Star Health And Allied Insurance Company Limited
Indra Arcade,# 81 1st floor, Dr Rajkumar Road Prakashnagar,
3rd Stage, Rajaji Nagar
Bengaluru City Karnataka-560021
Phone: 080-49438000 Telefax:
Collection Receipt
Customer Code
Received From
Customer Address
: 32878251
Collection No
: GOPALAKRISHNA K G .
Collection Date
: No 253, Opp Ramamandira,
Office Code
Kudur, Magadi Taluk,
Ramanagara Dist,
GSTIN
Magadi Taluk Karnataka 561101 Place of Supply
: 963XXXXX30
Type of proposal
Customer mobile
number
Customer GSTIN
: NO
State Code
Amount Collected
: Rs. 19,676/Amount in words
: INDIAN RUPEES Nineteen thousand six hundred
Towards the Following : Amount Receipted towards Premium
Sr.
Proposal
Fulfiller Intermediary Amount
Mode of
No
Ref. No
Code
Code
Collected payment
(Rs)
1 61240199594 SH44115 BA0000345558 19,676/Payment
3
Gateway
: 141123/RV/2024/0111826474
: 01-Mar-2024
: 141123 - Branch Office Rajaji Nagar
: 29AAJCS4517L1ZU
: Karnataka
: Renewal
: 29
seventy six only
Bank
Name
CHQ/CC/DD CHQ/DD/BC
No
Dt.
Legacy
Bank
Branch
240301135320 01-Mar-2024
199577
For Star Health and Allied Insurance Co. Ltd.
Authorised Signatory
Note : Receipt Subjected 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.
“Available modes of payments of Premium: Cash, Cheque, DD, Net Banking, RTGS/NEFT, Credit Card, Debit
Card, UPI, Payment Gateway(PAYTM, PAYU, AIRPAY, BBPS, CSC, UBONA).”
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IRDA Regn.No.129
Corporate Identity Number L66010TN2005PLC056649
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 : L66010TN2005PLC056649 Email :support@starhealth.in
Website :www.starhealth.in IRDAI Regn.no: 129