IMPORTANT

To, 17-JAN-20

Mr.Aayush Kumar Sisodia

F-588 KAMLA NAGAR,

AGRA
Agra,Agra,Uttar Pradesh -282005
Mobile : 9711265575.

Dear Customer,

Re: Health Insurance Policy - P/231120/01/2020/009203

We are extremely thankful for availing health insurance from us and we enclose the policy along with the terms and
conditions.

The said policy has been prepared based on the details furnished by you in the proposal form (copy enclosed) and the
medical reports, wherever applicable. We shall thank you if you can verify the policy to ensure that all the details are
incorporated correctly as per the proposal. In case of any discrepancy noticed, please communicate the same to us
immediately. You will appreciate that it is the primary duty of the proposer to fill the proposal form and also to make
sure that the proposal contains all the details correctly so also the policy has incorporated the details correctly.

This insurance policy is subject to various exclusions including exclusion for pre-existing diseases and conditions in
this policy. If there is suppression of any material fact in the proposal, the contract shall become null and void ab
initio.

We would like to mention that we have incorporated the name of the intermediary as indicated by you in the proposal
who will be of assistance to you.

The policy is subject to the condition of "free look period". As per this condition, a free look period of 15 days from
the date of receipt of the policy is available to you to review the terms and conditions of the policy. In case you are
not satisfied with the terms and conditions, you may seek cancellation of the policy and in such an event, we shall
allow refund of premium paid after adjusting the cost of pre-acceptance medical screening, if any, stamp duty
charges, and proportionate risk premium for the period on cover, provided no claim has been made until such
cancellation.

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 stay in eligible room as stated in the policy, to avoid payment of proportionate
increased charges claimed by the hospitals, from your hand.

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.

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 :U66010TN2005PLC056649 Email :support@starthealth.in Website :www.starhealth.in IRDAI Regn.no: 129
 STAR COMPREHENSIVE INSURANCE POLICY
SCHEDULE (Floater)
UNIQUE ID:SHAHLIP2077V041920
Policy No. : P/231120/01/2020/009203 Previous Policy No. :
Customer Code : AA000585604 GSTIN : 09AAJCS4517L1ZW
Customer Name : Mr.AAYUSH KUMAR SAC Code : 997133/Accident and Health Insurance Services
SISODIA
Proposer's Code : 13394212 Issuing Office Code : 231120
Proposer's Name : Mr.AAYUSH KUMAR Issuing Office Name : Branch Office - Aligarh
SISODIA
Address : F-588 Address : 2nd Floor, Krishna Complex,
KAMLA NAGAR, J-77 Janakpur Colony
AGRA Ramghat Road, Aligarh-202001
Agra,Agra,Uttar Pradesh-282005

Phone No : NA/9711265575/ Phone No : 0571-2742177 / 07351380777

E-mail Id : aayushsisodia1989@gmail.com E-mail Id : aligarh@starhealth.in
Proposer GSTIN : - Place of Supply : -
Proposal date : 16/01/2020 Fulfiller Code : SH20682

Date of Inception of first policy : 16/01/2020

Intermediary Code : BA0000326856
Renewal Year : NEW
Collection Number : 1315009845
Name : Ms.ARCHANA THAKUR
Receipt Date : 16/01/2020
Premium :Rs 20,660/-
Phone No : 8126671486/8126671486
CGST @9%: 1,859 /- SGST / UTGST @9%: 1,859/-
Stamp Duty :Rs 1/- Total Premium :Rs 24,378/- E-mail Id : AVDESHRAJ367@GMAI
L.COM

Total Premium In Words : Rupees Twenty Four Thousand Three Hundred Seventy Eight Only

Period of Insurance : FROM 16/01/2020 17:44:37 TO : Midnight Of 15/01/2021

Basic Floater Sum Insured : Rs. 1500000 /-
Bonus : Rs. 0 /-
Sum Insured Under Section 1 (Health) Rs. 1500000 /- Policy Term : 1 Year
Capital Sum Insured Under Section 10 (For Accidental Death & Permanent Total Disablement) : Rs.1500000 /-
For Mr / Ms. AAYUSH KUMAR SISODIA Only.

For Star Health and Allied Insurance Company Ltd.

Entered by : SH34202

IRDAI Regn. No 129

Corporate Identity Number U66010TN2005PLC056649
Authorised Signatory
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 :U66010TN2005PLC056649 Email :support@starthealth.in Website :www.starhealth.in IRDAI Regn.no: 129