Star Health And Allied Insurance Company Limited

Date : 07-Feb-2025
To, IMPORTANT

THOGARLA SHIVA SHIVA PRASAD,

HNO 1-96, Khotarmoor, Perket, ARMOOR, NIZAMABAD.
Khotarmoor

Armoor Mandal,Telangana-503224
Mobile : 9441395854

Dear Customer,

Re: Health Insurance Policy - 9572112302039780

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

Page 1 of 6

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. 26,324/- towards renewal premium of policy

number:11240693867501, the policy stands renewed for a further period of 1 Year as per the details
given below

Renewal Endorsement No:9572112302039780

Customer Code : 32668352 GSTIN : 36AAJCS4517L1ZZ
Customer Name : THOGARLA SHIVA SHIVA PRASAD SAC Code : 997133 / Accident and Health
Cust CKYC No : 30008678201900 Insurance Services

Proposer Code : 32668352 Issuing Office Code : 613028

Proposer Name : THOGARLA SHIVA SHIVA PRASAD Issuing Office Name : Branch Office - Armoor
Proposer Address : HNO 1-96, Khotarmoor, Perket, Issuing Office Address : H.NO.7-44/1,MORE SUPER
ARMOOR, NIZAMABAD. MARKET
Khotarmoor 2ND FLOOR SRINIDHI
COMPLEX
Armoor Mandal Telangana 503224 MAMIDIPALLY 'X'
ROAD,ARMOOR
Armoor Mandal Telangana
503224
Phone No : 9441395854 Phone No : 08462-243393
E-mail Id : tsp858@gmail.com E-mail Id :
Proposer GSTIN : NO Place of Supply : Telangana
Proposal date : 14-Feb-2023 Fulfiller Code : SH43068
Date of Inception : 14-Feb-2023
of first policy
Renewal Year : Second Year Intermediary : BA0000502137
Collection No : 613028/RV/2025/0195156604
Code
Collection Date : 07-Feb-2025
Premium : Rs. 22,308/- Name : Mr.JITTA MARUTHI

CGST @ 9% : Rs. 2,008/-

Phone No :9985555062/998555506
2
:
SGST @ 9% Rs. 2,008/-
E-mail Id : jittamaruthi1985@gmai
l.com
Total Premium : Rs. 26,324/-
Stamp Duty : Re. 1/-

Total Premium In Words : Rupees Twenty Six thousand three hundred

twenty four only
PERIOD OF INSURANCE : From : 14-Feb-2025 00:00 To : Midnight Of 13-Feb-2026 Policy Term :1 Year
Installment Facility Option:No Premium Payment Frequency :Annual Installment Amount Rs. : 0/-
Policy Type : FLOATER Scheme Description : 2A+2C
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). CONSOLIDATED STAMP DUTY FOR POLICY
STAMPS PAID VIDE PROCS NO: GSO5/5794/P/2024
IRDAI Regn.No.129 DT:8/5/2024
Corporate Identity Number L66010TN2005PLC056649
Authorised Signatory Page 2 of 6
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: 9572112302039780

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
THOGARLA SHIVA PRASAD
1 Male 31-Jul-1988 36 Self 32668352-1 14-Feb-2023

Pre Existing Disease : No PED Declared

MATTA SNEHALATHA
2 Female 04-Feb-1993 32 Spouse 32668352-2 14-Feb-2023

Pre Existing Disease : No PED Declared

THOGARLA HIMANSHU
3 Male 24-Jul-2017 7 Son 32668352-3 14-Feb-2023

Pre Existing Disease : No PED Declared

THOGARLA SAHISHNA
4 Female 06-May-2021 3 Daughter 32668352-4 14-Feb-2023

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 MATTA SNEHA Spouse 32 100

LATHA
Sector Classification:
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 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

Entered by : CUSTPORTAL This is an electronically generated document(Policy For Star Health and Allied Insurance Company Ltd.
Approved by : PORTAL Schedule). CONSOLIDATED STAMP DUTY FOR POLICY
STAMPS PAID VIDE PROCS NO: GSO5/5794/P/2024
DT:8/5/2024

Authorised Signatory Page 3 of 6

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

In witness whereof the undersigned being authorized by and on behalf of the company has set his hand at Branch
Office - Armoor on 07th Day of February 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 This is an electronically generated document(Policy For Star Health and Allied Insurance Company Ltd.
Approved by : PORTAL Schedule). CONSOLIDATED STAMP DUTY FOR POLICY
STAMPS PAID VIDE PROCS NO: GSO5/5794/P/2024
DT:8/5/2024

Authorised Signatory Page 4 of 6

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

Hospitalisation Benefit Policy

Premium Certificate for the purpose of deduction under Section 80 D of Income Tax (Amendment) Act,1986

Policy No : 9572112302039780 Type of Policy : Assure Insurance-2021

Issue Office : 613028-Branch Office - Armoor

Address : H.NO.7-44/1,MORE SUPER MARKET

2ND FLOOR SRINIDHI COMPLEX
MAMIDIPALLY 'X' ROAD,ARMOOR
Armoor Mandal Telangana 503224

Tel / Fax : 08462-243393

Email :

This is to certify that THOGARLA SHIVA SHIVA PRASAD has paid Rs 26,324/- (Total Premium : Indian Rupees
Twenty Six thousand three hundred twenty four only ) towards Premium for Hospitalization Insurance vide
Policy No: 9572112302039780 for the Period 14-Feb-2025 To 13-Feb-2026 issued on 07-Feb-2025.

Payment received by Payment Gateway vide Receipt No: 613028/RV/2025/0195156604/1 Receipt

Date: 07-Feb-2025

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 : 07-Feb-2025 For and on behalf of

Place : Branch Office - Armoor Star Health and Allied Insurance Company Ltd.

IRDAI Regn.No.129

Corporate Identity Number L66010TN2005PLC056649 Authorised Signatory

Email ID: info@starhealth.in

Entered by : CUSTPORTAL This is an electronically generated document(Policy For Star Health and Allied Insurance Company Ltd.
Approved by : PORTAL Schedule). CONSOLIDATED STAMP DUTY FOR POLICY
STAMPS PAID VIDE PROCS NO: GSO5/5794/P/2024
DT:8/5/2024

Authorised Signatory Page 5 of 6

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. : 362502I006131745 Customer ID : 32668352
Invoice Date : 07-Feb-2025 Policy No. : 9572112302039780
Recipient Supplier
GSTIN : GSTIN : 36AAJCS4517L1ZZ
Name : THOGARLA SHIVA SHIVA PRASAD Name : Star Health and Allied Insurance Co Ltd -
Branch Office - Armoor
Address : HNO 1-96, Khotarmoor, Perket, Address : H.NO.7-44/1,MORE SUPER MARKET
ARMOOR, NIZAMABAD.
Khotarmoor 2ND FLOOR SRINIDHI COMPLEX
MAMIDIPALLY 'X' ROAD,ARMOOR
City : Armoor Mandal Pin Code : 503224 City : Armoor Mandal Pin Code : 503224

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 22,308.00 0 22,308.00 0 2,008.00 2,008.00 0 26,324.00
Services

Total Invoice Value (in Figures) : Rs. 26,324/-

Total Invoice Value (in Words) : Rupees Twenty Six thousand three hundred twenty four 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). CONSOLIDATED STAMP DUTY FOR POLICY
STAMPS PAID VIDE PROCS NO: GSO5/5794/P/2024
DT:8/5/2024

Authorised Signatory Page 6 of 6

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