Star Health And Allied Insurance Company Limited

Date : 24-Sep-2024
To, IMPORTANT

LOGESHWARAN R .,
4/24 ANAND AGRO SERVICE SAKTHY
MANI ROAD SIRUMUGAI
.
Mettupalayam Taluka,Tamil Nadu-641302
Mobile : 8489972709

Dear Customer,

Re: Health Insurance Policy - 11251006770201

We are extremely thankful to you for your renewal instructions and payment of premium. We enclose the
renewed policy based on our records. We would request you to kindly study the renewed policy carefully and
revert to us if there is any discrepancy to enable us to attend to the same.

Kindly note that the above request is very important and if we do not hear anything from you within
15 days, we would presume that the policy issued by us is in order and the contract is concluded.

We would like to mention that we have incorporated the name of the intermediary as indicated by you.

We wish you good health and we look forward to serve you in the days to come.

With kind regards,

Authorised Signatory

In case of a need for hospitalization, kindly prefer our network hospital (list is available in our website) for a
quick response to your claim request.
Please select the room as per your eligibility stipulated in your policy to avoid additional payment
from your pocket towards the proportionate increase which would invariably be charged by the
hospital for the higher room category occupied.
Sum Insured of this Policy is meant for utilization till its expiry.Bearing this aspect in mind,we have no
doubt,you will choose appropriate hospital,room rent and treatment charges etc.

Should you need any assistance, our customer care will be delighted to assist you ,whose toll free no. is
1800-425-2255/1800-102-4477.

However,the ultimate decision will be that of yours only.

This is an electronically generated document(Policy

Schedule).

Page 1 of 5

Regd.&Corporate Office:1,New Tank Street,Valluvar Kottam High Road,Nungambakkam,Chennai - 600034,Phone : 044 -28302700 / 28288800
Toll Free No:1800-425-2255 / 1800-102-4477,CIN : L66010TN2005PLC056649 Email :[email protected] Website :www.starhealth.in
IRDAI Regn.no: 129
 Star Health And Allied Insurance Company Limited

Smart Health Pro

Unique Identification No. SHAHLIP23172V012223

In Consideration of payment of Rs. 5,984/- towards renewal premium of policy

number:P/161130/01/2024/103559, the policy stands renewed for a further period of 1 Year as per
the details given below

Renewal Endorsement No:11251006770201

Customer Code : 34270442 GSTIN : 06AAJCS4517L1Z2
Customer Name : LOGESHWARAN R . SAC Code : 997133 / Accident and Health
Cust CKYC No : - Insurance Services

Proposer Code : 34270442 Issuing Office Code : 161130

Proposer Name : LOGESHWARAN R . Issuing Office Name : Branch Office - Gurgaon III
Proposer Address : 4/24 ANAND AGRO SERVICE Issuing Office Address : Plot no 412/2, K - I Tower
SAKTHY M G Road, Sector -14,
MANI ROAD SIRUMUGAI .
. Gurugram Town Haryana
Mettupalayam Taluka Tamil Nadu 122001
641302
Phone No : 8489972709 Phone No : 0124-4797452
E-mail Id : [email protected] E-mail Id : [email protected]
Proposer GSTIN : NO Place of Supply : Haryana
Proposal date : 21-Sep-2023 Fulfiller Code : SO161130
Date of Inception : 22-Sep-2023
of first policy
Renewal Year : First Year Intermediary : LC0000000619
Collection No : 161130/RV/2025/0163472187
Code
Collection Date : 23-Sep-2024
Base Premium : Rs. 5,634/-
Name : M/S.POLICYBAZAAR
INSURANCE
Medical U/W Loading : Rs. 0/- BROKERS PRIVATE
Optional Cover : Rs. 0/-
Loading LIMITED
Optional Cover : Rs. 0/-
Discount
IGST @ 18% : Rs. 913/-
Phone No :1800-258-
5970/9971552250
E-mail Id : [email protected]
m
Total Premium : Rs. 5,984/-
Stamp Duty : Re. 1/-

Total Premium In Words : Rupees Five thousand nine hundred eighty four
only
PERIOD OF INSURANCE : From : 23-Sep-2024 22:22 To : Midnight Of 22-Sep-2025 Policy Term :1 Year

Entered by : MP659866 This is an electronically generated document(Policy For Star Health and Allied Insurance Company Ltd.
Approved by : MP659866 Schedule).

IRDAI Regn.No.129

Corporate Identity Number L66010TN2005PLC056649

Authorised Signatory Page 2 of 5
Email ID: [email protected]

Regd.&Corporate Office:1,New Tank Street,Valluvar Kottam High Road,Nungambakkam,Chennai - 600034,Phone : 044 -28302700 / 28288800
Toll Free No:1800-425-2255 / 1800-102-4477,CIN : L66010TN2005PLC056649 Email :[email protected] Website :www.starhealth.in
IRDAI Regn.no: 129
 Star Health And Allied Insurance Company Limited

Attached to and forming part of Policy No: 11251006770201

Details of Insured Persons : No. of Persons Insured : 1
Sl. Name of the Age in Relationship Sum Cumulative ID Card Inception
Gender Date of Birth
no Insured Yrs with Proposer Insured Bonus (Rs.) No date
LOGESHWARAN R 34270442
1 Male 27-Aug-1994 30 Self 5,00,000 2,50,000 22-Sep-2023
-1
Pre Existing Disease : No PED Declared

Optional Covers
Sl. Reduction of Pre Unlimited Automatic Modification Coverage for Non-
Name of the Cumulative
no. Existing Diseases Restoration of Sum of Room Medical Items
Insured Bonus Booster
Waiting period Insured Category (Consumables)
LOGESHWARAN R
1 Not Opted Not Opted Not Opted Not Opted Not Opted

Nominee Details:
Nominee Details for the Proposer Appointee Details
S.No Name Relationship Age % of the Appointee Name Appointee Relationship
with proposer claim Age with nominee

1 RANGARAJAN Father 66 100 0

Sector Classification:
Urban

Please check whether the details given by you about the insured person(s) in the proposal form are incorporated
correctly in the policy schedule. If you find any discrepancy, please inform us within 15 days from the date of
receipt of the policy, failing which the details relating to the insured person given in the policy schedule are deemed
to have been accepted by you.
Warranted that in case of dishonor of premium cheque(s), the Company shall not be liable under the policy and the
policy shall be void abinitio (from inception).

Important
In the event of hospitalization of insured person, intimation should be given to the Company immediately,
however, within 24 hrs from the time of admission.
Toll Free No : 1800 425 2255 Email: [email protected]

It is hereby made clear that all terms, conditions, clauses, warranties, exclusions etc., as already issued, forming
part of the policy of insurance originally issued at the time of inception of this relationship, shall continue to be
operative and unaltered, forming part of this renewal insurance cover also.

Reference may be made to those terms, conditions etc., for identifying the scope/extent of coverage.

Other excluded expenses as detailed in our website www.starhealth.in

In witness whereof the undersigned being authorized by and on behalf of the company has set his hand at Branch
Office - Gurgaon III on 24th Day of September 2024.
As per Section 34 of CGST Act of 2017, Policy Issued in one Financial Year and Cancelled in another Financial Year
on or after 01st of December, then Only Premium Amount will be Refunded to the Customer and GST Amount will
Not be Refunded. Customer has to Claim the Refund of GST Amount from the GST Portal.

Entered by : MP659866 This is an electronically generated document(Policy For Star Health and Allied Insurance Company Ltd.
Approved by : MP659866 Schedule).

Authorised Signatory Page 3 of 5

Regd.&Corporate Office:1,New Tank Street,Valluvar Kottam High Road,Nungambakkam,Chennai - 600034,Phone : 044 -28302700 / 28288800
Toll Free No:1800-425-2255 / 1800-102-4477,CIN : L66010TN2005PLC056649 Email :[email protected] Website :www.starhealth.in
IRDAI Regn.no: 129
 Star Health And Allied Insurance Company Limited

Hospitalisation Benefit Policy

Premium Certificate for the purpose of deduction under Section 80 D of Income Tax (Amendment) Act,1986

Policy No : 11251006770201 Type of Policy : Smart Health Pro

Issue Office : 161130-Branch Office - Gurgaon III

Address : Plot no 412/2, K - I Tower

M G Road, Sector -14,
.
Gurugram Town Haryana 122001

Tel / Fax : 0124-4797452

Email : [email protected]

This is to certify that LOGESHWARAN R . has paid Rs 5,984/- (Total Premium : Indian Rupees Five thousand
nine hundred eighty four only ) towards Premium for Hospitalization Insurance vide Policy No:
11251006770201 for the Period 23-Sep-2024 To 22-Sep-2025 issued on 23-Sep-2024.

Payment received by Electronic Fund Transfer vide Receipt No: 161130/RV/2025/0163472187/1

Receipt Date: 23-Sep-2024

Note :- This Certificate must be surrendered to the Insurance Company for issuance of fresh Certificate in
case of Cancellation of the Policy or any alteration in the Insurance affecting the Premium.

Date : 24-Sep-2024 For and on behalf of

Place : Branch Office - Gurgaon III Star Health and Allied Insurance Company Ltd.

IRDAI Regn.No.129

Corporate Identity Number L66010TN2005PLC056649 Authorised Signatory

Email ID: [email protected]

Entered by : MP659866 This is an electronically generated document(Policy For Star Health and Allied Insurance Company Ltd.
Approved by : MP659866 Schedule).

Authorised Signatory Page 4 of 5

Regd.&Corporate Office:1,New Tank Street,Valluvar Kottam High Road,Nungambakkam,Chennai - 600034,Phone : 044 -28302700 / 28288800
Toll Free No:1800-425-2255 / 1800-102-4477,CIN : L66010TN2005PLC056649 Email :[email protected] Website :www.starhealth.in
IRDAI Regn.no: 129
 Star Health And Allied Insurance Company Limited

Tax Invoice
Invoice No. : 062409I001889089 Customer ID : 34270442
Invoice Date : 23-Sep-2024 Policy No. : 11251006770201
Recipient Supplier
GSTIN : GSTIN : 06AAJCS4517L1Z2
Name : LOGESHWARAN R . Name : Star Health and Allied Insurance Co Ltd -
Branch Office - Gurgaon III
Address : 4/24 ANAND AGRO SERVICE SAKTHY Address : Plot no 412/2, K - I Tower
MANI ROAD SIRUMUGAI M G Road, Sector -14,
. .
City : Mettupalayam Pin Code : 641302 City : Gurugram Town Pin Code : 122001
Taluka

State : Tamil Nadu Client : IND State : Haryana Place of : Haryana

Category supply

Taxable IGST @ UT/SGST @ CESS @ Total Invoice

Total Discount CGST @ 9%
Value 18% 9% 1% Value
HSN / SAC Description of
Code Service(s) F=C*
D=C* E=C* G= C * H=C+D+
A B C=A-B UTGST or
IGST CGST Cess E+ F + G
SGST

Insurance
997133 5,071.00 0 5,071.00 913.00 0 0 0 5,984.00
Services

Total Invoice Value (in Figures) : Rs. 5,984/-

Total Invoice Value (in Words) : Rupees Five thousand nine hundred eighty four only
Amount of Tax Subject to reverse Charge : No

Important Note:
The invoice is issued as per Section 31 of the CGST Act
In case no GSTIN or incorrect GSTIN is provided by the Proposer at Proposal stage, Star Health and Allied Insurance Co Ltd shall not be
responsible for any Input Tax Credit losses and no subsequent revision of invoice will be undertaken
"I/We hereby declare that though our aggregate turnover in any preceding financial year from 2017-18 onwards is more than the aggregate
turnover notified under sub-rule (4) of rule 48, we are not required to prepare an invoice in terms of the provisions of the said sub-rule."
E. & O.E
This is a digitally signed document and hence no physical signature is required

IRDAI Regn.No.129 Corporate Identity Number L66010TN2005PLC056649 Email ID: [email protected]

Entered by : MP659866 This is an electronically generated document(Policy For Star Health and Allied Insurance Company Ltd.
Approved by : MP659866 Schedule).

Authorised Signatory Page 5 of 5

Regd.&Corporate Office:1,New Tank Street,Valluvar Kottam High Road,Nungambakkam,Chennai - 600034,Phone : 044 -28302700 / 28288800
Toll Free No:1800-425-2255 / 1800-102-4477,CIN : L66010TN2005PLC056649 Email :[email protected] Website :www.starhealth.in
IRDAI Regn.no: 129