IMPORTANT

To, 31-OCT-21

Ajeet Singh
C-2/111 Nagli Vihar Extension
Baaprola

New Delhi,South West,Delhi -110043

Mobile : 7827653123.

Dear Customer,

Re: Health Insurance Policy - P/161100/01/2022/028422

We are extremely thankful for availing health insurance from us and we enclose the policy along with the terms and
conditions.

The said policy has been prepared based on the details furnished by you in the proposal form (copy enclosed) and
the medical reports, wherever applicable. We shall thank you if you can verify the policy to ensure that all the details
are incorporated correctly as per the proposal. In case of any discrepancy noticed, please communicate the same to
us immediately. You will appreciate that it is the primary duty of the proposer to fill the proposal form and also to
make sure that the proposal contains all the details correctly so also the policy has incorporated the details correctly.
If you or any of the insured person(s) have suffered or suffering from any of the diseases which has not been
mentioned in the proposal, the claim that may arise will result in the repudiation of the claim/ cancellation of the
policy. The other option for you is to continue with the previous insurer.

This insurance policy is subject to various exclusions including exclusion for pre-existing diseases and conditions in
this policy.

We would like to mention that we have incorporated the name of the intermediary as indicated by you in the proposal
who will be of assistance to you.

The policy is subject to the condition of "free look period". As per this condition, a free look period of 15 days from
the date of receipt of the policy is available to you to review the terms and conditions of the policy. In case you are
not satisfied with the terms and conditions, you may seek cancellation of the policy and in such an event, we shall
allow refund of premium paid after adjusting the cost of pre-acceptance medical screening, if any, stamp duty
charges, and proportionate risk premium for the period on cover, provided no claim has been made until such
cancellation.

We wish you good health and we look forward to serve you in the days to come.

With kind regards,

Authorised Signatory
"Let Star Health help you to become healthier and happier. Star Wellness Benefits includes Mind Body healing and other
Condition management programmes (Weight management, Diabetes etc....) Visit www.starhealth.in / customer portal login and
start your journey with us to Better Health".

In case of a need for hospitalization, kindly prefer our network hospital (list is available in our website) for a quick
response to your claim request.

Please select the room as per your eligibility stipulated in your policy to avoid additional payment from your
pocket towards the proportionate increase which would invariably be charged by the hospital for the higher
room category occupied.

Sum insured of this Policy is meant for utilization till its expiry. Bearing this aspect in mind, we have no doubt, you
will choose appropriate hospital, room rent and treatment charges, etc.

Should you need any assistance, our customer care will be delighted to assist you, whose toll free no. is 1800-425-
2255/1800-102-4477. CN=R Margabandhu,

R Margabandhu
SERIALNUMBER=00f82dcf76fdf6537e3331f8479ef45e7b4f3861b154
75488cdf3b2c3c26c3c9, ST=TAMIL NADU, OID.2.5.4.17=600034,
OID.2.5.4.20=513b7b33f2ce960f23148ea208744690e09638750806c
a65f89e15179f5fe50a, OU=UNDERWRITING - Chief Risk Officer,
However, the ultimate decision will be that of yours only. O=STAR HEALTH AND ALLIED INSURANCE COMPANY, C=IN.
Date :Sun Oct 31 15:07:00 IST 2021

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
 YOUNG STAR INSURANCE POLICY
SCHEDULE (Floater)
UNIQUE ID:SHAHLIP22036V042122
Policy No. : P/161100/01/2022/028422 Previous Policy No. : 18877623
Customer Code : AA0021470514 GSTIN : 07AAJCS4517L1Z0
Customer Name : Ajeet Singh SAC Code : 997133/Accident and Health Insurance Services
Proposer's Code : 24719501 Issuing Office Code : 161100
Proposer's Name : Ajeet Singh Issuing Office Name : Area Office - Delhi
Address : C-2/111 Nagli Vihar Extension Address : 1st Floor, Himalaya House, 23,
Baaprola Kasturba Gandhi Marg,
New Delhi - 110001.
New Delhi,South West,Delhi-
110043
Phone No : /7827653123/ Phone No : 011- 23464610
E-mail Id : [email protected] E-mail Id : [email protected]
Proposer GSTIN : - Place of Supply : -
Proposal date : 31/10/2021 Fulfiller Code : SH63356

Date of Inception of first policy : 14-NOV-2021 Intermediary Code : BA0000457450

Renewal Year :
Collection Number : 1061030809 Name : Mrs.USHA CHAUDHARY
Receipt Date : 31/10/2021
Premium :Rs 11,010 /-
CGST @9% : 991 /- SGST / UTGST @9% : 991 /- Phone No : 9953929793/9953929793
Stamp Duty :Rs 1 /- Total Premium :Rs 12,992 /-
E-mail Id : NISHADHAMA86@GMA
IL.COM
Total Premium In Words : Rupees Twelve Thousand Nine Hundred Ninety Two Only Installment Facility Optn :No

Premium Payment Frequency :Annual Installment Amount Rs. : 0

Period of Insurance : FROM 14/11/2021 00:00 TO : Midnight Of 13/11/2022 Term : 1 Year

Scheme Description (Family Size) : 2 ADULTS + 2 CHILDREN Basic Floater Sum Insured : Rs. 500000 /-
Bonus : Rs. 0 /-
Total Sum Insured In Words : Rupees Five Lakhs Only Plan Type : SILVER
Details of Insured Persons :
Sl. Name of the Insured Sex Date of Birth Age in Relationship with ID Card No Pre Existing Disease Inception Date
no. Yrs Proposer
1 Ajeet Singh M 02/07/1993 28 SELF 24719501-1 No PED 13/09/2018
declared
2 Reeta Singh Bhadauria F 08/07/1993 28 SPOUSE 24719501-2 No PED 15/09/2018
declared
3 Garvit M 08/12/2013 7 DEPENDANT CHILD 24719501-3 No PED 15/09/2018
declared
4 Sarthak Bhadauria M 15/03/2019 2 DEPENDANT CHILD 24719501-4 No PED 15/09/2019
declared

Entered by : STAR_PORTAL For Star Health and Allied Insurance Company Ltd.
Approved by : SH29449

IRDAI Regn. No 129

Authorised Signatory
Corporate Identity Number U66010TN2005PLC056649
Email ID : [email protected]
2 of 7

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
Attached to and forming part of Policy No : P/161100/01/2022/028422

Please check whether the details given by you about the insured persons in the proposal form are incorporated correctly in the policy schedule. If
you find any discrepancy, please inform us within 15 days from the date of receipt of the policy, failing which the details relating to the insured
person given in the policy schedule are deemed to have been accepted by you.
Warranted that in case of dishonor of premium cheque(s), the Company shall not be liable under the policy and the policy shall be void abinitio
(from inception).

THE INSURANCE UNDER THIS POLICY IS SUBJECT TO CONDITIONS, CLAUSES, WARRANTIES, EXCLUSIONS ETC.,
ATTACHED.
IMPORTANT
IN THE EVENT OF HOSPITALIZATION OF INSURED PERSON, INTIMATION SHOULD BE GIVEN TO THE COMPANY IMMEDIATELY,
HOWEVER, WITHIN 24 HRS FROM THE TIME OF ADMISSION.
Sector Classification :

Urban

Toll Free No: 1800 425 2255/1800 102 4477 Email: [email protected], Fax No: 1800 425 5522

Nominee Details

Nominee Details for the proposer Appointee Details

S.No. Name Relationship Age % Appointee Relationship

Age
with proposer Name with Nominee

1 Reeta Singh Bhadauria Spouse 28 100

Entered by : STAR_PORTAL For Star Health and Allied Insurance Company Ltd.
Approved by : SH29449

Authorised Signatory

3 of 7

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
Attached to and forming part of Policy No : P/161100/01/2022/028422

Continuity Benefits applicable is as follows

30 Days 1st Year First Two

S.No. Name Of the Insured Id Card No Pre Existing
Waiting Period Exclusions Year Disease
Exclusion

1 Ajeet Singh 24719501-1 Waived Waived Covered

Not
Applicable

2 Reeta Singh 24719501-2 Waived Waived Covered

Not
Bhadauria
Applicable

3 Garvit 24719501-3 Waived Waived Covered

Not
Applicable

4 Sarthak 24719501-4 Waived Waived Covered

Not
Bhadauria
Applicable

"A waiting period apply as fresh from the date of enhancement for the increase in the sum insured, that is, the difference between the
expiring policy sum insured and the increased current sum insured".

In witness whereof the undersigned being authorised by and on behalf of the company has set his hand at Area Office - Delhi on 31st Day
of October 2021.

Permanent Exclusion Details

Insured Name ID Card Permanent Exclusion Disease

Entered by : STAR_PORTAL For Star Health and Allied Insurance Company Ltd.
Approved by : SH29449

Authorised Signatory

4 of 7

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
 Star Health and Allied Insurance
Company Limited
Emergency Help Line No. 1800 425 2255 / 1800 102 4477
e-mail : [email protected] Website : www.starhealth.in Customer Identity Card

Please quote the Customer Id No. for assistance Customer ID No. : 24719501-2
This Card is valid until otherwise Cancelled. Name : Reeta Singh Bhadauria
This ID Card is invalid, if the insurance cover is not in force Date Of Birth : 08-JUL-93 Age : 28 Years
Immediate intimation to 'Star' through above Tel Nos. is a must
Gender : Female Office Code : 161100
in case of Hospitalisation.
At the time of hospitalization, kindly submit any Government Valid From : 14-NOV-21 TA/SSM/SM Code : SH63356
approved photo ID Card. Agent/Broker/TE Code : BA0000457450
Corporate Identity Number: U66010TN2005PLC056649 IRDAI Regn. No:129

Star Health and Allied Insurance Star Health and Allied Insurance
Company Limited Company Limited
Customer Identity Card Customer Identity Card

Customer ID No. : 24719501-3 Customer ID No. : 24719501-4

Name : Garvit Name : Sarthak Bhadauria
Date Of Birth : 08-DEC-13 Age : 7 Years Date Of Birth : 15-MAR-19 Age : 2 Years
Gender : Male Office Code : 161100 Gender : Male Office Code : 161100
Valid From : 14-NOV-21 TA/SSM/SM Code : SH63356 Valid From : 14-NOV-21 TA/SSM/SM Code : SH63356
Agent/Broker/TE Code : BA0000457450 Agent/Broker/TE Code : BA0000457450
IRDAI Regn. No:129 IRDAI Regn. No:129

Star Health and Allied Insurance

Company Limited
Customer Identity Card

Customer ID No. : 24719501-1

Name : Ajeet Singh
Date Of Birth : 02-JUL-93 Age : 28 Years
Gender : Male Office Code : 161100
Valid From : 14-NOV-21 TA/SSM/SM Code : SH63356
Agent/Broker/TE Code : BA0000457450

IRDAIIRDAI
Regn. Regn.
No:129No:129

Entered by : STAR_PORTAL For Star Health and Allied Insurance Company Ltd.
Approved by : SH29449

Authorised Signatory

5 of 7

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
 TAX Invoice

Invoice No. : 7G061Y22P0003901 Customer ID : AA0021470514

Invoice Date : 31/10/21 Policy No : P/161100/01/2022/028422
Recipient Supplier

GSTIN : - GSTIN : 07AAJCS4517L1Z0

Proposer's : Ajeet Singh NAME : Star Health and Allied Insurance Co Ltd
Name - Area Office - Delhi
Address : C-2/111 Nagli Vihar Extension Address : 1st Floor, Himalaya House, 23,
Baaprola Kasturba Gandhi Marg,
New Delhi - 110001.

City : New Delhi,South West,Delhi- City : DELHI

110043
State : Delhi State : Delhi
Pincode : 110043 Pincode : 110 054
Client Category : IND Place of Supply : 7 - Delhi

HSN / Description of Total Discount TaxableValue IGST @ 18% CGST @9% UT/SGST@9% CESS@1% Total Invoice Value
SAC Service(s) G=C*Cess H =C+D+E +F+G
Code A B C=A-B D = C * IGST E=C F=C
*CGST *UTGST or
SGST

997133 Insurance 11010 0 11010 991 991 Rs. 12992

Services
Total Invoice Value (in Figures) : Rs. 12992
Total Invoice Value (in Words) : Rupees: Twelve thousand nine
hundred ninety-two only
Amount of Tax Subject to reverse Charge : No

Important Note:

The invoice is issued as per Section 31 of the CGST Act

In case no GSTIN or incorrect GSTIN is provided by the Proposer at Proposal stage, Star Health and Allied Insurance Co Ltd shall not be
responsible for any Input Tax Credit losses and no subsequent revision of invoice will be undertaken.

E. & O.E
This is a digitally signed document and hence no physical signature is required

IRDAI Regn. No 129 Corporate Identity Number U66010TN2005PLC056649 Email ID : [email protected]

Entered by : STAR_PORTAL For Star Health and Allied Insurance Company Ltd.
Approved by : SH29449

Authorised Signatory

6 of 7

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
 Name Of the Product YOUNG STAR INSURANCE POLICY
Product UIN No. SHAHLIP22036V042122
Summary of Important Benefits
Benefit Limits (in Rs.) Refer to Policy
Particulars of Coverage / clause No.
S.No
Benefits Individual and Floater
Individual
Sum Insured (in Rs.) 300000/- 500000/- 1000000/- 1500000/- 2000000/- 2500000/- 5000000/- 7500000/- 10000000/-
1 Plan Type Silver Plan

Room Rent (Per Day) - Up to

2 *Hospitalization expenses will be
considered in proportion to the eligible Single Private A/c Room II(A)
Room Rent
Surgeon, Anesthetist, Medical
3 Practitioner, Consultants, Specialist
Fees, Anesthesia, blood, oxygen,
operation theatre charges, Surgical Actual II(B & C)
Appliances, Medicines and Drugs

4 Road Ambulance charges(per policy

period) Actuals
II(D)

5 Pre-Hospitalization Expenses Up to 60 days prior to admission II(E)

6 Post-Hospitalization Expenses Up to 90 days from the date of discharge II(F)

7 Day Care Procedure All day care procedure covered. II(G)

8 Medical Opinion E -Medical Opinion" from the Company's expert panel. II(H)
Sum Insured/policy type Rs3,00,000/- Rs5,00,000/- Rs10,00,000/- Rs15,00,000/-and above
9. Health Check Individual 1,500/- 2,000/- 3,000/- 3,500/- II(I)
up
Floater N/A 3,000/- 4,000/- 5,000/-

10 Automatic Restoration of Basic Sum II(J)

Once during policy period by 100%
Insured
The insured person will be eligible for Cumulative bonus calculated at 20% of basic sum insured for each claim
11 Cumulative bonus free year subject to a maximum of 100% of the basic sum insured. II(K)

Additional Basic Sum Insured for Road 25% of the Sum Insured subject to a
12 II(L)
Traffic Accident (RTA) maximum of Rs10,00,000/-

13 Star Wellness Program Discount in the Renewal premium for healthy life style through wellness activities. II(M)

14 Special Features 10% Discount at the time of renewal after 40years of age. V(22 A)

15. Coverage for Modern Treatment Covered up to the limits II(N)

16. Instalment Facility (If Opted) Available V(13)

Note: The above information is only indicative. For complete details of the Terms & Conditions kindly read the policy wordings attached.

Entered by : STAR_PORTAL For Star Health and Allied Insurance Company Ltd.
Approved by : SH29449

Authorised Signatory

7 of 7

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