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    Receipt Doc

    Uploaded by

    Upasana Ashok Patil
    This receipt summarizes a payment made by Ms. Upasana Ashok Patil towards an online insurance policy premium. The customer paid Rs. 17,700 via credit card to Star Health and Allied Insurance Co. Ltd on January 19, 2023 for proposal reference number R/171119/01/2023/019771. The payment was collected at the company's Branch Office in Goregaon, Mumbai.

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    © All Rights Reserved
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    Receipt Doc

    Uploaded by

    Upasana Ashok Patil
    63 views1 page
    This receipt summarizes a payment made by Ms. Upasana Ashok Patil towards an online insurance policy premium. The customer paid Rs. 17,700 via credit card to Star Health and Allied Insurance Co. Ltd on January 19, 2023 for proposal reference number R/171119/01/2023/019771. The payment was collected at the company's Branch Office in Goregaon, Mumbai.

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    Original Title

    196933389_RECEIPT_DOC

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    This receipt summarizes a payment made by Ms. Upasana Ashok Patil towards an online insurance policy premium. The customer paid Rs. 17,700 via credit card to Star Health and Allied Insurance Co. Ltd on January 19, 2023 for proposal reference number R/171119/01/2023/019771. The payment was collected at the company's Branch Office in Goregaon, Mumbai.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    63 views1 page

    Receipt Doc

    Uploaded by

    Upasana Ashok Patil
    This receipt summarizes a payment made by Ms. Upasana Ashok Patil towards an online insurance policy premium. The customer paid Rs. 17,700 via credit card to Star Health and Allied Insurance Co. Ltd on January 19, 2023 for proposal reference number R/171119/01/2023/019771. The payment was collected at the company's Branch Office in Goregaon, Mumbai.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    Branch Office - Goregaon 2nd Floor, North Nalanda Samant Compound Near Sai Veg World Restaurant , Opp.

    Goregaon
    Railway Station Goregaon E Mumbai 400063. , , GOREGAON , 400063
    Collection Receipt
    Customer Code : AA0010690461

    Received from : Ms.UPASANA ASHOK PATIL


    Customer Address : ROOM NO-1282 ADIVASHI KATKARI PADA OPP.RUPALI Collection No : 11-01/1274019187
    TRADERS RABALE NAVI MUMBAI
    GHANSOLI THANE- Collection Date : 19/01/2023

    - Office Code : 171119 - Branch Office - Goregaon


    Supplier GSTIN : 27AAJCS4517L1ZY

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

    Amount Collected : Rs. 17700 /- Inclusive of tax :

    Amount in words : Indian Rupees Seventeen Thousand Seven Hundred 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/171119/01/2023/019771 SH12256 BA0000251699 17700 CC VISA 16623546231 19/01/2023

    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=R Margabandhu,

    R Margabandhu
    SERIALNUMBER=00f82dcf76fdf6537e3331f8479ef45e7b4f3861b15
    475488cdf3b2c3c26c3c9, ST=TAMIL NADU, OID.2.5.4.17=600034,
    OID.2.5.4.20=513b7b33f2ce960f23148ea208744690e09638750806
    ca65f89e15179f5fe50a, OU=UNDERWRITING - Chief Risk Officer,
    O=STAR HEALTH AND ALLIED INSURANCE COMPANY, C=IN.
    Date :Thu Jan 19 10:06:38 IST 2023

    IRDA Regn. No 129 Corporate Identity Number L66010TN2005PLC056649 Email id : [email protected]

    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 :[email protected] Website :www.starhealth.in IRDAI Regn.no: 129

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