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Policy

This receipt summarizes a payment of Rs. 12,231 made by Anurag Upadhyay towards an online insurance policy premium. The payment was made via credit card on December 14, 2020 to Branch Office - Gurgaon III. The receipt serves as evidence of money received by Star Health and Allied Insurance Co. Ltd, though the insurance risk will commence only once the proposal is examined and accepted.

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aniket goyal
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166 views1 page

Policy

This receipt summarizes a payment of Rs. 12,231 made by Anurag Upadhyay towards an online insurance policy premium. The payment was made via credit card on December 14, 2020 to Branch Office - Gurgaon III. The receipt serves as evidence of money received by Star Health and Allied Insurance Co. Ltd, though the insurance risk will commence only once the proposal is examined and accepted.

Uploaded by

aniket goyal
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Branch Office - Gurgaon III Ist Floor,, SCO 4, Sector 14 Market , Near Payal Cinema, Gurgaon , Gurgaon-122001 , Gurgaon ,

122001
Collection Receipt
Customer Code : AA0010315499

Received from : Anurag Upadhyay


Customer Address : H. No. 73, khushbu Residency, Rajrai Semri Road Collection No : 11-01/1439077576

Semri, Agra Collection Date : 14/12/2020


Office Code : 161130 - Branch Office - Gurgaon III

Supplier GSTIN : 06AAJCS4517L1Z2

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

Amount Collected : Rs. 12231 /- Inclusive of tax :

Amount in words : Indian Rupees Twelve Thousand Two Hundred Thirty-One Only

Towards the Following : PREMIUM RECEIPT ONLINE 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/161130/01/2021/184204 SO161130 WA0000000009 12231 CC BANK PB26952631 14/12/2020

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

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 :Mon Dec 14 13:32:20 IST 2020

IRDA Regn. No 129 Corporate Identity Number U66010TN2005PLC056649 Email id : [email protected]

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
:U66010TN2005PLC056649 Email :[email protected] Website :www.starhealth.in IRDAI Regn.no: 129

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