RENEWAL NOTICE

Policy No : P/161121/01/2018/014285
February 26, 2019

Mr.ANKIT NATH SAXENA 161121 - Branch Office - Noida

B - 14/01 , HIMGIRI APARTMENT Office No-606/607
SEC. - 34 6th Floor, P3, Krishna Apra Plaza,
NOIDA Sector-18, Noida-201301
Noida,Gautam Buddha Nagar,Uttar Pradesh-201301 0120-6618401, 02, 03
9871673274 / /ankitnsaxena@gmail.com noida@starhealth.in

Proposer/Cust Code : 6771112 / AA0004813997 Reference No : R/161121/01/2019/019869 - Direct Receipt

Dear Customer,
We value your relationship with us and thank you for the same.We wish to bring to your kind notice that your Star Comprehensive Insurance
Policy is due for renewal on 19/03/2019. The renewal premium, including Tax, works out to Rs.22550/- as per details given below.

Relationship Sum Premium

Age
S. No Name of the Insured Date Of Birth with Insured (Rs.)
(years)
proposer (Rs.)

1 Mr.ANKIT NATH SAXENA 08/06/1983 35 SELF 1000000 19110

2 PALLAVI NIGAM SAXENA 20/11/1985 33 SPOUSE
3 AVYAN NATH SAXENA 18/02/2014 5 DEPENDANT CHILD
GST@ 18% 3440
Total Renewal Premium 22550

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.22550/- on or before 18/03/2019. 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 benef
''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''.
Mobile Number : Email id :
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: 161121 SD CODE/SD161121

For Star Health and Allied Insurance Company Limited Phone No : 4514000/01/05
Fulfiller Name/Code : Mr.SANDEEP KUMAR/SH24807
Phone No : 7503449260
Authorised Signatory

IRDA Regn. No 129 Corporate Identity Number U66010TN2005PLC056649 Email ID : info@starhealth.in

Star Health and Allied Insurance Co.Ltd

Spot Acknowledgement
Acknowledged hereby receipt of Cash / Cheque / DD No.____________________ Dt _____________ for Rs. __________/- drawn on _____________
from Mr./Mrs/Ms._____________________________ towards premium for the renewal of Policy No. _________________________. A system generated
"Advance Premium Receipt" for this payment will follow from our office, which is subject to realization of the cheque.

_________________________________ ______________________________
Name & Code of the Authorised Person Signature of Authorised Person
Place:
Date: