Star Health And Allied Insurance Company Limited

Date : 05-Dec-2024
To, IMPORTANT

VEERABHADRA RAO PUNYAMANTHULA ,

2-1-64/A GANDU VARI VEEDHI
AGRAHARAM

Pithapuram Mandal,Andhra Pradesh-533450

Mobile : 9502955443

Dear Customer,

Re: Health Insurance Policy - 11251429523400

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.
This insurance policy is subject to various exclusions including exclusion for pre-existing diseases and conditions in this policy.
If there is suppression of any material fact in the proposal, the contract shall become null and void abinitio.

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 30 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,

Authorized Signatory

This is an electronically generated document(Policy

Schedule).

Page 1 of 8

Regd.&Corporate Office:1,New Tank Street,Valluvar Kottam High Road,Nungambakkam,Chennai - 600034,Phone : 044 -28302700 / 28288800
CN=NAGARAJAN RANGANATHAN,
NAGARAJAN
Toll Free No:1800-425-2255 / 1800-102-4477,CIN : L66010TN2005PLC056649 Email :[email protected] Website :www.starhealth.in
SERIALNUMBER=571a5eb638953f23a816eb6b4ba547263f54f12c3eb01eeff
e482ca5cef2a530, ST=KARNATAKA, OID.2.5.4.17=560097,
IRDAI Regn.no: 129
OID.2.5.4.20=6790b30666b75b5b38bb63bf7adee63ad3d22e5d7442f0f2901f
RANGANATHAN 2e91fd09c393, OID.2.5.4.65=3d419b0bb1a244e29097659c201722ac,
O=PERSONAL, C=IN. Date :Fri Dec 06 01:00:18 IST 2024
 Star Health And Allied Insurance Company Limited

Super Star
Unique Identification No. SHAHLIP25036V012425
POLICY SCHEDULE(Floater)
Policy No. : 11251429523400 Previous Policy No :
Customer Code : PI0007266172 GSTIN : 37AAJCS4517L1ZX
Customer Name : VEERABHADRA RAO SAC Code : 997133 / Accident and Health
Cust CKYC No : PUNYAMANTHULA
- Insurance Services

Proposer Code : PI0007266172 Issuing Office Code : 700022

Proposer Name : KRANTI KUMAR Issuing Office Name : Telesales - Visakhapatnam
PUNYAMANTHULA
Proposer Address : 2-1-64/A GANDU VARI VEEDHI Issuing Office Address : Balaji Mangalagiri Chambers,
AGRAHARAM D No.9-14-6,
4th Floor, Flat 5C, VIP Road,
Pithapuram Mandal Andhra Pradesh Opp Building Association of
533450 India Office,
Visakhapatnam Urban Andhra
Pradesh 530003
Phone No : 9502955443 Phone No : 0891-4822144
E-mail Id : [email protected] E-mail Id : [email protected],
Proposer GSTIN : NO Place of Supply : Andhra Pradesh
Proposal Date : 05-Dec-2024 Fulfiller Code : SO700022
Date of Inception : 05-Dec-2024
of first policy
Policy Category : New
Collection No : 700022/RV/2025/0178655768

Collection Date : 05-Dec-2024

Base Product Premium : Rs. 26,529/-
Life Style and Habit : Rs. 3,834/-
Name : Office Direct
related & Other discounts

Medical U/W Loading : Rs. 0/-

EMI Loading : Rs. null/-

Optional Cover : Rs. 11,806/-

Loading
Optional Cover : Rs. 0/-
Discount

CGST @ 9% : Rs. 3,105/-

Phone No :0891-4822144
:
SGST @ 9% Rs. 3,105/-
E-mail Id : yamala.rao@starhealth
.in,
Total Premium : Rs. 40,712/-
Stamp Duty : Re. 1/-

Total Premium In Words : Rupees Forty thousand seven hundred twelve only
Period of Insurance : From : 05-Dec-2024 14:04 Hrs To : Midnight of 04-Dec-2025 Policy Term :1 Year
Installment Facility Option:No Premium Payment Frequency :Annual Installment Amount Rs. : 0/-

Entered by : CRM This is an electronically generated document(Policy For Star Health and Allied Insurance Company Ltd.
Approved by : CRM Schedule).

IRDAI Regn.No.129

Corporate Identity Number L66010TN2005PLC056649

Authorised Signatory Page 2 of 8
Email ID: [email protected]

Regd.&Corporate Office:1,New Tank Street,Valluvar Kottam High Road,Nungambakkam,Chennai - 600034,Phone : 044 -28302700 / 28288800
Toll Free No:1800-425-2255 / 1800-102-4477,CIN : L66010TN2005PLC056649 Email :[email protected] Website :www.starhealth.in
IRDAI Regn.no: 129
 Star Health And Allied Insurance Company Limited

Attached to and forming part of Policy No: 11251429523400

Scheme Description (Family Size) :2A Basic Floater Sum Insured : Rs. 10,00,000/-
Total Sum Insured In Words : Rupees Ten lakhs only
Plan Type: FLOATER Bonus : Rs. 0/-

Details of Insured Persons : No. of Persons Insured : 2

Sl. Age in Relationship
Name of the Insured Gender Date of Birth ID Card No Inception date
no. Yrs with Proposer
VEERABHADRA RAO
1 PUNYAMANTHULA Male 01-Jan-1965 59 Self PI0007266172 05-Dec-2024

Pre Existing Disease : Diabetes Mellitus and its complications

Hypertension and its complications
PUNYAMANTHULA LAKSHMI
2 Female 01-Jan-1971 53 Spouse ME0458274326 05-Dec-2024

Pre Existing Disease : Hypertension and its complications

Entered by : CRM This is an electronically generated document(Policy For Star Health and Allied Insurance Company Ltd.
Approved by : CRM Schedule).

Authorised Signatory Page 3 of 8

Regd.&Corporate Office:1,New Tank Street,Valluvar Kottam High Road,Nungambakkam,Chennai - 600034,Phone : 044 -28302700 / 28288800
Toll Free No:1800-425-2255 / 1800-102-4477,CIN : L66010TN2005PLC056649 Email :[email protected] Website :www.starhealth.in
IRDAI Regn.no: 129
 Star Health And Allied Insurance Company Limited

Name of the optional cover-Status

S. VEERABHADRA RAO PUNYAMANTHULA

Name of the optional cover NA NA NA NA
No PUNYAMANTHULA LAKSHMI

1 Quick Shield Opted Opted NA NA NA NA

2 Personal Accident Cover Not Opted Not Opted NA NA NA NA

Reduction of PED Waiting Period

3 (from 36 months)
Not Opted Not Opted NA NA NA NA

S.
Name of the optional cover Status
No

1 Smart Network Not Opted

Coverage for Non-Medical Items (Consumables cover Table I (68

2 Opted
items))

3 Future Shield Not Opted

Delivery Expenses Not Opted

4 Maternity Expenses

Assisted Reproduction Treatment Not Opted

5 Women Care Not Opted

6 High-end Diagnostics Not Opted

7 Annual Health Check-up Opted

Voluntary Co-payment
8 10% /20% /30% /40% /50% Not Opted

9 Voluntary Deductible 10k/ 25k/ 50k/ 1L/ 2L/ 3L /4L /5L Not Opted

10 Room Rent Modification Not Opted

11 E- International Second Opinion Not Opted

12 Durable Medical Equipment Cover Not Opted

13 Compassionate Visit Not Opted

14 Hospital Cash(0 day deductible) Not Opted

Reduction of Specific Diseases Waiting

15 Not Opted
Period

16 Limitless Care Not Opted

17 Super Star Bonus (Guaranteed Bonus) Not Opted

Entered by : CRM This is an electronically generated document(Policy For Star Health and Allied Insurance Company Ltd.
Approved by : CRM Schedule).

Authorised Signatory Page 4 of 8

Regd.&Corporate Office:1,New Tank Street,Valluvar Kottam High Road,Nungambakkam,Chennai - 600034,Phone : 044 -28302700 / 28288800
Toll Free No:1800-425-2255 / 1800-102-4477,CIN : L66010TN2005PLC056649 Email :[email protected] Website :www.starhealth.in
IRDAI Regn.no: 129
 Star Health And Allied Insurance Company Limited

18 NRI Advantage Not Opted

Nominee Details:
Nominee Details for the Proposer Appointee Details
S.No Name Relationship Age % of the Appointee Name Appointee Relationship
with proposer claim Age with nominee

1 PUNYAMANTHUL Self 29 100

A KRANTI
Sector Classification:
Urban

Please check whether the details given by you about the insured person(s) 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.

Toll Free No : 1800 425 2255 Email: [email protected]

In witness whereof the undersigned being authorized by and on behalf of the company has set his hand at
Telesales - Visakhapatnam on 05th Day of December 2024.
As per Section 34 of CGST Act of 2017, Policy Issued in one Financial Year and Cancelled in another Financial Year
on or after 01st of December, then Only Premium Amount will be Refunded to the Customer and GST Amount will
Not be Refunded. Customer has to Claim the Refund of GST Amount from the GST Portal.

Entered by : CRM This is an electronically generated document(Policy For Star Health and Allied Insurance Company Ltd.
Approved by : CRM Schedule).

Authorised Signatory Page 5 of 8

Regd.&Corporate Office:1,New Tank Street,Valluvar Kottam High Road,Nungambakkam,Chennai - 600034,Phone : 044 -28302700 / 28288800
Toll Free No:1800-425-2255 / 1800-102-4477,CIN : L66010TN2005PLC056649 Email :[email protected] Website :www.starhealth.in
IRDAI Regn.no: 129
 Star Health And Allied Insurance Company Limited

Star Health and Allied Insurance

Company Limited
Customer Identity Card
Policy No : 11251429523400

Name DOB Gender Customer id

VEERABHADRA RAO
PUNYAMANTHULA 01-Jan-1965 Male PI0007266172

PUNYAMANTHULA LAKSHMI
01-Jan-1971 Female ME0458274326

Valid From : 05-Dec-2024 Valid Till : 04-Dec-2025

Office Code : 700022 Agent/Broker/TE Code : OD700022

TA/SSM/SM Code : SO700022

IRDAI Regn.No:129

Emergency Help Line No.1800 425 2255/1800 102 4477

e-mail : [email protected] Website : www.starhealth.in

Please quote the Customer Id No. for assistance

This ID Card is invalid,if the insurance cover is not in force.

Immediate Intimation to 'Star' through above Tel Nos. is a must in case of

Hospitalisation.

At the time of hospitalisation,kindly submit any Government approved photo ID

Card.

Corporate Identity Number : L66010TN2005PLC056649

Entered by : CRM This is an electronically generated document(Policy For Star Health and Allied Insurance Company Ltd.
Approved by : CRM Schedule).

Authorised Signatory Page 7 of 8

Regd.&Corporate Office:1,New Tank Street,Valluvar Kottam High Road,Nungambakkam,Chennai - 600034,Phone : 044 -28302700 / 28288800
Toll Free No:1800-425-2255 / 1800-102-4477,CIN : L66010TN2005PLC056649 Email :[email protected] Website :www.starhealth.in
IRDAI Regn.no: 129
 Star Health And Allied Insurance Company Limited

Tax Invoice
Invoice No. : 372412I002772062 Customer ID : PI0007266172
Invoice Date : 05-Dec-2024 Policy No. : 11251429523400
Recipient Supplier
GSTIN : GSTIN : 37AAJCS4517L1ZX
Name : VEERABHADRA RAO PUNYAMANTHULA Name : Star Health and Allied Insurance Co Ltd -
Telesales - Visakhapatnam
Address : 2-1-64/A GANDU VARI VEEDHI Address : Balaji Mangalagiri Chambers, D No.9-14-6,
AGRAHARAM 4th Floor, Flat 5C, VIP Road,
Opp Building Association of India Office,
City : Pithapuram Pin Code : 533450 City : Visakhapatnam Pin Code : 530003
Mandal Urban

State : Andhra Pradesh Client : IND State : Andhra Pradesh Place of : Andhra Pradesh
Category supply

Taxable IGST @ UT/SGST @ CESS @ Total Invoice

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

Insurance
997133 34,502.00 0 34,502.00 0 3,105.00 3,105.00 0 40,712.00
Services

Total Invoice Value (in Figures) : Rs. 40,712/-

Total Invoice Value (in Words) : Rupees Forty thousand seven hundred twelve 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
"I/We hereby declare that though our aggregate turnover in any preceding financial year from 2017-18 onwards is more than the aggregate
turnover notified under sub-rule (4) of rule 48, we are not required to prepare an invoice in terms of the provisions of the said sub-rule."
E. & O.E
This is a digitally signed document and hence no physical signature is required

IRDAI Regn.No.129 Corporate Identity Number L66010TN2005PLC056649 Email ID: [email protected]

Entered by : CRM This is an electronically generated document(Policy For Star Health and Allied Insurance Company Ltd.
Approved by : CRM Schedule).

Authorised Signatory Page 8 of 8

Regd.&Corporate Office:1,New Tank Street,Valluvar Kottam High Road,Nungambakkam,Chennai - 600034,Phone : 044 -28302700 / 28288800
Toll Free No:1800-425-2255 / 1800-102-4477,CIN : L66010TN2005PLC056649 Email :[email protected] Website :www.starhealth.in
IRDAI Regn.no: 129