Tax Certificate

To
Customer Name : Mr.CHIMMILI MANI KUMAR
Address S/O LATE CHIMMILI MALAKONDAIAH,
: G2,TRISHUL APARTMENT,2ND CROSS STREET,ISKON CITY
Nellore
524004

Subject: Premium Certificate for the purpose of deduction under Section 80 D of Income Tax Act 1961 and any amendments
made thereafter.

Dear Customer,
This is to certify that the company has received the premium for Health Insurance Coverage under "Health Insurance Policy"
with the following details.

Mr.CHIMMILI MANI KUMAR

Policy Holder's Name : P/131125/01/2024/005566
Policy No. :

Policy Name : Family Health Optima Total Premium : 28467

Insurance Plan
Policy End Date :
Policy Start Date : 15/09/2023 14/09/2024
Servicing Branch
Customer GSTIN : GSTIN :
- 37AAJCS4517L1ZX

Customer Code : Premium Terms :

Non-Installment
AA0020681104
Servicing Branch
Servicing Branch D No 24/385, Arya Towers
131125 - Branch Office - Address :
Code & Name : Rajagopalapuram, Opp Bollineni Hospitals
Nellore
Branch Office - Nellore Dargamitta, Nellore-524003

IGST CGST SGST

Receipt Date Basic Premium Total Premium
% Rs. % Rs. % Rs.

01-AUG-23 24125 0 0 9 2171 9 2171 28467

The Product is eligible for deduction us 80D of the Income Tax Act 1961 and any amendments made there to.

Financial Year Amount

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
CN=R Margabandhu,

R Margabandhu
SERIALNUMBER=00f82dcf76fdf6537e3331f8479ef45e7b4f3861b154
75488cdf3b2c3c26c3c9, ST=TAMIL NADU, OID.2.5.4.17=600034,
OID.2.5.4.20=513b7b33f2ce960f23148ea208744690e09638750806c
a65f89e15179f5fe50a, OU=UNDERWRITING - Chief Risk Officer,
O=STAR HEALTH AND ALLIED INSURANCE COMPANY, C=IN.
Date :Tue Aug 01 16:04:37 IST 2023
 2023-2024 28467

Note:-
1) This certificate must be surrendered to the Insurance Company of insurance of fresh Certificate in case of Cancellation of the
Policy or any alternation in the Insurance affecting the Premium.
2) This Certificate is reflecting the Premium(s) Receipts cleared at the time of generating this certificate.
3) The Liability of any changes in the Premium Receipt's clearing status post generating the certificate shall be upon the
policy holder.

Date : 01/08/2023 For and On behalf of

Place : Nellore Star Health and Allied Insurance Company Ltd

IRDA Regn. No 129

Corporate Identity Number L66010TN2005PLC056649

Email ID : info@starhealth.in Authorised signatory.

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