RED CARPET HEATHL INSURANCE POLICY Schedule - Unique Identification No.

SHAHLIP22040V052223

In consideration of payment of Rs.,60,000/- towards renewal of premium of Policy number: P/140023/01/2022/002888, the policy stands
renewed for further period of 1 year as per the details given below.

Renewal Endorsement No : R/1230000/01/2022/0029369

Customer Code : AA000444999 GSTIN : 29AAJCS4517L1ZU
Customer Name : Ms. RAMYA SUDHA SAC Code : 9973133/Accident and Health Insurance Services

Proposer's Code : 3666456 Issue office Code : 14000

Proposers Name : Ms. RAMYA SUDHA issue office Name : Zonal office - Bangalore
: No 10 second floor, Shree
Venkateshwara nilaya, 1st main,
Nagappa reddy layout, : 1st Floor, No 2, Venkataswamy Road,
Opposite to Lakshmi hospital, Kumara Park west,
Kaggadaspura, Bangalore Bangalore – 560020
Address 560093 Address

: 080 - 40874040 DIR

Phone No : 9611341507 Phone No 41636311/17
Email ID : Ramya94484@gmail.com Email ID : bzo.uw@starhealth.in
Proposer GSTIN :- Place of supply :-
Proposal Date : 1/08/2022 Fulfiller Code : SH12875
Premium : Rs.60,000/- Intermediary Code: BA0000370903

Name: YAMUNA V
CGST @ 9% Rs.4576/- SGST @9% Rs.4576/-
Phone No: 9060561475
Stamp Duty : Re 1/- Total Premium : Rs. 60,000/-
Email ID: vighu.gowda@gmail.com

Total Premium in words : Rupees one lakh twenty five thousand rupees only
Period of Insurance From : 01/08/2022 00:00 Hrs To Midnight of 31/07/2023

Date of Relationship with OP Limit Sum Insured

SL No NAME SEX Age in Yrs ID Card Inception Date
Birth proposer Rs. (Rs)
1 Mr. Perumal T M 30/06/1965 58 FATHER 0 111564-1 1000000 1/08/2022