IMPORTANT

To,

VEMULA RAMESH BABU,

V Ramesh babu, door no 6-44, Pathamajeru
Challapalli mandal krishna dist

Bhogireddipalle,Krishna,-521131
Mobile : 8008901398.

Dear Customer,

Re: Health Insurance Policy - P/171116/01/2018/015156

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

CN=AGARA MALLEGOWDA MALLESH,

AGARA MALLEGOWDA SERIALNUMBER=bcdac65cb756b13d25cbd11f5c72e361804d2cd0bd3ee
3b3a8ba17d08345dc31,
OID.2.5.4.20=9faf86b6b361d64e4cd62938c6e1325d59597414ba783c8768
MALLESH f251f1ca0a418f, ST=Tamil Nadu, OID.2.5.4.17=600034, OU=EXECUTIVE
DIRECTOR, O=STAR HEALTH AND ALLIED INSURANCE COMPANY
LIMITED, C=IN. Date :Wed Mar 07 17:46:34 IST 2018
 Family Health Optima Insurance Plan
Unique Identification No. IRDAI/HLT/SHAI/P-H/V.III/129/2017-18
Policy Schedule
Policy No. : P/171116/01/2018/015156 Previous Policy No. : P/700002/01/2017/097622
Customer Code : AA0004798302 GSTIN : 27AAJCS4517L1ZY
Customer Name : VEMULA RAMESH BABU SAC Code : 997133/Accident and Health Insurance Services
Proposer Code : 6752223 Issuing Office Code : 171116
Proposer Name : VEMULA RAMESH BABU Issuing Office Name : Branch Office - Ghatkopar
Address : V Ramesh babu, door no 6-44, Address : Room No: 110-111-112, Sanghvi Square,
Pathamajeru Opp: Bank of Baroda,
Challapalli mandal krishna dist M. G. Road, Ghatkopar (West), Mumbai - 400
086.
Bhogireddipalle,Krishna,-521131
Tel/Mobile : /8008901398/ Tel/Mobile : 022 - 42267000
E-mail id : ramesh_v54@yahoo.com E-mail id : ghatkopar.mumbai@starhealth.in
Proposer GSTIN : - Place of Supply : -
Proposal date : 16/03/2017 Fulfiller Code : SO171116
Date of Inception of first policy : 17-MAR-17
Intermediary Code : LC0000000351
Renewal Year : First Year
Name : M/S.COVERFOX INSURANCE
Receipt No & Date : 1173016112 & 07/03/2018
Premium : Rs 16455 /- BROKING PVT. LTD.
IGST @18% : Rs 2,962 /-
Tel/Mobile : 1800 209 9970/1800 209 9970
Total Premium : Rs 19417 /- Stamp Duty : Re 1 /-

E-mail id : Contact@coverfox.com
Total Premium In Words : Rupees Nineteen Thousand Four Hundred Seventeen Only

Period of insurance : From : 17/03/2018 00:00:00 To : Midnight of 16/03/2019

Basic Floater Sum Insured : 500000 Scheme Description : 2A
In words : Rupees: Five Lakhs Only
Bonus: Rs. 125000 Limit of Coverage : Rs. 625000 Recharge Benefit : Rs. 150000
Details of Insured Persons :

Sl. Name of the Insured Gender Date of Birth Age in Relationship ID Card No Pre-existing Disease Inception Date
No. Yrs with Proposer
1 Vemula Venugopala rao M 20/05/1964 53 DEPENDANT 6752223-1 17/03/2017
PARENT
PED : No PED declared
2 Vemula Padmavathi F 23/08/1970 47 DEPENDANT 6752223-2 No PED declared 17/03/2017
PARENT

Nominee Details

Nominee Details for the proposer Appointee Details

Relationship Age % of Appointee Relationship

S.No. Name Age
with proposer the Name with Nominee
claim

1 VEMULA RAMESH BABU Son 29 100

Sector Classification

Rural

Entered By : PREMIA This is an electronically generated For Star Health and Allied Insurance Company Ltd.
document(Policy Schedule).
Consolidated Stamp Duty paid vide
IRDAI Regn. No 129 certificate NO: Adj/CS/277/102437/10
Corporate Identity Number U66010TN2005PLC056649
Email ID : support@starhealth.in Authorised Signatory
2 of 4
Attached to and forming part of Policy No. P/171116/01/2018/015156
Please check whether the details given by you about the insured persons 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).

THE INSURANCE UNDER THIS POLICY IS SUBJECT TO CONDITIONS, CLAUSES, WARRANTIES, EXCLUSIONS ETC., ATTACHED.
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 / 1800 102 4477 Email: support@starhealth.in, Fax No: 1800 425 5522 .
"Consolidated stamp paid vide certificate No.CSD/225/2017/4540/17 Dt.08.11.2017"
In witness whereof the undersigned being authorized by and on behalf of the company has set his hand at Branch Office - Ghatkopar on 07th
Day of March 2018.

Entered By : PREMIA This is an electronically generated For Star Health and Allied Insurance Company Ltd.
document(Policy Schedule).
Consolidated Stamp Duty paid vide
certificate NO: Adj/CS/277/102437/10

Authorised Signatory
3 of 4
 Hospitalisation Benefit Policy
Premium Certificate for the purpose of deduction under Section 80 D of Income Tax (Amendment) Act,1986

Policy No P/171116/01/2018/015156 Type Of Policy : Family Health Optima Insurance - 2017

Issue Office 171116 - Branch Office - Ghatkopar
Address Room No: 110-111-112, Sanghvi Square,
Opp: Bank of Baroda,
M. G. Road, Ghatkopar (West), Mumbai -
400 086.

Toll Free No 022 - 42267000

Email ghatkopar.mumbai@starhealth.in

This is to certify that VEMULA RAMESH BABU has paid Rs 19417 (Total Premium In Words : Indian Rupees Nineteen
Thousand Four Hundred Seventeen Only ) towards Premium for Hospitalization Insurance vide Policy No:
P/171116/01/2018/015156 for the Period 17-MAR-18 To 16-MAR-19 issued on 07-MAR-18 .
Payment received by Cheque/Credit/Debit Card vide collection No:1173016112

Note :- This Certificate must be surrendred 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.

For Star Health and Allied Insurance Company Ltd.

Authorised Signatory

Entered By : PREMIA This is an electronically generated For Star Health and Allied Insurance Company Ltd.
document(Policy Schedule).
Consolidated Stamp Duty paid vide
certificate NO: Adj/CS/277/102437/10

Authorised Signatory
4 of 4