Tax Certificate

To
Customer Name : TRUSHAL SURESHBHAI PARMAR
Address MUKTA MANI AT NADIAD
: DESAI PODE DIST KHEDA
Nadiad (M+OG)
387001

Subject: Premium Certificate for the purpose of deduction under Section 80 D of Income Tax Act 1961 and any amendments
made thereafter.

Dear Customer,
This is to certify that the company has received the premium for Health Insurance Coverage under "Health Insurance Policy"
with the following details.

TRUSHAL SURESHBHAI PARMAR

Policy Holder's Name : P/171229/01/2023/002394
Policy No. :

Policy Name : Family Health Optima Total Premium : 11665

Insurance Plan
Policy End Date :
Policy Start Date : 29/06/2022 28/06/2023
Servicing Branch
Customer GSTIN : GSTIN :
- 24AAJCS4517L1Z4

Customer Code : Premium Terms :

Non-Installment
AA0019359181
Servicing Branch
Servicing Branch 3rd Floor, 318 Centre point,
171229 - Branch Office - Address :
Code & Name : Opp. Ippcowala Hall,
Nadiad
Branch Office - Nadiad Nadiad - 387001.

IGST CGST SGST

Receipt Date Basic Premium Total Premium
% Rs. % Rs. % Rs.

29-JUN-22 9885 0 0 9 890 9 890 11665

The Product is eligible for deduction us 80D of the Income Tax Act 1961 and any amendments made there to.

Financial Year Amount

CN=R Margabandhu,

R Margabandhu
SERIALNUMBER=00f82dcf76fdf6537e3331f8479ef45e7b4f3861b15
475488cdf3b2c3c26c3c9, ST=TAMIL NADU, OID.2.5.4.17=600034,
OID.2.5.4.20=513b7b33f2ce960f23148ea208744690e09638750806
ca65f89e15179f5fe50a, OU=UNDERWRITING - Chief Risk Officer,
O=STAR HEALTH AND ALLIED INSURANCE COMPANY, C=IN.
Date :Wed Jun 29 18:39:55 IST 2022

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 : L66010TN2005PLC056649 Email :support@starthealth.in Website :www.starhealth.in IRDAI Regn.no: 129
 2022-2023 11665

Note:-
1) This certificate must be surrendered to the Insurance Company of insurance of fresh Certificate in case of Cancellation of the
Policy or any alternation in the Insurance affecting the Premium.
2) This Certificate is reflecting the Premium(s) Receipts cleared at the time of generating this certificate.
3) The Liability of any changes in the Premium Receipt's clearing status post generating the certificate shall be upon the
policy holder.

Date : 29/06/2022 For and On behalf of

Place : NADIAD Star Health and Allied Insurance Company Ltd

IRDA Regn. No 129

Corporate Identity Number L66010TN2005PLC056649

Email ID : info@starhealth.in Authorised signatory.

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 : L66010TN2005PLC056649 Email :support@starthealth.in Website :www.starhealth.in IRDAI Regn.no: 129