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STAR HEALTH AND ALLIEDiNSURANCE CO LTDBranch《〕ffice‥ Sh:rnoga D‥ Block,lst F:oor,Basava Sadana,,Nehru Road,Shirnoga… 577201., , ,577201

Advance Premium Receipt

Office Code

Collection No

Collection Date

Received with thanks from Sh./Smt./M/s.

Sum Of Rs.

141121-Branch Ofrce― ShimOga

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04/07ノ2013

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STAR HEALTH AND ALLIED INSURANCE CO LTD

Branch Office - shlmoga D - Block,lst Floor,Basava Sadana, , Nehru Road,Shimoga ' 577 2O1. ' ' ' 577 2O1

Advance Premium Recelpt lY4-orflca cod. : 141i21 -B€nch ornc€ - shimosa Banr cod€ eloo(cr4r121.ol) Ef1!lii-col€crion No : 11-ot/1oe30oo838 sorvicc rElr Resn No ] AAJcs4siTLSrool

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O,$No. cod. ttams i;i- - t{o E1 04 -JUL.,3 732761 732761 2,E2A-OO C 80@ AA0OO0()O00O1 01 CHO 255251 03/07/0013 I

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