IMPORTANT

To, 20-AUG-22

NEELAM GURUNATH BHOIR

VATSALY NIWAS KALYAN SHIL ROAD,
NEAR HANUMAN MANDIR, PISAVALI GAON
KALYAN
Kalyan-Dombivli (M Corp.),Thane,Maharashtra -421306
Mobile : 95XXXXXX44.

Dear Customer,

Re: Health Insurance Policy - P/171130/01/2023/011111

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
"Let Star Health help you to become healthier and happier. Star Wellness Benefits includes Mind Body healing and other
Condition management programmes (Weight management, Diabetes etc....) Visit www.starhealth.in / customer portal login and
start your journey with us to Better Health".
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.

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 : L66010TN2005PLC056649 Email :support@starthealth.in Website :www.starhealth.in IRDAI Regn.no: 129
 STAR COMPREHENSIVE INSURANCE POLICY
SCHEDULE (Floater)
UNIQUE ID:SHAHLIP22028V072122

In consideration of payment of Rs.14562/- towards renewal premium of Policy number: P/171130/01/2022/010299, the policy stands
renewed for a further period of 1 year as per the details given below.

Renewal Endorsement No : P/171130/01/2023/011111

Customer Code : AA0009251542 GSTIN : 27AAJCS4517L1ZY
Customer Name : NEELAM GURUNATH BHOIR SAC Code : 997133/Accident and Health Insurance Services
Proposer's Code : 11844486 Issuing Office Code : 171130
Proposer's Name : NEELAM GURUNATH BHOIR Issuing Office Name : Branch Office - Vashi I
Address : VATSALY NIWAS KALYAN SHIL Address : INTERNATIONAL INFOTECH
ROAD, PARK,T-761
NEAR HANUMAN MANDIR, 6TH FLOOR,TOWER
PISAVALI GAON NO.3,ABOVE VASHI RAILWAY
KALYAN STATION
Kalyan-Dombivli (M Navi Mumbai, Mumbai-400705
Corp.),Thane,Maharashtra -421306
Phone No : 95XXXXXX44 / - Phone No : 022-41121400
E-mail Id : moXXXXXXX@gmail.com E-mail Id : vashi.bo1@starhealth.in
Proposer GSTIN : - Place of Supply : -
Proposal date : 29/07/2019 Fulfiller Code : SH20807

Date of Inception of first policy : 29-JUL-2019 Intermediary Code : BA0000275104

Renewal Year : Third Year
Collection Number : 1456011591
Receipt Date : 20/08/2022
Name : Mr.SANDEEP GAVHANE

Premium :Rs 12,340 /-

Phone No : 9820313098/9820313098
CGST @9% : 1,111 /- SGST / UTGST @9% : 1,111 /- E-mail Id : sandy.73mumbai@gmail.c
Stamp Duty :Rs 1 /- Total Premium :Rs 14,562 /-
om
Total Premium In Words : Rupees Fourteen Thousand Five Hundred Sixty Two Only Installment Facility Optn :No

Premium Payment Frequency :Annual Installment Amount : Rs. 0

Period of Insurance : FROM 27/08/2022 00:00 TO : Midnight Of 26/08/2023
Scheme Description (Family Size) : 1 ADULT + 1 CHILD Basic Floater Sum Insured : Rs. 750000 /-
Bonus : Rs. 750000 /-
Sum Insured Under Section 1 (Health) Rs. 750000 /- Policy Term : 1 Year
Capital Sum Insured Under Section 10 (For Accidental Death & Permanent Total Disablement) : Rs. 750000 /-
For Mr / Ms. NEELAM G BHOIR Only.

For Star Health and Allied Insurance Company Ltd.

Entered by : PREMIA
Aproved by : SH36297

IRDAI Regn. No 129

Authorised Signatory
Corporate Identity Number L66010TN2005PLC056649
Email ID : info@starhealth.in
2 of 4

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 : L66010TN2005PLC056649 Email :support@starthealth.in Website :www.starhealth.in IRDAI Regn.no: 129
Attached to and forming part of Policy No : P/171130/01/2023/011111
Details of Insured Persons :
Sl. Name of the Insured Sex Date of Birth Age in Relationship with ID Card No Co-Pay Buy Back Pre- Inception Date
no. Yrs Proposer PED Opted Existing
Disease/s
1 NEELAM G BHOIR F 20/06/1985 37 SELF 11844486-1 0 No No PED 29/07/2019
declared
2 VEDANT G BHOIR M 19/01/2008 14 DEPENDANT CHILD 11844486-2 0 No No PED 29/07/2019
declared
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.
Warranted that in case of dishonor of premium cheque(s), the Company shall not be liable under the policy and the policy shall be void abinitio
(from inception).

IMPORTANT
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
"CONSOLIDATED STAMP DUTY FOR POLICY STAMPS PAID VIDE NO. LOA/CSD/667/2023/1172 DT. 28/MAR/2023"

Nominee Details
Nominee Details for the proposer Appointee Details

S.No. Name Relationship Age % Appointee Relationship

Age
with proposer Name with Nominee

1 MORESHWAR BHOIR Brother 42 100

It is hereby made clear that all terms, conditions, clauses, warranties, exclusions etc., as already issued, forming part of the policy of insurance
originally issued at the time of inception of this relationship, shall continue to be operative and unaltered, forming part of this renewal insurance
cover also.

Reference may be made to those terms, conditions etc., for identifying the scope/extent of coverage.

Other excluded expenses as detailed in our website "www.starhealth.in"

In witness whereof the undersigned being authorised by and on behalf of the company has set his hand at Branch Office - Vashi I on 20th
Day of August 2022.

Permanent Exclusion Details

Insured Name ID Card Permanent Exclusion Disease

For Star Health and Allied Insurance Company Ltd.

Entered by : PREMIA
Aproved by : SH36297

Authorised Signatory

3 of 4

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 : L66010TN2005PLC056649 Email :support@starthealth.in Website :www.starhealth.in IRDAI Regn.no: 129
 TAX Invoice

Invoice No. : 27E456Y23P001700 Customer ID : AA0009251542

Invoice Date : 20/08/22 Policy No : P/171130/01/2023/011111
Recipient Supplier

GSTIN : - GSTIN : 27AAJCS4517L1ZY

Proposer's : NEELAM GURUNATH BHOIR NAME : Star Health and Allied Insurance Co Ltd
Name - Branch Office - Vashi I
Address : VATSALY NIWAS KALYAN SHIL Address : INTERNATIONAL INFOTECH
ROAD, PARK,T-761
NEAR HANUMAN MANDIR, 6TH FLOOR,TOWER NO.3,ABOVE
PISAVALI GAON VASHI RAILWAY STATION
KALYAN Navi Mumbai, Mumbai-400705
City : City : VASHI I
State : Maharashtra State : Maharashtra
Pincode : 421306 Pincode : 400705
Client Category : IND Place of Supply : 27 - Maharashtra

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

997133 Insurance 12340 0 12340 1111 1111 Rs. 14562

Services
Total Invoice Value (in Figures) : Rs. 14562
Total Invoice Value (in Words) : Rupees: Fourteen thousand five
hundred sixty-two 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 L66010TN2005PLC056649 Email ID : stargst@starhealth.in

For Star Health and Allied Insurance Company Ltd.

Entered by : PREMIA
Aproved by : SH36297

Authorised Signatory

4 of 4

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 : L66010TN2005PLC056649 Email :support@starthealth.in Website :www.starhealth.in IRDAI Regn.no: 129