Star Health And Allied Insurance Company Limited

RENEWAL NOTICE
Policy No: P/171139/01/2023/005010

Date :27-Sep-2023
HIRALAL R. YADAV Branch Office - Andheri IV-171139

R.NO.14,CHIMBAI KOLWADA Shree Padmini, 1st Floor,

OPP. DHAVAL GANGA BLDG.,1ST CARTER RD CHIMBAI,BANDRA(W) Teli Galli,Cross Lane
MUMBAI Andheri (East),
Mumbai City,Maharashtra-400050 Mumbai City Maharashtra 400069
98XXXXXX98 blXXX@gmail.com Ph : 022-26814701
Email ID : andheri.bo4@starhealth.in
Proposer/CustomerCode:888324/888324 Reference No : 612407525923 - 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 Family Health Optima Insurance Plan is due for
renewal on 14-Dec-2023. The renewal premium, including Tax, works out to Rs. 35,954/- as per details given below.

Age as on Relationship with

S. No Name of the Insured DOB Sum Insured(Rs.) Premium (Rs.)
renewal proposer
1 HIRALAL R. YADAV 15-May-1969 54 Self
3,00,000 30,470
2 TARA H. YADAV 10-Aug-1975 48 Spouse
GST @ 18% 5,484
Total Renewal Premium 35,954
You can cover yourself with more Suminsured Coverages

HIRALAL R. YADAV SI 4,00,000 SI 5,00,000 SI 10,00,000 SI 15,00,000 SI 20,00,000

Rs. 40,396/- Rs. 42,433/- Rs. 50,919/- Rs. 58,558/- Rs. 65,584/-
**Excess if any shall be refunded to proposer

The expiring policy contained the cover for KAJAL H. YADAV aged 25 related to the Insured as Daughter. This person cannot be continued on renewal as per terms
and conditions of the expiring policy. A separate supplementary renewal notice has been prepared and sent. Please contact your Agent/Broker/Office to obtain
suitable cover for such person(s).
Please note that the premium quoted above does not include the premium for KAJAL H. YADAV since said person has been already deleted from the policy or
ineligible to be continued for cover
However, we require below mentioned additional information from you:-
Mobile Number and Package Amount has been added in the Product

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 so that we can work out the revised renewal premium and advise you. Otherwise, please arrange to remit the renewal premium of Rs.
35,954/- on or before 14-Dec-2023. Please note that the payment of premium by any mode other than by cash will be eligible for benefit 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.

''Please furnish your mobile number and email id in the space provided below to enable our company to communicate with you as our valued customer, whenever
required''.

Mobile Number : Email id :

You can also update your Address / Mobile No / E Mail ID, online by visiting our website www.starhealth.in
Please note that this policy can be renewed online or using your mobile. Kindly log on to our website www.starhealth.in to know the details.

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 : JAGDISHPAL SINGH / BA0000021614

For Star Health and Allied Insurance Company Limited
Phone No : 9323712137
Fulfiller Name/Code : NAYANA UDAY OZA / SH4308

Authorised Signatory Phone No : 9320006365

This is an example of Promotional Message.

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 : HIRALAL R. YADAV
Policy Number : P/171139/01/2023/005010
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: