321003000450048 DTD 18/03/2021"
AYUSH Hospital means a healthcare facility wherein medical/surgical/para-surgical treatment procedures and interventions are
carried out by AYUSH Medical Practitioner(s) comprising of any of the following:
1. Central or State Government AYUSH Hospital or
2. Teaching hospital attached to AYUSH College recognized by the Central Government / Central Council of Indian
Medicine/Central Council for Homeopathy; or
3. AYUSH Hospital, standalone or co-located with in-patient healthcare facility of any recognized system of medicine,
registered with the local authorities, wherever applicable, and is under the supervision of a qualified registered AYUSH
Medical Practitioner and must comply with all the following criterion:
i. Having at least 5 in-patient beds;
ii. Having qualified AYUSH Medical Practitioner in charge round the clock;
iii. Having dedicated AYUSH therapy sections as required and/or has equipped operation theatre where
surgical procedures are to be carried out;
iv. Maintaining daily records of the patients and making them accessible to the insurance Company's
authorized representative.
AYUSH Day Care Centre means and includes Community Health Centre (CHC), Primary Health Centre (PHC), Dispensary,
Clinic, Polyclinic or any such health centre which is registered with the local authorities, wherever applicable and having facilities for
carrying out treatment procedures and medical or surgical/para-surgical interventions or both under the supervision of registered
AYUSH Medical Practitioner (s) on day care basis without in-patient services and must comply with all the following criterion:
i. Having qualified registered AYUSH Medical Practitioner(s) in charge;
ii. Having dedicated AYUSH therapy sections as required and/or has equipped operation theatre where surgical procedures
are to be carried out;
iii. Maintaining daily records of the patients and making them accessible to the insurance company's authorized representative.
Nominee Details
Nominee Details for the proposer Appointee Details
S.No. Name Relationship Age % Appointee Relationship

Age
with proposer Name with Nominee
1 GOPI NAIK MEGAVATHI Son 37 100
Please see overleaf 3 of 5
Attached to and forming part of Policy No : P/140000/01/2022/004639
In witness whereof the undersigned being authorized by and on behalf of the company has set his hand at Zonal office - Bangalore on 03rd Day
of November 2021.
Permanent Exclusion Details
Insured Name ID Card Permanent Exclusion Disease
TAX Invoice
Invoice No. : 29H026Y22P000027 Customer ID : AA0015804311

Invoice Date : 03/11/21 Policy No : P/140000/01/2022/004639
Recipient Supplier
GSTIN : - GSTIN : 29AAJCS4517L1ZU

Proposer's : Mr.GOPI NAIK MEGAVATH NAME : Star Health and Allied Insurance Co Ltd
Name - Zonal office - Bangalore
Address : FLAT NO: 'A', 307, TRIFECTA Address : 1st Floor, No.2 Venkatasamy Road
JOLA APPARTMENT, Kumara Park West ,Bangalore - 560
KODATHI VILLAGE, 020.
CARMELARAM POST,
NEAR HADOSIDDAPURA,
RAILWAY CROSS, BANGALORE
City : Bangalore,Bangalore,Karnataka- City : BANGALORE
560035
State : Karnataka State : Karnataka
Pincode : 560035 Pincode : 560 001
Client Category : IND Place of Supply : 29 - Karnataka
HSN / Description of Total Discount TaxableValue IGST @ 18% CGST @9% UT/SGST@9% CESS@1% Total Invoice Value
SAC Service(s)
A B C=A-B D = C * IGST E=C F=C G=C*Cess H=C+D+E+F+G
Code
*CGST *UTGST or
SGST
997133 Insurance 13964 0 13964 1257 1257 Rs. 16478 /-
Services
Total Invoice Value (in Figures) : Rs. 16478 /-
Total Invoice Value (in Words) : Rupees: Sixteen thousand four
hundred seventy-eight 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.
E. & O.E
This is a digitally signed document and hence no physical signature is required
IRDAI Regn. No 129 Corporate Identity Number U66010TN2005PLC056649 Email ID : stargst@starhealth.in

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IMPORTANT

Mr.GOPI NAIK MEGAVATH,

Re: Health Insurance Policy - P/140000/01/2022/004639

With kind regards,

However, the ultimate decision will be that of yours only.

Details of Insured Persons : No. of Persons Insured: 1

1 MEGAVATH F 21/11/1970 50 DEPENDANT 1000000 50000 18794797-1 07/11/2020

Nominee Details for the proposer Appointee Details

S.No. Name Relationship Age % Appointee Relationship

1 GOPI NAIK MEGAVATHI Son 37 100

Please see overleaf 3 of 5

Insured Name ID Card Permanent Exclusion Disease

Please see overleaf 4 of 5

Invoice No. : 29H026Y22P000027 Customer ID : AA0015804311

GSTIN : - GSTIN : 29AAJCS4517L1ZU

The invoice is issued as per Section 31 of the CGST Act

This is a digitally signed document and hence no physical signature is required

IRDAI Regn. No 129 Corporate Identity Number U66010TN2005PLC056649 Email ID : stargst@starhealth.in

Please see overleaf 5 of 5

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