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Health
Insurance
HealthInsurance
STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITEDRegd. & Corporate Office: 1, New Tank Street, Valluvar Kottam High Road, Nungambakkam,
Chennai - 600 034. « Phone : 044 - 28288800 « Email : support@starhealth.in
Website : www.starhealth.in « CIN : U66010TN2005PLC056649 « IRDAI Regn. No. : 129
Proposal Form No.:
YOUNG STAR INSURANCE POLICY
Unique Identification No.: SHAHLIP20132V011920
Proposal Form - Unique Reference No.: SHAI/PR0048
Ref. No. The company will not be on risk until the proposal has been accepted and full payment of premium has been received. Please fill up the form in block letters.Policy No.
Policy Issuing Office : SM CODE SM NAME
AGENT /SPECIFIED PERSON / BROKER / IMF CODE
AGENT /SPECIFIEDPERSON /BROKER / IMF NAME
Name of the Proposer Mr / Mrs / Ms.
Date of Birth DD/MM/YYYY
Occupation of the Proposer
Annual Income Rs.
Residential Address:
Office Address:
Email ID Mobile Number
Policy Term (Please P) c 1 Year / c 2 Years Period of Insurance From: To:
GST Number PAN Number
Nominee’s NameRelationship to the Proposer
Date of Birth Age in Yrs
DD/MM/YYYY
Name of the Appointee(if nominee is a minor)
Relationship to the Nominee
Date of Birth Age in Yrs
DD/MM/YYYY
(Incase of Multiple nominees a separate form containing nominee details should be enclosed duly specifying the % to each nominee)
Policy Type (Please P) c Individual c Floater Plan Type (Please P) c Silver c Gold
For policy type on Individual basis : Please see page no.2
Sum Insured Rs. in Lakhs* : ________________________________________________________________________________________
Family Size (A=Adult, C=Child) (Please P) : q 1A q 1A+1C q 1A+2C q 1A+3C q 2A q 2A+1C q 2A+2C q 2A+3C
* please check brochure for the available sum insured options
Do you want to pay the premium in Instalments (Only on ECS mode): c YES c NO Instalment option is not available for 2 year term
If yes choose Instalment options available for 1 year term c Monthly c Quarterly c Halfyearly
Premium can also be paid: Annually for 1 year term / Biennial for 2 year term
I would like to receive my insurance policy and all the information related to the proposed insurance policy through insurance repository Yes / Non n
If you already have an e-Insurance Account (eIA) number, kindly provide e-Insurance Account (eIA) number _____________________________________
If you don't have an e-Insurance Account (eIA) number, choose any one Insurance Repository
c KARVY c CAMSRep - CAMS Insurance Repository & Services c CIRL - Central Insurance Repository Limited c NDML - NSDL Data Management Services limited
Bank Details of the Proposer
Account Number Type of Account : q SB q CA q Others please specify______________
Name of the Bank Name of the Branch IFSC Code
Please attach a photo copy of cancelled cheque leaf of the above Bank Account.
Payments Details Annual Premium Rs.
Mode of Payment Cash / Cheque / DD / Credit Card / Debit Card / NEFT / CC Mandate / ECS (Please fill the enclosed ECS form)
Cheque / DD No. Date Drawn on Branch
Please attach any one proof of Date of Birthq Birth Certificate q Voter ID q PAN Card
q Driving License q Aadhar Card q Any other Govt. Recognised Proof
STA
R H
EA
LTH
AN
D A
LL
IED
IN
SU
RA
NC
E C
OM
PA
NY
LIM
ITE
D
Acknow
ledgem
ent
Rec
eive
d th
e pr
opos
al f
or _
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
__ p
olic
y fr
om M
r/ M
rs/
Ms.
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
__ a
long
with
pay
men
t of
R
s___
____
____
____
__/-
by
Cas
h / v
ide
Che
que/
DD
No.
___
____
____
____
____
____
____
dt._
____
____
____
____
____
____
dra
wn
on _
____
____
____
____
____
____
____
. The
Cas
h/C
hequ
e gi
ven
by y
ou is
ban
ked
for
oper
atio
nal c
onve
nien
ce a
nd b
anki
ng o
f the
Cas
h/C
hequ
e do
es n
ot m
ean
acce
ptan
ce o
f ris
k by
us.
The
rec
eipt
of
the
Cas
h/C
hequ
e w
ill a
lso
be a
ckno
wle
dged
by
our
offic
e vi
de a
dvan
ce p
rem
ium
rec
eipt
. If
the
prop
osal
is a
ccep
ted,
the
cov
er w
ill c
omm
ence
fro
m t
he d
ate
of t
he a
dvan
ce p
rem
ium
rec
eipt
, su
bjec
t to
rea
lizat
ion
of t
he
Che
que.
If th
e pr
opos
al is
not
acc
epte
d, th
e am
ount
pai
d w
ill b
e re
fund
ed. C
onta
ct o
ur o
ffice
, in
case
pol
icy
is n
ot r
ecei
ved
with
in 1
5 da
ys fr
om th
e da
te o
f pay
men
t of p
rem
ium
.N
ame
& C
od
e o
f th
e
Sig
nat
ure
of
the
D
ate:
P
lace
: au
tho
rise
d p
erso
n:
a uth
ori
sed
per
son
:
1. I
here
by d
ecla
re, o
n m
y be
half
and
on b
ehal
f of a
ll pe
rson
s pr
opos
ed to
be
insu
red,
that
the
abov
e st
atem
ents
, ans
wer
s an
d/or
par
ticul
ars
give
n by
me
are
true
and
com
plet
e in
all
resp
ects
to th
e be
st o
f my
know
ledg
e an
d th
at I
am a
utho
rized
to p
ropo
se o
n be
half
of
thes
e ot
her
pers
ons.
2.
I un
ders
tand
tha
t th
e in
form
atio
n pr
ovid
ed b
y m
e w
ill f
orm
the
bas
is o
f th
e in
sura
nce
polic
y is
sub
ject
to
the
Boa
rd a
ppro
ved
unde
rwrit
ing
polic
y of
the
insu
rer
and
that
the
pol
icy
will
com
e in
to f
orce
onl
y af
ter
full
paym
ent
of t
he p
rem
ium
char
geab
le. 3
. I fu
rthe
r de
clar
e th
at I
will
not
ify in
writ
ing
any
chan
ge o
ccur
ring
in th
e oc
cupa
tion
or g
ener
al h
ealth
of t
he li
fe to
be
insu
red/
prop
oser
afte
r th
e pr
opos
al h
as b
een
subm
itted
but
bef
ore
com
mun
icat
ion
of th
e ris
k ac
cept
ance
by
the
com
pany
. 4. I
dec
lare
and
cons
ent t
o th
e co
mpa
ny s
eeki
ng m
edic
al in
form
atio
n fr
om a
ny d
octo
r or
from
a h
ospi
tal w
ho/w
hich
at a
nytim
e ha
s at
tend
ed o
n th
e pe
rson
to b
e in
sure
d/pr
opos
er o
r fr
om a
ny p
ast o
r pr
esen
t em
ploy
er c
once
rnin
g an
ythi
ng w
hich
affe
cts
the
phys
ical
or
men
tal h
ealth
of
the
pers
on to
be
insu
red/
prop
oser
and
see
king
info
rmat
ion
from
any
insu
rer
to w
hom
an
appl
icat
ion
for
insu
ranc
e on
the
pers
on to
be
insu
red/
prop
oser
has
bee
n m
ade
for
the
purp
ose
of u
nder
writ
ing
the
prop
osal
and
/or
clai
m s
ettle
men
t. 5.
I au
thor
ize
the
com
pany
to
shar
e in
form
atio
n pe
rtai
ning
to m
y pr
opos
al in
clud
ing
the
med
ical
rec
ords
of t
he in
sure
d/pr
opos
er fo
r th
e so
le p
urpo
se o
f und
erw
ritin
g th
e pr
opos
al a
nd /o
r cl
aim
s se
ttlem
ent a
nd w
ith a
ny G
over
nmen
tal a
nd/o
r R
egul
ator
y au
thor
ity. I
con
firm
that
the
paym
ent i
s m
ade
thro
ugh
my
card
/ ba
nk a
ccou
nt. I
als
o co
nfirm
that
the
sour
ce o
f fun
ds fo
r pr
emiu
m p
aid
unde
r th
is p
olic
y is
lega
l. I h
ereb
y co
nfirm
that
the
feat
ures
of t
he p
rodu
ct h
ave
been
und
erst
ood
by m
e.
Dec
lara
tio
n
Proposal Form No.:
Sig
nat
ure
/ T
hu
mb
im
pre
ssio
n o
f th
e p
rop
ose
r:
Pla
ceD
ate
Nam
e
YO
UN
G S
TAR
INS
UR
AN
CE
PO
LIC
Y
Sub
mitt
ed t
he a
bove
pro
posa
l fo
r __
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
___
polic
y al
ong
with
pay
men
t of
Rs.
____
____
____
____
____
____
____
_/ b
y ca
sh/v
ide
cheq
ue/D
D n
o __
____
____
____
____
____
__
date
d __
____
____
____
____
____
____
____
dra
wn
on _
____
____
____
____
___.
I un
ders
tand
that
the
cash
/che
que
give
n is
ban
ked
for o
pera
tiona
l con
veni
ence
and
com
men
cem
ent o
f ris
k is
sub
ject
to th
e ac
cept
ance
of p
ropo
sal b
y yo
u.
YO
UN
G S
TAR
INS
UR
AN
CE
PO
LIC
Y
PRO / YSI / V.1 / 2020Young Star Insurance Policy - Proposal Form Young Star Insurance Policy - Proposal Form4 of 4 1 of 4
Pin Code:
Pin Code:
Ple
ase
affix
stam
p si
zeph
otog
raph
of In
sure
dP
erso
n -
1
Ple
ase
affix
stam
p si
zeph
otog
raph
of In
sure
dP
erso
n -
2
Ple
ase
affix
stam
p si
zeph
otog
raph
of In
sure
dP
erso
n -
3
Ple
ase
affix
stam
p si
zeph
otog
raph
of In
sure
dP
erso
n -
4
Ple
ase
affix
stam
p si
zeph
otog
raph
of In
sure
dP
erso
n -
5
Pro
hib
itio
n o
f R
ebat
es:
Sec
tio
n 4
1 o
f In
sura
nce
Act
193
8. N
o p
erso
n s
hal
l
allo
w o
r o
ffer
to
allo
w,
eit
her
dir
ectl
y o
r in
dir
ectl
y, a
s an
in
du
cem
ent
to
any
per
son
to
tak
e o
ut
or
ren
ew o
r co
nti
nu
e an
in
sura
nce
in
res
pec
t o
f
any
kin
d o
f ri
sk r
elat
ing
to
liv
es o
r p
rop
erty
in
In
dia
, an
y re
bat
e o
f th
e
wh
ole
or
par
t o
f th
e co
mm
issi
on
pay
able
or
any
reb
ate
of
the
pre
miu
m
sho
wn
on
th
e p
olic
y, n
or
shal
l an
y p
erso
n t
akin
g o
ut
or
ren
ewin
g o
r
con
tin
uin
g a
po
licy
acce
pt
any
reb
ate,
exc
ept
such
reb
ate
as m
ay b
e
allo
wed
in
acc
ord
ance
wit
h t
he
pu
blis
hed
pro
spec
tuse
s o
r ta
ble
s o
f th
e
insu
rer.
An
y p
erso
n
mak
ing
d
efau
lt
in
com
ply
ing
w
ith
th
e p
rovi
sio
ns
of
this
sect
ion
sh
all b
e lia
ble
fo
r a
pen
alty
wh
ich
may
ext
end
to
ten
lakh
ru
pee
s.
Th
e co
nte
nts
of
the
pro
po
sal f
orm
an
d f
eatu
res
of
the
pro
du
ct h
ave
bee
n f
ully
exp
lain
ed t
o m
e an
d I
hav
e fu
lly u
nd
erst
oo
d t
he
sig
nifi
can
ce o
f th
e
pro
po
sed
co
ntr
act.
Dat
eS
ign
atu
re /
Th
um
b im
pre
ssio
n o
f th
e p
rop
ose
rN
ame
of
the
per
son
wh
o e
xpla
ined
Sig
nat
ure
of
the
per
son
wh
o e
xpla
ined
I her
eby
con
firm
th
at t
he
det
ails
hav
e b
een
exp
lain
ed t
o t
he
pro
po
ser.
WH
ER
E T
HE
PR
OP
OS
ER
IS
ILL
ITE
RA
TE
OR
SIG
NS
IN A
LA
NG
UA
GE
DIF
FE
RE
NT
FR
OM
TH
AT
OF
TH
E L
AN
GU
AG
E O
F
TH
E P
RO
PO
SA
L F
OR
M.
NO
MIN
AT
ION
HealthInsurance
Health
Insurance
Det
ails
of
the
per
son
pro
po
sed
fo
r in
sura
nce
Insu
red
Per
son
- 1
Insu
red
Per
son
- 2
Insu
red
Per
son
- 3
Insu
red
Per
son
- 4
Insu
red
Per
son
- 5
Nam
e
Gen
der
Dat
e o
f B
irth
M /
F /
Thi
rdge
nder
DD
/MM
/YY
YY
M /
F /
Thi
rdge
nder
DD
/MM
/YY
YY
M /
F /
Thi
rdge
nder
DD
/MM
/YY
YY
M /
F /
Thi
rdge
nder
DD
/MM
/YY
YY
M /
F /
Thi
rdge
nder
DD
/MM
/YY
YY
Hei
gh
t (c
ms)
W
eig
ht
(kg
s)C
MS
KG
SC
MS
KG
SC
MS
KG
SC
MS
KG
SC
MS
KG
S
Rel
atio
nsh
ip w
ith
pro
po
ser
Occ
up
atio
n
An
nu
al In
com
e (R
s.)
Fo
r p
olic
y ty
pe
on
Ind
ivid
ual
bas
is
Su
m In
sure
d O
pte
d (
Rs.
)
c
Silv
erc
G
old
c
Silv
erc
G
old
c
Silv
erc
G
old
c
Silv
erc
G
old
c
Silv
erc
G
old
Pla
n T
ype
(Ple
ase P
)
Exi
stin
g
Insu
ran
ce
Co
vera
ge
wit
h
this
co
mp
any
and
an
y o
ther
co
mp
any
- g
ive
det
ails
1. N
ame
of
the
Insu
ran
ce C
om
pan
y
2. P
erio
d o
f In
sura
nce
3. S
um
Insu
red
(R
s)
4. P
olic
y N
o.
Det
ails
of
Cla
ims
1. A
ilmen
t fo
r w
hic
h C
laim
w
as m
ade
Yea
rY
YY
YY
YY
YY
YY
YY
YY
YY
YY
Y
2. C
laim
Am
ou
nt
Pai
d /
Rej
ecte
d
Hea
lth
His
tory
: P
leas
e p
rovi
de
answ
er
in
det
ail.
A m
ere
das
h is
no
t su
ffici
ent.
Fam
ily P
hys
icia
n's
Nam
e:__
____
____
____
____
____
____
____
____
____
____
____
____
____
Ph
on
e:__
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
__R
egn
No
:___
____
____
____
____
____
____
____
____
_
1.
Is t
he
per
son
pro
po
sed
fo
r in
sura
nce
in
go
od
hea
lth
fr
ee f
rom
ph
ysic
al a
nd
men
tal
dis
ease
or
infi
rmit
y. I
f n
ot
giv
e d
etai
ls
2.
Has
th
e p
erso
n p
rop
ose
d f
or
insu
ran
ce c
on
sult
ed /
d
iag
no
sed
/ t
aken
tre
atm
ent
/ b
een
ad
mit
ted
fo
r an
y ill
nes
s/in
jury
. If Y
es, g
ive
det
ails
3.
Do
es t
he
per
son
pro
po
sed
fo
r in
sura
nce
hav
e an
y co
mp
licat
ion
s d
uri
ng
/ f
ollo
win
g b
irth
. If
yes
, p
leas
e su
bm
it a
ll n
eces
sary
do
cum
ents
.
4.
Has
th
e p
erso
n p
rop
ose
d f
or
insu
ran
ce e
ver
suff
ered
or
suff
erin
g f
rom
an
y o
f th
e fo
llow
ing
a) D
iab
etes
Mel
litu
s -
If Y
es, s
ince
wh
en
b)
Hig
h B
P, C
ho
lest
ero
l - If
Yes
, sin
ce w
hen
c) H
eart
Dis
ease
- If
Yes
, sin
ce w
hen
d)
Str
oke
, ep
ilep
sy,
fain
tin
g a
ttac
k, c
hro
nic
hea
dac
he,
P
arki
nso
n's
dis
ease
, A
lzh
eim
er's
dis
ease
, -
If Y
es
sin
ce w
hen
e) T
ub
ercu
losi
s, a
sth
ma,
oth
er r
esp
irat
ory
in
fect
ion
s -
If Y
es, s
ince
wh
en
f) D
isea
se
of
bo
nes
/join
ts,
slip
ped
d
isc,
sp
inal
d
iso
rder
, in
jury
to
lig
amen
ts -
If Y
es, s
ince
wh
en
g)
Can
cer,
Pre
Can
cero
us
Les
ion
- If
Yes
, sin
ce w
hen
h)
Gyn
eco
log
ical
d
iso
rder
su
ch
as
DU
B,
Fib
roid
U
teru
s, O
vari
an c
yst
- o
r h
ave
un
der
go
ne
cesa
rean
/ H
ys-
tere
cto
my
If Y
es, s
ince
wh
en
i)
Trea
tmen
t fo
r su
b f
erti
lity
or
has
bee
n a
dvi
sed
fo
r?
(an
swer
if a
pp
licab
le)
– If
Yes
pro
vid
e d
etai
ls.
j)
Dis
ease
of
Sto
mac
h,
Inte
stin
e, L
iver
, G
all
bla
dd
er /
P
ancr
eas,
K
idn
ey,
Uri
nar
y b
lad
der
, U
rin
ary
Trac
t D
isea
ses
- If
Yes
, sin
ce w
hen
k) D
isea
se
of
Pro
stra
te
/ F
istu
la
/ P
iles
/ G
enit
al
dis
ease
s -
If Y
es, s
ince
wh
en
l)
Cat
arac
t an
d o
ther
dis
ease
s o
f th
e ey
e an
d E
NT
d
isea
se -
If Y
es s
ince
wh
en
m)
An
y O
ther
Pro
ble
m (
Ple
ase
Sp
ecif
y)
5.
Has
th
e p
erso
n/s
pro
po
sed
fo
r in
sura
nce
a) U
nd
erg
on
e an
y m
edic
al t
est?
b)
Pre
scri
bed
an
y m
edic
ines
? If
yes
i) N
ame
the
illn
ess
for
wh
ich
med
icin
es h
ave
bee
n
pre
scri
bed
ii) D
etai
ls o
f m
edic
ines
an
d d
rug
s p
resc
rib
ed.
iii)P
erio
d f
or
wh
ich
th
ese
dru
gs
wer
e ta
ken
.
c) B
een
ad
vise
d f
or
any
surg
ery
/ tr
eatm
ent
? -
If
Yes
, g
ive
det
ails
d)
Rec
eive
d /
rece
ivin
g a
ny
pay
men
t fo
r an
y d
isab
ility
/
inju
ry /
illn
ess/
dis
ease
. Giv
e d
etai
ls
6.
Do
es t
he
per
son
pro
po
sed
for
insu
ran
ce
a)
Ch
ew T
ob
acco
- If
Yes
, sin
ce w
hen
b)
Sm
oke
- If
Yes
, sin
ce w
hen
c)
Co
nsu
me
Alc
oh
ol
- If
Y
es,
sin
ce
wh
en
7.
Is t
he
per
son
pro
po
sed
fo
r in
sura
nce
po
siti
ve f
or
HIV
If
yes
, p
leas
e m
enti
on
yo
ur
CD
4co
un
t (P
leas
e at
tach
p
roo
f)
Dec
lara
tio
n o
f th
e A
gen
t / In
term
edia
ry :
I / W
e co
nfi
rm th
at th
e p
rod
uct
‘s s
uit
abili
ty h
as b
een
exp
lain
ed to
the
pro
po
ser.
Th
e in
form
atio
n fu
rnis
hed
in th
e p
rop
osa
l is
tru
e to
the
bes
t of m
y
kno
wle
dg
e an
d r
eco
mm
end
acc
epta
nce
of t
he
pro
po
sal.
(Ple
ase
En
clo
se In
sura
nce
Ag
ent’s
Co
nfi
den
tial
Rep
ort
, If A
ny)
co
de
Nam
e o
f th
e A
gen
t / S
pec
ified
Per
son
of
Co
rpo
rate
Ag
ent
/
Bro
ker
Qu
alifi
ed P
erso
n /
Insu
ran
ce S
ales
Per
son
of
the
IMF
Sig
nat
ure
of
the
Ag
ent
/ Sp
ecifi
ed P
erso
n o
f C
orp
ora
te A
gen
t /
Bro
ker
Qu
alifi
ed P
erso
n /
Insu
ran
ce S
ales
Per
son
of
the
IMF
BU
SIN
ES
S
TY
PE
Soc
ial S
ecto
r C
lass
ifica
tion*
: q
Yes
q N
o
If Ye
s:q
a. U
norg
aniz
ed S
ecto
r q
b. O
ther
Cat
egor
ies
of P
erso
ns
q c
. Eco
nom
ical
ly V
ulne
rabl
e or
Bac
kwar
d C
lass
es
q d
. Inf
orm
al S
ecto
r
Rur
al S
ecto
r C
lass
ifica
tion
(Thi
s cl
assi
ficat
ion
is b
ased
upo
n th
e ad
dres
s of
the
prop
oser
) : q
Urb
an q
Rur
al
* “S
ocia
l Sec
tor”
incl
udes
uno
rgan
ised
sec
tor,
info
rmal
sec
tor,
econ
omic
ally
Vul
nera
ble
or b
ackw
ard
clas
ses
and
othe
r ca
tego
ries
of p
erso
ns, b
oth
in r
ural
and
urb
an a
reas
.
a.
“Uno
rgan
ised
sec
tor”
incl
udes
sel
f-em
ploy
ed w
orke
rs s
uch
as a
gric
ultu
ral l
abou
rers
, bid
i wor
kers
, bric
k ki
ln w
orke
rs, c
arpe
nter
s, c
obbl
ers,
con
stru
ctio
n w
orke
rs, fi
sher
men
, ham
als,
han
dicr
aft a
rtis
ans,
han
dloo
m a
nd k
hadi
wor
kers
, lad
y ta
ilors
, lea
ther
and
tann
ery
wor
kers
, pap
ad m
aker
s, p
ower
loom
w
orke
rs,
phys
ical
ly h
andi
capp
ed s
elf-
empl
oyed
per
sons
, pr
imar
y m
ilk p
rodu
cers
, ric
ksha
w p
ulle
rs,
safa
ikar
mac
haris
, sa
lt gr
ower
s, s
eric
ultu
re w
orke
rs,
suga
rcan
e cu
tters
, te
ndu
leaf
col
lect
ors,
tod
dy t
appe
rs,
vege
tabl
e ve
ndor
s, w
ashe
rwom
en,
wor
king
wom
en in
hill
s, d
aily
wag
ers,
hire
d dr
iver
s an
d co
olie
s or
suc
h ot
her
cate
gorie
s of
per
sons
;.
b.
“Eco
nom
ical
ly V
ulne
rabl
e or
Bac
kwar
d C
lass
es”
mea
ns p
erso
ns w
ho li
ve b
elow
the
pove
rty
line;
c.
“Oth
er C
ateg
orie
s of
Per
sons
” in
clud
es p
erso
ns w
ith d
isab
ility
as
defin
ed in
the
Per
sons
with
Dis
abili
ties
(Equ
al O
ppor
tuni
ties,
Pro
tect
ion
of R
ight
s an
d F
ull P
artic
ipat
ion)
Act
, 199
5 an
d w
ho m
ay n
ot b
e ga
infu
lly e
mpl
oyed
; and
als
o in
clud
es g
uard
ians
who
nee
d in
sura
nce
to p
rote
ct s
past
ic p
erso
ns o
r pe
rson
s w
ith d
isab
ility
;
d.
“Inf
orm
al S
ecto
r” in
clud
es s
mal
l sca
le, s
elf-
empl
oyed
wor
kers
typi
cally
at a
low
leve
l of o
rgan
isat
ion
and
tech
nolo
gy, w
ith th
e pr
imar
y ob
ject
ive
of g
ener
atin
g em
ploy
men
t and
inco
me,
with
het
erog
eneo
us a
ctiv
ities
like
ret
ail t
rade
, tra
nspo
rt, r
epai
r an
d m
aint
enan
ce, c
onst
ruct
ion,
per
sona
l and
dom
estic
se
rvic
es a
nd m
anuf
actu
ring,
with
the
wor
k m
ostly
labo
ur in
tens
ive,
hav
ing
ofte
n un
writ
ten
and
info
rmal
em
ploy
er-e
mpl
oyee
rel
atio
nshi
p;
2 of 4 3 of 4Young Star Insurance Policy - Proposal FormYoung Star Insurance Policy - Proposal Form