Star Health And Allied Insurance Company Limited

Date : 19-Jul-2023
To, IMPORTANT

SADASIV PATTAR ,
S/O BASAPPA PATTAR
CHICHAKANDI LANE NEAR HIREMANE BAVI BANHATTI

Jamkhandi Town,Karnataka-587311
Mobile : 9611077501

Dear Customer,

Re: Health Insurance Policy - 11240328796201

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.

Page 1 of 4

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
CN=R Margabandhu,
Website :www.starhealth.in IRDAI Regn.no: 129
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 :Wed Jul 19 15:08:41 IST 2023
 Star Health And Allied Insurance Company Limited

Star Micro Rural and Farmers Care

Unique Identification No. SHAHMIP22038V032122

In Consideration of payment of Rs. 2,868/- towards renewal premium of policy

number:P/614009/01/2023/000224, the policy stands renewed for a further period of 1 Year as per
the details given below

Renewal Endorsement No:11240328796201

Customer Code : 30185242 GSTIN : 29AAJCS4517L1ZU
Customer Name : SADASIV PATTAR SAC Code : 997133 / Accident and Health
Insurance Services
Proposer Code : 30185242 Issuing Office Code : 614009
Proposer Name : SADASIV PATTAR Issuing Office Name : Branch Office - Jamakhandi
Proposer Address : S/O BASAPPA PATTAR Issuing Office Address : Desai Circle
CHICHAKANDI LANE NEAR Teli Complex
HIREMANE BAVI BANHATTI Near KLE Hospital, Vijayapura
Road
Jamkhandi Town Karnataka Jamkhandi Taluk Karnataka
587311 587301
Phone No : 9611077501 Phone No : 9880058223
E-mail Id : kavitakadlimati@gmail.com E-mail Id : jamakhandi.bo@starhealth.in
Proposer GSTIN : NO Place of Supply : Karnataka
Proposal date : 14-Jul-2022 Fulfiller Code : SH60030
Date of Inception : 14-Jul-2022
of first policy
Renewal Year : First Year Intermediary :BA0000519569
Collection No : 191768000294
Code
Collection Date : 19-Jul-2023

Premium : Rs. 2,430/-

Name : Mr.ALOK MURAGOD

CGST @ 9% : Rs. 219/-

Phone No :7899337868/789933786
8
:
SGST @ 9% Rs. 219/-
E-mail Id : ALOKMURAGOD@GM
AIL.COM
Total Premium : Rs. 2,868/-
Stamp Duty : Re. 1/-

Total Premium In Words : Rupees Two thousand eight hundred sixty eight
only
PERIOD OF INSURANCE : From : 19-Jul-2023 11:30 To : Midnight Of 18-Jul-2024
Installment Facility Option:No Premium Payment Frequency :Annual Installment Amount Rs. : 0/-

Policy Type : INDIVIDUAL

Sum Insured : Rs 1,00,000/- (One lakh only)

Entered by : SH62465 For Star Health and Allied Insurance Company Ltd.
Approved by : SH62465
IRDA Regn.No.129

Corporate Identity Number L66010TN2005PLC056649

Authorised Signatory Page 2 of 4
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 Company Limited

Attached to and forming part of Policy No: 11240328796201

Details of Insured Persons :
Sl. Name of the Age in Relationship Sum Insured ID Card Inception
Gender Date of Birth
no. Insured Yrs with Proposer Rs.(*) No date
SADASIV PATTAR
1 Male 01-Jan-1973 50 Self 1,00,000 30185242-1 14-Jul-2022

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 BASAPPA PATTAR Father 75 100

Sector Classification:
Rural

''CONSOLIDATED STAMP DUTY FOR POLICY STAMPS PAID VIDE ORDER NO. NO IG0223003027565328 DT
14.02.2023''
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 persons 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).
Expenses relating to the hospitalisation will be considered in proportion to the room rent stated in the policy.

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 2255/1800 102 4477 Email: support@starhealth.in, Fax No:1800 425 5522.
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 here in to set his hand at Branch Office - Jamakhandi on 19th
Day of July 2023.

Entered by : SH62465 For Star Health and Allied Insurance Company Ltd.
Approved by : SH62465

Authorised Signatory Page 3 of 4

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 Company Limited

Tax Invoice
Invoice No. : 292307I000896092 Customer ID : 30185242
Invoice Date : 19-Jul-2023 Policy No. : 11240328796201
Recipient Supplier
GSTIN : GSTIN : 29AAJCS4517L1ZU
Name : SADASIV PATTAR Name : Star Health and Allied Insurance Co Ltd -
Branch Office - Jamakhandi
Address : S/O BASAPPA PATTAR Address : Desai Circle
CHICHAKANDI LANE NEAR HIREMANE Teli Complex
BAVI BANHATTI
Near KLE Hospital, Vijayapura Road
City : Jamkhandi Pin Code : 587311 City : Jamkhandi Taluk Pin Code : 587301
Town

State : Karnataka Client : IND State : Karnataka Place of : Karnataka

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 2,430.00 0 2,430.00 0 219.00 219.00 0 2,868.00
Services

Total Invoice Value (in Figures) : Rs. 2,868/-

Total Invoice Value (in Words) : Rupees Two thousand eight hundred sixty eight 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

IRDA Regn.No.129 Corporate Identity Number L66010TN2005PLC056649 Email ID: stargst@starhealth.in

Entered by : SH62465 For Star Health and Allied Insurance Company Ltd.
Approved by : SH62465

Authorised Signatory Page 4 of 4

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