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    Endorsement Schedule: LC0000000619 Intermediary Code Name M/S.Policybazaar Insurance Brokers Private Limited

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    Prakhar Shukla
    This document is an endorsement schedule for a Young Star Insurance policy that revises the proposer's name and address. Specifically, it changes the address of the proposer, Gaurav Kumar, to a new address in Bulandshahr, Uttar Pradesh. No other terms or conditions of the policy are altered by this endorsement. The endorsement is effective from February 5, 2022 until the policy expiration date of February 26, 2022.

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    Endorsement Schedule: LC0000000619 Intermediary Code Name M/S.Policybazaar Insurance Brokers Private Limited

    Uploaded by

    Prakhar Shukla
    31 views1 page
    This document is an endorsement schedule for a Young Star Insurance policy that revises the proposer's name and address. Specifically, it changes the address of the proposer, Gaurav Kumar, to a new address in Bulandshahr, Uttar Pradesh. No other terms or conditions of the policy are altered by this endorsement. The endorsement is effective from February 5, 2022 until the policy expiration date of February 26, 2022.

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    Original Title

    101099

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    This document is an endorsement schedule for a Young Star Insurance policy that revises the proposer's name and address. Specifically, it changes the address of the proposer, Gaurav Kumar, to a new address in Bulandshahr, Uttar Pradesh. No other terms or conditions of the policy are altered by this endorsement. The endorsement is effective from February 5, 2022 until the policy expiration date of February 26, 2022.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
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    31 views1 page

    Endorsement Schedule: LC0000000619 Intermediary Code Name M/S.Policybazaar Insurance Brokers Private Limited

    Uploaded by

    Prakhar Shukla
    This document is an endorsement schedule for a Young Star Insurance policy that revises the proposer's name and address. Specifically, it changes the address of the proposer, Gaurav Kumar, to a new address in Bulandshahr, Uttar Pradesh. No other terms or conditions of the policy are altered by this endorsement. The endorsement is effective from February 5, 2022 until the policy expiration date of February 26, 2022.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    of 1

    ENDORSEMENT SCHEDULE

    Young Star Insurance Policy Revised


    SHAHLIP22036V042122
    Policy No : P/161130/01/2021/101099 Endorsement No : P/161130/01/2021/101099/013

    Policy Period : 27-FEB-21 To 26-FEB-22 Endorsement Date : 05/02/2022


    Proposer Code : 20533275 Issuing Office Code : 161130
    Proposer Name : Gaurav Kumar Issuing Office Name : Branch Office - Gurgaon III

    Address : S/O Mahendra Sharma, House No - 93, Address : 412/2, K - I Tower,


    Jamalpur MAJRA, Nimchana, M G Road, Sector 14,
    Bulandshahar, Uttar Pradesh, 245407
    Nimchana,Bulandshahr,Uttar Pradesh-245407 Gurgaon, Haryana

    Tel/Mobile : nil/9716858214/ Tel/Mobile : 0124-4797452

    Email id : gauravk900@gmail.com Email id : gurgaon3@starhealth.in


    Proposer GSTIN : - Place of Supply : -

    Collection No : Fulfiller Code : SO161130


    Collection Date :
    Intermediary Code : LC0000000619
    Premium: Rs.0/- IGST @18% : /-
    Name : M/S.POLICYBAZAAR INSURANCE
    CGST @9% : SGST / UTGST @9% : /-
    Kerala Flood Cess@1%: Rs./-
    BROKERS PRIVATE LIMITED
    Total Premium: Rs.0/- Phone : 1800-258-5970/9971552250

    Email_id : care@policybazaar.com
    Endorsement Effective : From 13:23 On 05/02/2022 To Midnight Of 26/02/2022

    Type of Endorsement : Change in Name/Address of Proposer


    Description :

    It is hereby agreed and declared that the name / address of the proposer stands changed as mentioned here in with effect from Address:S/O Mahendra
    Sharma, House No - 93,Jamalpur MAJRA, Nimchana, Bulandshahar, Uttar Pradesh, 245407

    "All other terms and conditions remains unaltered".

    Warranted that in case of dishonour of premium cheque(s) the within mentioned policy stands cancelled from inception and the company absolves all liabilities under the
    Policy/Endorsement.
    In witness whereof the undersigned being authorised by and on behalf of the company has herein to set his hand at Branch Office - Gurgaon III on 05th Day of February 2022.

    Entered By : SH49988 Approved By : SH49988

    Place : Gurgaon For and on behalf of


    Date : 05/02/2022 Star Health And Allied Insurance Co Ltd

    IRDA Regn. No 129


    Corporate Identity Number U66010TN2005PLC056649
    Email ID : info@starhealth.in
    Authorised Signatory

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