Star Health And Allied Insurance Company Limited

201-202-203, 2nd floor Pragati Deep Building Lakshmi Nagar

Distt.Centre .
East Delhi Delhi-110092
Phone: 011-40454938 Telefax:

Collection Receipt

Customer Code : PI0004652858 Collection No : 161111/RV/2024/0085849881

Received From : AMAN BHARDWAJ Collection Date : 11-Dec-2023
Customer Address : S.O. KRISHAN KUMAR Office Code : 161111 - Branch Office - East
BHARDWAJ, B-4, GALI NO.-9, Delhi
JAGATPURI EXTENSION, GSTIN : 07AAJCS4517L1Z0
SHAHDARA, NAND NAGARI, Place of Supply : Delhi
NORTH EAST DELHI, DELHI
Karawal Nagar Delhi 110093
Customer mobile : 737XXXXX15 Type of proposal : Fresh
number
Customer GSTIN : NO State Code : 07
Amount Collected : Rs. 5,664/-
Amount in words : INDIAN RUPEES Five thousand six hundred sixty four only
Towards the Following : Amount Receipted towards Premium
Sr. Proposal Fulfiller Intermediary Amount Mode of Bank CHQ/CC/DD CHQ/DD/BC
No Ref. No Code Code Collected payment Name No Dt.
(Rs)
1 61240019096 SH9272 BA0000087591 5,664/- CC 231211114297 11-Dec-2023
1 062573

For Star Health and Allied Insurance Co. Ltd.

Authorised Signatory

Note : Receipt Subjected 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.
“Available modes of payments of Premium: Cash, Cheque, DD, Net Banking, RTGS/NEFT, Credit Card, Debit
Card, UPI, Payment Gateway(PAYTM, PAYU, AIRPAY, BBPS, CSC, UBONA).”

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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