Star Health And Allied Insurance Company Limited

Date : 19-Nov-2024
To, IMPORTANT

ANIRBAN SAHA,
CF - 332, Salt Lake
Sector - 1, Bidhannagar(M),
SALTLAKE
Rajarhat Tehsil,West Bengal-700064
Mobile : 9840415566

Dear Customer,

Re: Health Insurance Policy - 11230214403902

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 4

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 :support@starhealth.in Website :www.starhealth.in
IRDAI Regn.no: 129
 Star Health And Allied Insurance Company Limited

Star Health Assure Insurance Policy

Unique Identification No. SHAHLIP23131V022223

In Consideration of payment of Rs. 22,683/- towards renewal premium of policy

number:11230214403901, the policy stands renewed for a further period of 1 Year as per the details
given below

Renewal Endorsement No:11230214403902

Customer Code : PI0002131384 GSTIN : 19AAJCS4517L1ZV
Customer Name : ANIRBAN SAHA SAC Code : 997133 / Accident and Health
Cust CKYC No : 60097267828334 Insurance Services

Proposer Code : PI0002178823 Issuing Office Code : 190000

Proposer Name : ANIRBAN SAHA Issuing Office Name : Zonal Office - Kolkata
Proposer Address : CF - 332, Salt Lake Issuing Office Address : 75C, Park Street,
Sector - 1, Bidhannagar(M), 6th floor
SALTLAKE .
Rajarhat Tehsil West Bengal Kolkata West Bengal 700016
700064
Phone No : 9840415566 Phone No : 033-40036814
E-mail Id : saha.anirban@gmail.com E-mail Id : kolkata.zo@starhealth.in
Proposer GSTIN : NO Place of Supply : null
Proposal date : 14-Nov-2022 Fulfiller Code : SH12439
Date of Inception : 28-Nov-2022
of first policy
Renewal Year : Second Year Intermediary : BA0000471735
Collection No : 190000/RV/2025/0175178713
Code
Collection Date : 19-Nov-2024

Premium : Rs. 19,223/-

Name : MR.SUSHANTA
BHANDARY
CGST @ 9% : Rs. 1,730/-
Phone No :7890253629/789025362
9
:
SGST @ 9% Rs. 1,730/-
E-mail Id : sushanta.abcon@gmai
l.com
Total Premium : Rs. 22,683/-
Stamp Duty : Re. 1/-

Total Premium In Words : Rupees Twenty Two thousand six hundred eighty
three only
PERIOD OF INSURANCE : From : 28-Nov-2024 00:00 To : Midnight Of 27-Nov-2025 Policy Term :1 Year
Installment Facility Option:No Premium Payment Frequency :Annual Installment Amount Rs. : 0/-
Policy Type : FLOATER Scheme Description : 2A+1C
Basic Floater Sum Insured : Rs. 10,00,000/- Bonus : Rs. 5,00,000/-
Sum Insured In Words : Rupees Ten lakhs only
Optional Cover (Deductible) : No Deductible : Rs. 0/-

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

IRDAI 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 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: 11230214403902

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
ANIRBAN SAHA
1 Male 25-Nov-1981 43 Self PI0002178823 28-Nov-2022

Pre Existing Disease : Hypertension and its complications

ARPITA SAHA
2 Female 18-Oct-1985 39 Spouse ME0331820693 28-Nov-2022

Pre Existing Disease : Diseases related to Female Genital System and their Complications
ADHIRAJ SAHA
3 Male 24-Sep-2010 14 Son ME0331820694 28-Nov-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 Arpita Saha Spouse 39 100

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: 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 by and on behalf of the company has set his hand at Zonal
Office - Kolkata on 19th Day of November 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 : CUSTPORTAL This is an electronically generated document(Policy For Star Health and Allied Insurance Company Ltd.
Approved by : PORTAL Schedule).

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 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. : 192411I007085254 Customer ID : PI0002131384
Invoice Date : 19-Nov-2024 Policy No. : 11230214403902
Recipient Supplier
GSTIN : GSTIN : 19AAJCS4517L1ZV
Name : ANIRBAN SAHA Name : Star Health and Allied Insurance Co Ltd - Zonal
Office - Kolkata
Address : CF - 332, Salt Lake Address : 75C, Park Street,
Sector - 1, Bidhannagar(M), 6th floor
.
City : Rajarhat Tehsil Pin Code : 700064 City : Kolkata Pin Code : 700016

State : West Bengal Client : IND State : West Bengal Place of : West Bengal
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 19,223.00 0 19,223.00 0 1,730.00 1,730.00 0 22,683.00
Services

Total Invoice Value (in Figures) : Rs. 22,683/-

Total Invoice Value (in Words) : Rupees Twenty Two thousand six hundred eighty three 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: stargst@starhealth.in

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

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 No:1800-425-2255 / 1800-102-4477,CIN : L66010TN2005PLC056649 Email :support@starhealth.in Website :www.starhealth.in
IRDAI Regn.no: 129