Corona Kavach Policy,Star Health and Allied Insurance Co.

Ltd
Unique Identification No. SHAHLIP21066V012021
Certificate of Insurance

Certificate no : P/141223/01/2021/001332 Previous Certificate :

no
Customer Code : AA0013570242 GSTIN : 29AAJCS4517L1ZU
Customer Name : NITHESH SALIAN SAC Code : 997133/Accident and Health Insurance Services
Proposer's Code : 16482243 Issuing Office Code : 141223
Proposer's Name : NITHESH SALIAN Issuing Office Name : Branch Office - Moodbidri
Address : S/o GOPALA, SUREKHA, D NO Address : Pancharathna Business Centre,
9-46, Near Alvas Health Centre,
KUTHADKA, BAJAL, PADIL Moodbidri - 574227
Phone No : 08258-298331
Bajala (CT),Dakshina E-mail Id : moodbidri@starhealth.in
Kannada,Karnataka-575007
Place of Supply : -
Phone No : /9108230414/
Fulfiller Code : SH27574
E-mail Id : REONCONSULTANCY@GMAIL.C
OM Intermediary Code : BA0000233031
Proposer GSTIN : -
Proposal date : 27/07/2020 Name : Mrs.HENCIL R N DSOUZA
Date of Inception of first policy : 27/07/2020
Phone No : 9448216661/9448216661
Renewal Year : NEW
Collection Number : 1437001461 : ronylic@gmail.com
E-mail Id
Receipt Date : 27/07/2020
Premium :Rs 1,901 /-
CGST @9% :Rs 171 /- SGST / UTGST @9% :Rs 171 /-
Stamp Duty :Rs 1 /- Total Premium :Rs 2243 /-
Total Premium In Words : Rupees Two Thousand Two Hundred Forty Three Only

PERIOD OF INSURANCE : 27/07/2020 16:32:00 TO : Midnight Of 08/05/2021 No. of Days : 285

Details of Insured Persons : No. of Persons Insured: 1

Sex Date of Birth Age in Relationship Optional Inception Date

Sl.n Name of the Insured Sum Insured (Rs.) ID Card No Pre-existing
Yrs Cover Opted
o. with Proposer Y/N Disease/s

1 NITHESH SALIAN M 17/08/1983 36 SELF 500000 No 16482243-1 NONE 27/07/2020

For detailed coverage, terms & Conditions and exclusions, kindly visit website : www.starhealth.in

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.

In witness whereof the undersigned being authorized by and on behalf of the company has set his hand at Chennai on 27th Day of July 2020.

Entered by : STAR_PORTAL For Star Health and Allied Insurance Company Ltd.

Authorised Signatory
IRDAI Regn. No 129
Corporate Identity Number U66010TN2005PLC056649 CN=R Margabandhu,

R Margabandhu
SERIALNUMBER=00f82dcf76fdf6537e3331f8479ef45e7b4f3861b154
75488cdf3b2c3c26c3c9, ST=TAMIL NADU, OID.2.5.4.17=600034,
OID.2.5.4.20=513b7b33f2ce960f23148ea208744690e09638750806c

Email ID : info@starhealth.in a65f89e15179f5fe50a, OU=UNDERWRITING - Chief Risk Officer,

Please see overleaf
O=STAR HEALTH AND ALLIED INSURANCE COMPANY, C=IN.
Date :Mon Jul 27 19:28:53 IST 2020 1 of 1

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