Star Health And Allied Insurance Company Limited

RENEWAL NOTICE
Policy No: P/181319/01/2023/005014

Date :22-Jan-2024
MR.ROSHAN SHAJI Branch Office - West Nadakavu-181319

PALLIMUTTAM HOUSE, 2nd floor, Elite Arcade,

DEVAGIRI , Chakkorathkulam,Nadakavu,
MEDICAL COLLEGE,CALICUT .
Kozhikode Taluk,Kerala-673008 Kozhikode Taluk Kerala 673011
90XXXXXX88/roXXXXXXXXXX@gmail.com Ph : 0495-3100134
Email ID : westnadakavu.bo@starhealth.in
Proposer/CustomerCode:32751241/32751241 Reference No : 612401661239 - Direct Receipt

Dear Customer,
We value your relationship with us and thank you for the same. We wish to bring to your kind notice that your Star Comprehensive Insurance Policy is due for
renewal on 07-Mar-2024. The renewal premium including GST works out to Rs. 15,540/- as per details given below.

Relationship with
S. No Name of the Insured Date of Birth Age(years) Sum Insured(Rs.) Premium (Rs.)
proposer
1 ETHAN JOHN ROSHAN 14-Apr-2021 2 Son
2 ROSHAN SHAJI 10-Apr-1989 34 Self 5,00,000 13,170
3 LAYA DEVASIA 30-Mar-1994 29 Spouse
Wellness Discount 0
GST @18% 2,370
Total Renewal Premium 15,540

If there is any change in the list of insured persons to be covered and/ or you desire any changes in the sum insured etc., please inform us immediately. Please note
that the payment of premium by any mode other than by cash will be eligible for benefit under Income tax under sec. 80 D of the Income Tax Act. If you pay by
Cheque or DD, please make payment in favour of Star Health and Allied Insurance Company Limited.
We request you to renew the policy before the renewal date to ensure continuity of cover and benefits. If you wish to incorporate any change in the renewal policy
relating to your address, mobile no., email id etc., please furnish us the same at the time of payment. If you have not provided the mobile number please provide the
same.
Mobile Number : Email ID :

Kindly share your 14 digit ABHA (Ayushman Bharat Health Account) number at the time of renewal. If not registered yet,
please visit our webpage starhealth.in/abha to get registered and to share your ABHA number.

Always at your service. Intermediary Name/Code : BABU PN / BA0000006346

For Star Health and Allied Insurance Company Limited
Phone No : 0495-2742798/9447042798
Fulfiller Name/Code : Mr.SMITHESH P K / SH30132

Authorised Signatory Phone No : 0495-2365211/9846665428

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@starthealth.in Website :www.starhealth.in IRDAI Regn.no: 129
 Star Health And Allied Insurance Company Limited

Sheet attached to and forming part of the Renewal notice

( for Health/Personal Accident)
Name of the Proposer : MR.ROSHAN SHAJI
Policy Number : P/181319/01/2023/005014
As per the Regulatory requirements ,we can effect payment of refund / claims only through Electronic Clearing System (ECS) / National Electronic Funds Transfer
(NEFT) / Real Time Gross Settlement (RTGS) / Interbank Mobile Payment Service (IMPS).
For this purpose please submit the following details

Name of the proposer

Name of the Bank & Branch

Type of Account SB Account / Current Account / Others (please specify)

Account Number

IFSC Code of Bank

Please attach a photo copy of a cheque leaf of the above Bank Account.

Date :
Place : Signature of the Proposer

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

Star Health and Allied Insurance Co.Ltd

Spot Acknowledgement
Acknowledged hereby receipt of Cash / Cheque / DD No. Dt for Rs.
drawn on from Mr./Mrs/Ms. towards premium for the renewal of Policy No.
. A system generated "Advance Premium Receipt" for this payment will follow from our office, which is subject to
realization of the cheque.

Name & Code of the Authorised Person Signature of Authorised Person

Place:
Date: