Star Health And Allied Insurance Company Limited

Date : 21-Feb-2024
To, IMPORTANT

MR.AMIT SONAJI KASBEKAR ,

4 DA CITY HEIGHT SAMRAT COLONY,
KHADKESHWAR,
AURANGABAD
Aurangabad Town - M H,Maharashtra-431001
Mobile : 74XXXXXX11

Dear Customer,

Re: Health Insurance Policy - 16240718820800

We are extremely thankful for availing health insurance from us and we enclose the policy along with the terms and conditions.

The said policy has been prepared based on the details furnished by you in the proposal form (copy enclosed) and the medical
reports, wherever applicable. We shall thank you if you can verify the policy to ensure that all the details are incorporated
correctly as per the proposal. In case of any discrepancy noticed, please communicate the same to us immediately. You will
appreciate that it is the primary duty of the proposer to fill the proposal form and also to make sure that the proposal contains
all the details correctly so also the policy has incorporated the details correctly.
This insurance policy is subject to various exclusions including exclusion for pre-existing diseases and conditions in this policy.
If there is suppression of any material fact in the proposal, the contract shall become null and void abinitio.

We would like to mention that we have incorporated the name of the intermediary as indicated by you in the proposal who will
be of assistance to you.
The policy is subject to the condition of “free look period”. As per this condition, a free look period of 15 days from the date of
receipt of the policy is available to you to review the terms and conditions of the policy. In case you are not satisfied with the
terms and conditions, you may seek cancellation of the policy and in such an event, we shall allow refund of premium paid
after adjusting the cost of pre-acceptance medical screening, if any, stamp duty charges, and proportionate risk premium for
the period on cover, provided no claim has been made until such cancellation.
We wish you good health and we look forward to serve you in the days to come.

With kind regards,

Authorized Signatory
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.

Page 1 of 4

Regd.&Corporate Office:1,New Tank Street,Valluvar Kottam High Road,Nungambakkam,Chennai - 600034,Phone : 044 -28302700 / 28288800
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 Company Limited

Family Accident Care Insurance Policy

Unique Identification No. SHAHLIP21042V012021
POLICY SCHEDULE
Policy No. : 16240718820800 Previous Policy No :
Customer Code : 10755281 GSTIN : 27AAJCS4517L1ZY
Customer Name : MR.AMIT SONAJI KASBEKAR SAC Code : 997133 / Accident and Health
Insurance Services
Proposer Code : 10755281 Issuing Office Code : 151120
Proposer Name : MR.AMIT SONAJI KASBEKAR Issuing Office Name : Branch Office - Nagpur II
Proposer Address : 4 DA CITY HEIGHT SAMRAT Issuing Office Address : Block No 16, Gandhi Grain
COLONY, Market
KHADKESHWAR, Near Telephone Exchange
AURANGABAD Square,Opp.Axis Bank
Aurangabad Town - M H C.A Road
Maharashtra 431001 Nagpur Urban Tehsil
Maharashtra 440008
Phone No : 74XXXXXX11 Phone No : 0712-6688701/0712-6688702

E-mail Id : amXXXXXXXXXX@gmail.com E-mail Id : nagpur.bo2@starhealth.in

Proposer GSTIN : NO Place of Supply : Maharashtra
Proposal date : 21-Feb-2024 Fulfiller Code : SH16464
Date of Inception : 21-Feb-2024
of first policy
Policy Category : New Intermediary : BA0000405811
Collection No : 151120/RV/2024/0110005533
Code
Collection Date : 21-Feb-2024

Premium : Rs. 1,500/-

Name : KALYANI ASHOKRAO
WANASKAR
CGST @ 9% : Rs. 135/-
Phone No :9730320251
:
SGST @ 9% Rs. 135/-
E-mail Id : wanaskarkalyani@gma
il.com
Total Premium : Rs. 1,770/-
Stamp Duty : Rs. 100/-

Total Premium In Words : Rupees One thousand seven hundred seventy only
PERIOD OF INSURANCE : From : 21-Feb-2024 18:26 To : Midnight Of 20-Feb-2025

Basic Floater Sum Insured : Rs. 20,00,000/- Scheme Description :

In Words : Rupees
Relationship
Sl. Name of the Age Pre Existing
Gender Date of Birth with ID Card No Inception date
No. Insured in Yrs Disabilities
Proposer
MR.AMIT SONAJI
1 KASBEKAR Male 23-Apr-1982 41 Self 10755281 No PED Declared 21-Feb-2024

NIKITA AMIT
ME04428886
2 KASBEKAR Female 30-Aug-1989 34 Spouse No PED Declared 21-Feb-2024
94

OVEE AMIT
ME04428886
3 KASBEKAR Female 03-Jan-2019 5 Daughter No PED Declared 21-Feb-2024
95

Entered by : CUSTPORTAL For Star Health and Allied Insurance Company Ltd.
Approved by : PORTAL
IRDAI Regn.No.129

Corporate Identity Number L66010TN2005PLC056649

Authorised Signatory Page 2 of 4
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 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 Company Limited

Attached to and forming part of Policy No: 16240718820800

Nominee Details:
Nominee Details for the Proposer Appointee Details
S.No Name Relationship Age % of the Appointee Name Appointee Relationship
with proposer claim Age with nominee

1 NIKITA AMIT Spouse 34 100

KASBEKAR
Sector Classification:
Urban

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

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).
THE INSURANCE UNDER THIS POLICY IS SUBJECT TO CONDITIONS, CLAUSES, WARRANTIES,
EXCLUSIONS ETC., ATTACHED.
Toll Free No : 1800 425 2255 / 1800 102 4477 Email: support@starhealth.in, Fax No: 1800 425 5522.
In witness whereof the undersigned being authorized by and on behalf of the company has set his hand at Branch
Office - Nagpur II on 21st Day of February 2024.

Entered by : CUSTPORTAL For Star Health and Allied Insurance Company Ltd.
Approved by : PORTAL

Authorised Signatory Page 3 of 4

Regd.&Corporate Office:1,New Tank Street,Valluvar Kottam High Road,Nungambakkam,Chennai - 600034,Phone : 044 -28302700 / 28288800
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 Company Limited

Tax Invoice
Invoice No. : 272402I007282211 Customer ID : 10755281
Invoice Date : 21-Feb-2024 Policy No. : 16240718820800
Recipient Supplier
GSTIN : GSTIN : 27AAJCS4517L1ZY
Name : MR.AMIT SONAJI KASBEKAR Name : Star Health and Allied Insurance Co Ltd -
Branch Office - Nagpur II
Address : 4 DA CITY HEIGHT SAMRAT COLONY, Address : Block No 16, Gandhi Grain Market
KHADKESHWAR, Near Telephone Exchange Square,Opp.Axis
Bank
AURANGABAD C.A Road
City : Aurangabad Pin Code : 431001 City : Nagpur Urban Pin Code : 440008
Town - M H Tehsil

State : Maharashtra Client : IND State : Maharashtra Place of : Maharashtra

Category supply

Taxable IGST @ UT/SGST @ CESS @ Total Invoice

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

Insurance
997133 1,500.00 0 1,500.00 0 135.00 135.00 0 1,770.00
Services

Total Invoice Value (in Figures) : Rs. 1,770/-

Total Invoice Value (in Words) : Rupees One thousand seven hundred seventy 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
"I/We hereby declare that though our aggregate turnover in any preceding financial year from 2017-18 onwards is more than the aggregate
turnover notified under sub-rule (4) of rule 48, we are not required to prepare an invoice in terms of the provisions of the said sub-rule."
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

Entered by : CUSTPORTAL For Star Health and Allied Insurance Company Ltd.
Approved by : PORTAL

Authorised Signatory Page 4 of 4

Regd.&Corporate Office:1,New Tank Street,Valluvar Kottam High Road,Nungambakkam,Chennai - 600034,Phone : 044 -28302700 / 28288800
Toll Free No:1800-425-2255 / 1800-102-4477,CIN : L66010TN2005PLC056649 Email :support@starhealth.in Website :www.starhealth.in
IRDAI Regn.no: 129