RENEWAL NOTICE

Policy No.P/700002/01/2016/030681
Online Business-700002
349 Business Point, Unit No.204 / 205,2nd Floor, Near Sai
Service,
Western Express Highway,
Andheri (E), Mumbai -400069
MUMBAI - 400069

G Kari Basappa
303, Classic Avenue, Street no:4
Czech Colony, Sanathnagar
Hyderabad,Rangareddi,Andhra Pradesh-500018
/9866160447 / /basavaraj@gmail.com

1800-425-2255
online@starhealth.in
Reference No

Proposer/Customer Code : 4672694 / AA0002985376

R/700002/01/2017/051376

Dear Customer,
We value your relationship with us and thank you for the same. We wish to bring to your kind notice that your Family Health Optima Insurance Policy
is due for renewal on 21/10/2016. The renewal premium, including Service Tax, works out to Rs.16347/- as per details given below.
Name of the Insured

S. No

DOB

Age as
on
Renewal

Relationship

GUDEKOTA KARI BASAPPA

15/07/1974

42

SELF

T V BHUVANESHWARI JYOTHI

15/04/1980

36

SPOUSE

G SRUJAN

05/08/2005

11

DEPENDANT CHILD

G SRIHITHA

17/11/2008

DEPENDANT CHILD

Sum Insured
(Rs.)
1000000

"Service Tax payable is subject to revision as per Govt. notification." Service tax @ 15%
Total Renewal Premium

Premium
(Rs.)
14215

2132
16347

To match escalation of medical costs, you can also opt for higher Sum Insured. The higher sum insured options and the respective
premium (including S. Tax) are given below
SI 1500000 : Rs. 19372/-

If there is any change in the list of insured persons to be covered and/ or you desire any changes in the sum insured etc., please inform us
immediately so that we can work out the revised renewal premium and advise you. Otherwise, please arrange to remit the renewal premium of
Rs.16347/- on or before 20/10/2016. Please note that the payment of premium by any mode other than by cash will be eligible for benefit under Sec.
80 D of the Income Tax Act. If you pay by Cheque or DD, please make payment in favour of Star Health and Allied Insurance Company Limited.,
We request you to renew the policy before the renewal date to ensure continuity of cover and benefits.
''Please furnish your mobile number and email id in the space provided below to enable our company to communicate with you as our valued
customer, whenever required''.
Email id :

Mobile Number :

You can also update your Address / Mobile No / E Mail ID, online by visiting our website www.starhealth.in.
Please note that this policy can be renewed online or using your mobile. Kindly log on to our website www.starhealth.in to know the details.
Always at your service.

Intermediary Name/Code: Direct/OL0000000001

For Star Health and Allied Insurance Company Limited

Phone No :
Fulfiller Name/Code : 700002 SO CODE/SO700002

Authorised Signatory

IRDA Regn. No 129

Phone No :

Corporate Identity Number U66010TN2005PLC056649

Email ID : info@starhealth.in

Star Health and Allied Insurance Co.Ltd

Acknowledgement
Received renewal premium for Policy No. ___________________________________________from Mr./ Mrs /Ms_______________________________
along with payment of Rs. __________/- by Cash / Cheque / DD No. _____________ dt. ___________ drawn on ________________. The receipt of
Cash/Cheque/DD will be acknowledged by the office through an Advance Premium Receipt. The receipt is subject to realization of cheque.
_________________________________
Name & Code of the Authorised Person

________________________________
Signature of Authorised Person