Star Health And Allied Insurance Company Limited

RENEWAL NOTICE
Policy No: P/141113/01/2023/007167

Date :01-Jun-2023
GEETHA H G Branch Office - Indira Nagar-141113

32/2, 6TH MAIN, SRIKANTESHWARA NAGAR No.57

SRIKANTESHWARA PROVISION STORES NEAR, MAHALAKSHMI III rd Floor
LAYOUT, Double Road, Indiranagar
Bengaluru City Karnataka 560038
Bengaluru City,Karnataka-560096 Ph : 080-41616154/080-41616156/080-41616157
99XXXXXX78 maXXXXXXX@gmail.com Email ID : indiranagar.bangalore@starhealth.in
Proposer/CustomerCode:12070450/12070450 Reference No : 612404384488 - Direct Receipt

Dear Customer,
We value your relationship with us and thank you for the same. We wish to bring to your kind notice that your Family Health Optima Insurance Plan is due for
renewal on 30-Aug-2023. The renewal premium, including Tax, works out to Rs. 39,784/- as per details given below.

Age as on Relationship with

S. No Name of the Insured DOB Sum Insured(Rs.) Premium (Rs.)
renewal proposer
1 GEETHA H G 20-Nov-1968 54 Self
2 SURESH S R 06-Jun-1964 59 Spouse 4,00,000 33,716
3 HITESH. S 28-Oct-2002 20 Son
GST @ 18% 6,068
Total Renewal Premium 39,784
**Excess if any shall be refunded to proposer

We are pleased to inform you that we have revised the product terms and conditions in lieu of the product version purchased by you last year. This renewal notice is
prepared as per new terms and conditions. In case you wish to have more details of the revision, kindly approach your Agent/Broker/Our Office.
However, we require below mentioned additional information from you:-
Mobile Number and Package Amount has been added in the Product

If there is any change in the list of insured persons to be covered and/ or you desire any changes in the sum insured etc., please inform us
immediately so that we can work out the revised renewal premium and advise you. Otherwise, please arrange to remit the renewal premium of Rs.
39,784/- on or before 30-Aug-2023. Please note that the payment of premium by any mode other than by cash will be eligible for benefit under Sec. 80 D of the
Income Tax Act. If you pay by Cheque or DD, please make payment in favour of ''Star Health and Allied Insurance Company Limited.''

We request you to renew the policy before the renewal date to ensure continuity of cover and benefits.

''Please furnish your mobile number and email id in the space provided below to enable our company to communicate with you as our valued customer, whenever
required''.

Mobile Number : Email id :

You can also update your Address / Mobile No / E Mail ID, online by visiting our website www.starhealth.in
Please note that this policy can be renewed online or using your mobile. Kindly log on to our website www.starhealth.in to know the details.

Always at your service. Intermediary Name/Code : H.G. MALLIKARJUNA / BA0000008281

For Star Health and Allied Insurance Company Limited
Phone No : 9844096882/9844096882
Fulfiller Name/Code : Mr.ANIL KUMAR M S / SH60073

Authorised Signatory Phone No : 080-41616154/080-41616156/080-

41616157/9591924441

This is an example of Promotional Message.

IRDA Regn.No.129 Corporate Identity Number L66010TN2005PLC056649 Email ID: info@starhealth.in

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 Health And Allied Insurance Company Limited

Sheet attached to and forming part of the Renewal notice

( for Health/Personal Accident)
Name of the Proposer : GEETHA H G
Policy Number : P/141113/01/2023/007167
As per the Regulatory requirements ,we can effect payment of refund / claims only through Electronic Clearing System (ECS) / National Electronic Funds Transfer
(NEFT) / Real Time Gross Settlement (RTGS) / Interbank Mobile Payment Service (IMPS).
For this purpose please submit the following details

Name of the proposer

Name of the Bank & Branch

Type of Account SB Account / Current Account / Others (please specify)

Account Number

IFSC Code of Bank

Please attach a photo copy of a cheque leaf of the above Bank Account.

Date :
Place : Signature of the Proposer

IRDA Regn.No.129 Corporate Identity Number L66010TN2005PLC056649 Email ID: info@starhealth.in

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@starhealth.in Website :www.starhealth.in IRDAI Regn.no: 129

Star Health and Allied Insurance Co.Ltd

Spot Acknowledgement
Acknowledged hereby receipt of Cash / Cheque / DD No. Dt for Rs.
drawn on from Mr./Mrs/Ms. towards premium for the renewal of Policy No.
. A system generated "Advance Premium Receipt" for this payment will follow from our office, which is subject to
realization of the cheque.

Name & Code of the Authorised Person Signature of Authorised Person

Place:
Date: