Hospitalisation Benefit Policy

Premium Certificate for the purpose of deduction under Section 80 D of Income Tax (Amendment) Act,1986
P/700002/01/2016/040608

Policy No
Issue Office

:
:

700002 - Online Business

Address

VILCO CENTRE

Type of Policy : Family Health Optima Insurance-Revised

1st Floor, Subhash Road 8,Near Garware House

Vile Parle (E), Mumbai - 400057
Tel / Fax

1800-425-2255 /

Email

online@starhealth.in

This is to certify that Phani Sekhar has paid Rs 9197 (Total Premium : Indian Rupees Nine Thousand One Hundred
Ninety-Seven Only ) towards Premium for Hospitalization Insurance vide Policy No: P/700002/01/2016/040608 for the
Period 19/12/2015 To 18/12/2016 issued on 18-DEC-15.
Payment received by Cheque/Credit/Debit Card vide Receipt No: Receipt Date:
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 :

30/12/2015

Place :

MUMBAI

IRDA Regn. No 129

Corporate Identity Number U66010TN2005PLC056649
Email ID : info@starhealth.in

For and On behalf of

STAR HEALTH AND ALLIED INSURANCE CO LTD,

Authorised signatory.