Area Office - Ranchi No:404, 4th Floor,Modi Heights phase- II, , Opposite All India Radio Station, , Ratu

Road,Ranchi-834001
Jharkhand , , 834001
Advance Premium Receipt
Customer Code : AA0007462033

Received from : Miss.ISHITA CHATTERJEE

Customer Address : D/O: SUBHASH CHANDRA CHATTERJEE Collection No : 11-01/1243003986

ROAD NO-5, VILL- SHASTRI NAGAR, KABRISTAN KA BAGAL Collection Date : 16/09/2019
BASTI ROAD,
MISIRGONDA, ALIAS, PAHAR GONDA, PS-GONDA, RANCHI Office Code : 231200 - Area Office - Ranchi

Supplier GSTIN : 20AAJCS4517L1ZC

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

Amount Collected : Rs. 5994 /- Inclusive of tax :

Amount in words : Indian Rupees Five Thousand Nine Hundred Ninety-Four 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/231200/01/2020/003090 SH19780 BA0000234304 5994 CC BANK 190916611988 16/09/2019

550368

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=PVS Lakshmiprasad,

PVS SERIALNUMBER=9e461d073974cff564ee9ba39dcb9f6c1b1fe484d
e3bff77fe99ff653e852cf9, ST=TAMIL NADU, OID.2.5.4.17=600034,
OID.2.5.4.20=3fbc716070e67ba3c9fed3530e1e3d7e9732722433b0
b08c8ac802f047aae330, OU=Technical, O=STAR HEALTH AND

Lakshmiprasad ALLIED INSURANCE COMPANY LIMITED, C=IN. Date :Mon Sep

16 10:14:57 IST 2019

IRDA Regn. No 129 Corporate Identity Number U66010TN2005PLC056649 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
:U66010TN2005PLC056649 Email :support@starthealth.in Website :www.starhealth.in IRDAI Regn.no: 129