Ds Policy Schedule 11220011335300 v1.0 (1) Removed

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Star Health And Allied Insurance Company Limited

Tax Invoice
Invoice No. : 332201I000771177 Customer ID : PI0000066824
Invoice Date :07-Dec-2022 Policy No. : 11220011335300
Recipient Supplier
GSTIN : NO GSTIN : 33AAJCS4517L1Z5
Name :Mr. BALAJI ARUMUGAM Name : Star Health and Allied Insurance Co Ltd -
Branch Office - Cuddalore
Address : 21/3,MELAPALAYAM ROAD PANRUTI TK Address : No.41/1 G A B Complex , Opp to Daily Thanthi,
PANRUTI Imperial Road , Cuddalore - 607 002
CUDDALORE DISTRICT
City : Panruti Town Pin Code : 607106 City : Cuddalore Town Pin Code : 607002

State : Tamil Nadu Client : IND State : Tamil Nadu Place of : Tamil Nadu
Category supply

Taxable IGST @ UT/SGST @ CESS @ Total Invoice


Total Discount CGST @ 9%
Value 18% 9% 1% Value
HSN / SAC Description of
Code Service(s) F=C*
D=C* E=C* G= C * H=C+D+
A B C=A-B UTGST or
IGST CGST Cess E+ F + G
SGST

Insurance
997133 20,465.00 0 20,465.00 0 1,842.00 1,842.00 0 24,149.00
Services

Total Invoice Value (in Figures) : Rs. 24,149/-


Total Invoice Value (in Words) : Rupees Twenty Four thousand one hundred forty nine 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

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

Entered by : CUSTPORTAL For Star Health and Allied Insurance Company Ltd.
Approved by : PORTAL

Authorised Signatory Page 6 of 7

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

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