Branch Office - Pune - I 2nd Floor, 805, Above Ethix Skoda Showroom, , The Reverie Apartments, , Bhandarkar Road,

, PUNE
, 411004
Collection Receipt
Customer Code : AA0025003676

Received from : Dr Balkrishna Kamble

Customer Address : B,303,Trillum,Magarpattacity city near amanora,,Hadapsar Collection No : 11-01/1073000348

,Pune (M Corp.) Collection Date : 04/04/2023

Maharashtra-411013 Office Code : 151111 - Branch Office - Pune

Mobile No : 96XXXXX971 Supplier GSTIN : 27AAJCS4517L1ZY

Customer GSTIN :- Place of Supply : - State Code: -

Amount Collected : Rs. 43599 /- Inclusive of tax :

Amount in words : Indian Rupees Forty-Three Thousand Five Hundred Ninety-Nine Only Business Type :

Towards the Following : PREMIUM RECEIPT ONLINE POLICY

S. No. Proposal Ref. No Fulfiller Code Intermediary Code Amount Collected Mode of Pay Bank Name CHQ/CC/DD No CHQ/DD/BC Dt

1 R/151111/01/2024/001401 SO151111 BA0000032583 43599 CC INTENT 17118698375 04/04/2023

Note : Receipt Subject to realization of Cheque / DD For Star Health and Allied Insurance Co. Ltd
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 payment of Premium : Cash, Cheque, DD, Net Banking, RTGS/NEFT, Credit Card,
Debit card, UPI, Customer Portal and Star website. Authorised Signatory

CN=R Margabandhu,

R Margabandhu
SERIALNUMBER=00f82dcf76fdf6537e3331f8479ef45e7b4f3861b15
475488cdf3b2c3c26c3c9, ST=TAMIL NADU, OID.2.5.4.17=600034,
OID.2.5.4.20=513b7b33f2ce960f23148ea208744690e09638750806
ca65f89e15179f5fe50a, OU=UNDERWRITING - Chief Risk Officer,
O=STAR HEALTH AND ALLIED INSURANCE COMPANY, C=IN.
Date :Tue Apr 04 23:29:42 IST 2023

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