Tax Certificate

To
Policy Holder Name : ARJIT SINGHA
Address 197 G, Rajpur Road Telpehone Exchange Lane
: Rajpur Road , Dehradun
Dehradun (CB)
248009

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

Dear ARJIT SINGHA

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

ARJIT SINGHA
Policy Holder's Name : P/161300/01/2022/003235
Policy No. :

Policy Name : Young Star Insurance Policy Total Premium : 9375

Revised
Policy End Date :
Policy Start Date : 18/03/2022 17/03/2023
Servicing Branch
Proposer GSTIN : GSTIN :
- 05AAJCS4517L1Z4

Servicing Branch Servicing Branch 2nd Floor, NCR Plaza, New Cant Road,
161300 - Area Office - Address :
Code & Name : Ravindranath Tagore Marg, Dehradun-
Dehradun
248001 (Uttarakhand )
Area Office - Dehradun

IGST CGST SGST

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

16-MAR-22 7945 0 0 9 715 9 715 9375

Financial Year Amount

2021-2022 9375
CN=R Margabandhu,

R Margabandhu
SERIALNUMBER=00f82dcf76fdf6537e3331f8479ef45e7b4f3861b15
475488cdf3b2c3c26c3c9, ST=TAMIL NADU, OID.2.5.4.17=600034,
OID.2.5.4.20=513b7b33f2ce960f23148ea208744690e09638750806
ca65f89e15179f5fe50a, OU=UNDERWRITING - Chief Risk Officer,
O=STAR HEALTH AND ALLIED INSURANCE COMPANY, C=IN.
Date :Thu Mar 17 13:43:40 IST 2022

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
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 : 17/03/2022 For and On behalf of

Place : DEHRADUN 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