Star Health And Allied Insurance Company Limited

1,3-6-111/8 and 3-6-111/9 3rd Floor,Far East Plaza

Himayatnagar, Hyderabad_x005f500029
Himayat Nagar - Hyderabad Telangana-500029
Phone: Telefax:

Collection Receipt

Customer Code : 28035706 Collection No : 131127/RV/2024/0116165182

Received From : GORJAM NARENDRA KUMAR Collection Date : 19-Mar-2024
Customer Address : h.no.8-1-2/8E, ayyapaa nagar, Office Code : 131127 - Branch Office -
ayyappa temple tandur, Himayat Nagar
vikarabad dist GSTIN : 36AAJCS4517L1ZZ
Tandur Mandal - Vikrabad Place of Supply : Telangana
Telangana 501141
Customer mobile : 984XXXXX24 Type of proposal : Renewal
number
Customer GSTIN : NO State Code : 36
Amount Collected : Rs. 19,364/-
Amount in words : INDIAN RUPEES Nineteen thousand three hundred sixty four 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 61240079550 SH47258 BA0000368356 19,364/- Payment Legacy 240319124778 19-Mar-2024
7 Gateway Bank 601684
Branch

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, Payment Gateway(PAYTM, PAYU, AIRPAY, BBPS, CSC, UBONA).”

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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