Star Health And Allied Insurance Company Limited
Date : 28-Mar-2022
To, IMPORTANT
Mr. B. AITHA JWALAKANTH ,
NO: 15-430, RAJPUT ST,
SUBEDARPET, NEAR KANAKA MAHAL,
NELLORE, ANDRA PRADESH-524001
Nellore Town,Andhra Pradesh-524001
Mobile : 9788860067
Dear Customer,
Re: Health Insurance Policy - 11220023679904
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.
CN=R Margabandhu,
SERIALNUMBER=00f82dcf76fdf6537e3331f8479ef45e7b4f3861b15475488cdf
R Margabandhu 3b2c3c26c3c9, ST=TAMIL NADU, OID.2.5.4.17=600034,
OID.2.5.4.20=513b7b33f2ce960f23148ea208744690e09638750806ca65f89e15
179f5fe50a, OU=UNDERWRITING - Chief Risk Officer, O=STAR HEALTH AND
ALLIED INSURANCE COMPANY, C=IN. Date :Mon Mar 28 11:31:09 IST 2022
Page 1 of 5
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 :U66010TN2005PLC056649 Email :support@starhealth.in
Website :www.starhealth.in IRDAI Regn.no: 129
Star Health And Allied Insurance Company Limited
Family Health Optima Insurance Plan
Unique Identification No. SHAHLIP22030V062122
POLICY SCHEDULE
Policy No. : 11220023679904 Previous Policy No : P/111200/01/2021/014033
Customer Code : 9038568 GSTIN : 34AAJCS4517L1Z3
Customer Name : Mr. B. AITHA JWALAKANTH SAC Code : 997133 / Accident and Health
Insurance Services
Proposer Code : 9038568 Issuing Office Code : 111200
Proposer Name : Mr. B. AITHA JWALAKANTH Issuing Office Name : Branch Office - Pondichery
Proposer Address : NO: 15-430, RAJPUT ST, Issuing Office Address : No 8, I Floor, Bajanai Madam
SUBEDARPET, NEAR KANAKA street,
MAHAL, Ellapillaichavady,
NELLORE, ANDRA PRADESH- Pondicherry-605005.
524001 Puducherry Town Puducherry
Nellore Town Andhra Pradesh 605005
524001
Phone No : 9788860067 Phone No : 413-2203372
E-mail Id : ajwalakanth@rediffmail.com E-mail Id : pondicherry.ao@starhealth.in
Proposer GSTIN : NO Place of Supply : Puducherry
Proposal date : 30-Mar-2018 Fulfiller Code : SH37474
Date of Inception : 30-Mar-2018
of first policy
Policy Category : Fourth Year Intermediary : SMD
Collection No : 171066016241
Code
Collection Date : 28-Mar-2022 Name : Mr.SHAJAHAN N
Premium : Rs. 13,950/-
IGST @ 18% : Rs. 2,511/-
Phone No :9500566786/950056678
6
E-mail Id : shajahan.n@starinsura
nce.in
Total Premium : Rs. 16,461/-
Stamp Duty : Re. 1/-
Total Premium In Words : Rupees Sixteen thousand four hundred sixty one
only
PERIOD OF INSURANCE : From : 30-Mar-2022 00:00 To : Midnight Of 29-Mar-2023
Installment Facility Option:No Premium Payment Frequency :Annual Installment Amount Rs. : 0/-
Basic Floater Sum Insured : Rs. 5,00,000/- Scheme Description : 2A+2C
In Words : Rupees Five lakhs only
Bonus : Rs. 1,05,000/- Limit of Coverage : Rs. 6,05,000/- Recharge Benefit : Rs. 1,50,000/-
Entered by : CUSTPORTAL For Star Health and Allied Insurance Company Ltd.
Approved by : PORTAL
IRDA Regn.No.129
Corporate Identity Number U66010TN2005PLC056649
Authorised Signatory Page 2 of 5
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 :U66010TN2005PLC056649 Email :support@starhealth.in
Website :www.starhealth.in IRDAI Regn.no: 129
Star Health And Allied Insurance Company Limited
Attached to and forming part of Policy No: 11220023679904
Details of Insured Persons :
Sl. Age in Relationship Inception
Name of the Insured Gender Date of Birth ID Card No
no. Yrs with Proposer date
Mr. AITHA JWALAKANTH
1 Male 17-Aug-1978 43 Self 9038568-1 30-Mar-2018
Pre Existing Disease : No PED Declared
Mrs. N.UMAMAHESWARI
2 Female 20-Mar-1980 42 Spouse 9038568-2 30-Mar-2018
Pre Existing Disease : No PED Declared
Miss. A.SAI SRIDHANYAA
3 Female 11-Nov-2011 10 Daughter 9038568-3 30-Mar-2018
Pre Existing Disease : No PED Declared
Mr. A.KARTHIKRAGAV
4 Male 23-Jun-2016 5 Son 9038568-4 30-Mar-2018
Pre Existing Disease : No PED Declared
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 N.UMAMAHESWA Spouse 42 100
RI
Sector Classification:
Urban No
Please check whether the details given by you about the insured persons 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).
THE INSURANCE UNDER THIS POLICY IS SUBJECT TO CONDITIONS, CLAUSES, WARRANTIES,
EXCLUSIONS ETC., ATTACHED.
Important
“This policy covers 68 other excluded expenses. Accordingly, exclusion (Code Excl 37) appearing in
the policy wordings stands deleted”
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 / 1800 102 4477 Email: support@starhealth.in, Fax No: 1800 425 5522.
In witness whereof the undersigned being authorized by and on behalf of the company has set his hand at Branch
Office - Pondichery on 28th Day of March 2022.
Entered by : CUSTPORTAL For Star Health and Allied Insurance Company Ltd.
Approved by : PORTAL
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 Fax No: 1800-425-5522 Toll Free No:1800-425- 2255 / 1800-102-4477,CIN :U66010TN2005PLC056649 Email :support@starhealth.in
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 : 11220023679904 Type of Policy : Family Health Optima Insurance
Plan - 2021
Issue Office : 111200-Branch Office - Pondichery
Address : No 8, I Floor, Bajanai Madam street,
Ellapillaichavady,
Pondicherry-605005.
Puducherry Town Puducherry 605005
Tel / Fax : 413-2203372
Email : pondicherry.ao@starhealth.in
This is to certify that Mr. B. AITHA JWALAKANTH has paid Rs 16,461/- (Total Premium : Indian
Rupees Sixteen thousand four hundred sixty one only ) towards Premium for Hospitalization Insurance vide
Policy No: 11220023679904 for the Period 30-Mar-2022 To 29-Mar-2023 issued on 28-Mar-2022.
Payment received by Payment Gateway vide Receipt No: 171066016241/1 Receipt Date: 28-Mar-2022
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 : 28-Mar-2022 For and on behalf of
Place : Branch Office - Pondichery Star Health and Allied Insurance Company Ltd.
IRDA Regn.No.129
Corporate Identity Number U66010TN2005PLC056649 Authorised Signatory
Email ID: info@starhealth.in
Entered by : CUSTPORTAL For Star Health and Allied Insurance Company Ltd.
Approved by : PORTAL
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 Fax No: 1800-425-5522 Toll Free No:1800-425- 2255 / 1800-102-4477,CIN :U66010TN2005PLC056649 Email :support@starhealth.in
Website :www.starhealth.in IRDAI Regn.no: 129
Star Health And Allied Insurance Company Limited
Tax Invoice
Invoice No. : 342203I000052882 Customer ID : 9038568
Invoice Date : 28-Mar-2022 Policy No. : 11220023679904
Recipient Supplier
GSTIN : NO GSTIN : 34AAJCS4517L1Z3
Name : Mr. B. AITHA JWALAKANTH Name : Star Health and Allied Insurance Co Ltd -
Branch Office - Pondichery
Address : NO: 15-430, RAJPUT ST, Address : No 8, I Floor, Bajanai Madam street,
SUBEDARPET, NEAR KANAKA MAHAL, Ellapillaichavady,
NELLORE, ANDRA PRADESH-524001 Pondicherry-605005.
City : Nellore Town Pin Code : 524001 City : Puducherry Pin Code : 605005
Town
State : Andhra Pradesh Client : IND State : Puducherry Place of : Puducherry
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 13,950.00 0 13,950.00 2,511.00 0 0 0 16,461.00
Services
Total Invoice Value (in Figures) : Rs. 16,461/-
Total Invoice Value (in Words) : Rupees Sixteen thousand four hundred sixty one 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
E. & O.E
This is a digitally signed document and hence no physical signature is required
IRDA Regn.No.129 Corporate Identity Number U66010TN2005PLC056649 Email ID: stargst@starhealth.in
Entered by : CUSTPORTAL For Star Health and Allied Insurance Company Ltd.
Approved by : PORTAL
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 Fax No: 1800-425-5522 Toll Free No:1800-425- 2255 / 1800-102-4477,CIN :U66010TN2005PLC056649 Email :support@starhealth.in
Website :www.starhealth.in IRDAI Regn.no: 129
