Star Health And Allied Insurance Company Limited

Date : 31-Jan-2025
To, IMPORTANT

VELPULA RAMESH .,
HNO 1-92 CHAMANPALLI DHARMARAM PEDDAPALLY
HNO 1-92 CHAMANPALLI DHARMARAM PEDDAPALLY

Dharmaram,Telangana-505416
Mobile : 99XXXXXX52

Dear Customer,

Re: Health Insurance Policy - 9713162401065682

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

Registered Office : No. 1, New Tank Street, Valluvar Kottam High Road, Nungambakkam, Chennai - 600 034. Phone : 044 - 2828 8800 Corporate
Office : No. 148, Acropolis, Dr. Radha Krishnan Salai, Mylapore, Chennai - 600 004. Phone : 044 - 4788 6666 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

Family Accident Care Insurance Policy

Unique Identification No. SHAHLIP21042V012021

In Consideration of payment of Rs. 4,426/- towards renewal premium of policy

number:16240668545000, the policy stands renewed for a further period of 1 Year as per the details
given below
Renewal Endorsement No:9713162401065682
Customer Code : PI0004950883 GSTIN : 36AAJCS4517L1ZZ
Customer Name : VELPULA RAMESH . SAC Code : 997133 / Accident and Health
Cust CKYC No : 20096377543679 Insurance Services

Proposer Code : PI0004950883 Issuing Office Code : 131412

Proposer Name : VELPULA RAMESH . Issuing Office Name : Branch Office - Jagitial
Proposer Address : HNO 1-92 CHAMANPALLI Issuing Office Address : H-NO:- 3-6-35,2nd FLOOR
DHARMARAM PEDDAPALLY Bedside:- NALANDA DEGREE
HNO 1-92 CHAMANPALLI COLLEGE,OPPOSITE:-
DHARMARAM PEDDAPALLY BOMBAY SHOPPING MALL
OPP:BOMBAY SHOPING MALL
Dharmaram Telangana 505416 Jagitial Town Telangana
505327
Phone No : 99XXXXXX52 Phone No : 9640336335
E-mail Id : RAXXXXXXXXXXX152@GMAIL.CO E-mail Id : jagitial.bo@starhealth.in
M
Proposer GSTIN : NO Place of Supply : Telangana
Proposal date : 31-Jan-2024 Fulfiller Code : SH33443
Date of Inception : 31-Jan-2024
of first policy
Renewal Year : First Year Intermediary : BA0000257608
Collection No : 131412/RV/2025/0193425120
Code
Collection Date : 31-Jan-2025
Premium : Rs. 3,750/- Name : Mr.DUMPETA
THIRUPATHI
CGST @ 9% : Rs. 338/-
Phone No :9441671646/944167164
6
:
SGST @ 9% Rs. 338/-
E-mail Id : dumpetathirupathi@g
mail.com
Total Premium : Rs. 4,426/-
Stamp Duty : Rs. 250/-

Total Premium In Words : Rupees Four thousand four hundred twenty six
only
PERIOD OF INSURANCE : From : 31-Jan-2025 16:06 To : Midnight Of 30-Jan-2026

Basic Floater Sum Insured : Rs. 50,00,000/- Scheme Description : 2A+2C

In Words : Rupees Fifty lakhs only

Entered by : CUSTPORTAL For Star Health and Allied Insurance Company Ltd.
Approved by : PORTAL
IRDAI Regn.No.129

Corporate Identity Number L66010TN2005PLC056649

Authorised Signatory Page 2 of 4
Email ID: info@starhealth.in

Registered Office : No. 1, New Tank Street, Valluvar Kottam High Road, Nungambakkam, Chennai - 600 034. Phone : 044 - 2828 8800 Corporate
Office : No. 148, Acropolis, Dr. Radha Krishnan Salai, Mylapore, Chennai - 600 004. Phone : 044 - 4788 6666 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: 9713162401065682

Relationship
Sl. Name of the Age Pre Existing
Gender Date of Birth with ID Card No Inception date
No. Insured in Yrs Disabilities
Proposer
VELPULA RAMESH . PI000495088
1 Male 10-Jul-1981 43 Self No PED Declared 31-Jan-2024
3
VELPULA LAXMI . ME04427020
2 Female 01-Jan-1983 42 Spouse No PED Declared 31-Jan-2024
54
VELPULA SAIRAJ . ME04427020
3 Male 25-Oct-2002 22 Son No PED Declared 31-Jan-2024
55
VELPULA AJAY . ME04427020
4 Male 16-Jan-2004 21 Son No PED Declared 31-Jan-2024
56

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 VELPULA LAXMI Spouse 41 100

Sector Classification:
Urban Urban

''CONSOLIDATED STAMP DUTY FOR POLICY STAMPS PAID VIDE PROCS NO: GSO5/5794/P/2024 DT:8/5/2024''

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.
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 by and on behalf of the company has set his hand at Branch
Office - Jagitial on 31st Day of January 2025.
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 For Star Health and Allied Insurance Company Ltd.
Approved by : PORTAL

Authorised Signatory Page 3 of 4

Registered Office : No. 1, New Tank Street, Valluvar Kottam High Road, Nungambakkam, Chennai - 600 034. Phone : 044 - 2828 8800 Corporate
Office : No. 148, Acropolis, Dr. Radha Krishnan Salai, Mylapore, Chennai - 600 004. Phone : 044 - 4788 6666 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. : 362501I006026640 Customer ID : PI0004950883
Invoice Date : 31-Jan-2025 Policy No. : 9713162401065682
Recipient Supplier
GSTIN : GSTIN : 36AAJCS4517L1ZZ
Name : VELPULA RAMESH . Name : Star Health and Allied Insurance Co Ltd -
Branch Office - Jagitial
Address : HNO 1-92 CHAMANPALLI DHARMARAM Address : H-NO:- 3-6-35,2nd FLOOR
PEDDAPALLY
HNO 1-92 CHAMANPALLI DHARMARAM Bedside:- NALANDA DEGREE
PEDDAPALLY COLLEGE,OPPOSITE:- BOMBAY SHOPPING
OPP:BOMBAY SHOPING MALL
City : Dharmaram Pin Code : 505416 City : Jagitial Town Pin Code : 505327

State : Telangana Client : IND State : Telangana Place of : Telangana

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 3,750.00 0 3,750.00 0 338.00 338.00 0 4,426.00
Services

Total Invoice Value (in Figures) : Rs. 4,426/-

Total Invoice Value (in Words) : Rupees Four thousand four hundred twenty six 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 For Star Health and Allied Insurance Company Ltd.
Approved by : PORTAL

Authorised Signatory Page 4 of 4

Registered Office : No. 1, New Tank Street, Valluvar Kottam High Road, Nungambakkam, Chennai - 600 034. Phone : 044 - 2828 8800 Corporate
Office : No. 148, Acropolis, Dr. Radha Krishnan Salai, Mylapore, Chennai - 600 004. Phone : 044 - 4788 6666 Toll Free No:1800-425-2255 /
1800-102-4477,CIN : L66010TN2005PLC056649 Email :support@starhealth.in Website :www.starhealth.in IRDAI Regn.no: 129