Star Health And Allied Insurance Company Limited

NO:63-C3 2nd Floor NSR Road, Sai Baba Colony

Coimbatore Tamil Nadu-641011
Phone: 0422-4212592 Telefax:

Collection Receipt

Customer Code : BP0037220033 Collection No : 121111/RV/2024/0067443126

Received From : CAROLINA TECHNOLOGY Collection Date : 03-Aug-2023
SOLUTIONS PVT LTD
Customer Address : 23-26, ANSARI STREET, Office Code : 121111 - Branch Office - Sai
RAMNAGAR, COIMBATORE . Baba Clny
Coimbatore Tamil Nadu 641009 GSTIN : 33AAJCS4517L1Z5
Place of Supply : Tamil Nadu
Customer mobile : 904XXXXX80 Type of proposal : Fresh
number
Customer GSTIN : 33AACCC9193R1ZY State Code : 33
Amount Collected : Rs. 1,770/-
Amount in words : INDIAN RUPEES One thousand seven hundred seventy only
Towards the Following : Amount Receipted towards Premium
Sr. Proposal Fulfiller Intermediary Amount Mode of Bank CHQ/CC/DD CHQ/DD/BC
No Ref. No Code Code Collected payment Name No Dt.
(Rs)
1 66240611860 TA0000015 BA0000003521 1,770/- NEFT/RTGS CIUBH2321302 03-Aug-2023
0 805 (IDFC) 5974

For Star Health and Allied Insurance Co. Ltd.

Authorised Signatory

Note : Receipt Subjected to realization of Cheque/DD

This is only an evidence of receipt of money by the company.
Risk will commence once the proposal is examined and accepted.
“Available modes of payments of Premium: Cash, Cheque, DD, Net Banking, RTGS/NEFT, Credit Card,
Debit Card, UPI, Customer Portal and Star website.”

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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