Branch Office-Pimpri Premises No.

6 & 7, 13 & 14, Sunshine Plaza, , CTS NO - 4713, Near Ambedkar Chouk,Station Road ,
Above Ratna Hotel,Pimpri, Pune - 411018 , PUNE , 411018
Collection Receipt
Customer Code : AA0015647485

Received from : Saniya A Sayed

: Sr No-34A/7C/2, 1st Floor, Fl No-04 Collection No : 11-01/1210536598

Customer Address
Ashish Apartment, Vadgaonsheri, Pune - 411014 : 02/06/2023
Collection Date
Office Code : 151118 - Branch Office-Pimpri

Supplier GSTIN : 27AAJCS4517L1ZY

Customer GSTIN : - Place of Supply : - State Code: -

Amount Collected : Rs. 27824 /- Inclusive of tax :

Amount in words : Indian Rupees Twenty-Seven Thousand Eight Hundred Twenty-Four Only

Towards the Following : PREMIUM RECEIPT AGAINST RENEWAL FHO POLICY

S. No. Proposal Ref. No Fulfiller Code Intermediary Code Amount Collected Mode of Pay Bank Name CHQ/CC/DD No CHQ/DD/BC Dt

1 R/151418/01/2023/01476 SH8752 BA0000062142 27824 CSH

For Star Health and Allied Insurance Co. Ltd

Note : Receipt Subject to realization of Cheque / DD

This is only an evidence of receipt of money by the company
Risk will commence once the proposal is examined and accepted Authorised Signatory
" CONSOLIDATED CERTIFICATE LOA/CSD/481/2022/4306 DATED 02-JUN-2023"

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 :Thu Dec 08 18:20:56 IST 2022

IRDA Regn. No 129 Corporate Identity Number L66010TN2005PLC056649 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 : L66010TN2005PLC056649 Email :support@starhealth.in Website :www.starhealth.in IRDAI Regn.no: 129