80D Certificate

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Tax Certificate

To
Policy Holder Name : Yeleswarapu Sridhar
Address S/o Y sita Ramaiah
: 9_277_1. Gowrishankar puram.
Gudivada
521301

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

Dear Yeleswarapu Sridhar


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

Yeleswarapu Sridhar
Policy Holder's Name : P/131200/01/2022/017870
Policy No. :

Policy Name : Medi classic Insurance Policy Total Premium : 15717


(Individual)
Policy End Date :
Policy Start Date : 28/01/2022 27/01/2023
Servicing Branch
Proposer GSTIN : GSTIN :
- 37AAJCS4517L1ZX

Servicing Branch Servicing Branch #38-4-12, VR-Inhouse-Corporate,


131200 - Area Office - Address :
Code & Name : Montessori Mahila Kalasala Road,
Vijayawada
Punnamma Thota,
Area Office - Vijayawada
OPP: All India Radio Station,

IGST CGST SGST


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

28-JAN-22 13319 0 0 9 1199 9 1199 15717

Financial Year Amount

2021-2022 15717

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@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 :Fri Jan 28 12:40:33 IST 2022
The Product is eligible for deduction us 80D of the Income Tax Act 1961 and any amendments made there to.

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 : 28/01/2022 For and On behalf of

Place : VIJ Star Health and Allied Insurance Company Ltd

IRDA Regn. No 129


Corporate Identity Number U66010TN2005PLC056649

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 :U66010TN2005PLC056649 Email :support@starthealth.in Website :www.starhealth.in IRDAI Regn.no: 129

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