ea 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 PolicyNe —:P9TEDOIS2021/107982 Type Of Polley : Medi-classic Insurance Paligy (Individual) Issue Office; 700002 Address: VILCO CENTRE 4st Floor, Subhash Road 8,Near Garware House Vile Parle (E), Mumbai - 400057 Toll Free No eee 180-425-2255. online@starhealth in This is to cory that MAYA TAPAN has paid Rs 51089 (Total Pramium In Words - INR Fifty One Thousand and Eighty Nine Only) towards Premium for Hospitalization Insurance vide Poliey No: P/976002I03/202 1/167982 for the Period O1-MAR.21 To 28-FEB-22 icsuad on 01-MAR-21 Payment received by Cheque/CreditDebit Card vide collection No:5772759887 Note = This Certificate must be surrendered to the Insurance Company for issuance of fresh Certificate in case of Cancellation of the Policy of any alteration inthe Insurance affecting the Premium, For and on behalf of Star Health and Allied Insurance Company Ltd Yen ‘Authorised Signatory