STATE TRANSPORT DEPARTMENT

State Transport Department

MIS Dholpur Fitness Center
FORM 38
[See Rule 62(1)]
CERTIFICATE OF FITNESS
(Applicable in the case of transport vehicles only)
Vehicle No: RJ11GB1108(Goods Carrier) is certified as
1988 and the rules made there under. complyingwith the provisionsof the Motor vehicles Act,
Registration No :RJ11GB1108
Application No
:RJ23112496365086
Inspection Fee Receipt No :RJ201 D2311000703
Receipt Date : 24-Nov-2023
Chassis No
Engine No :MAT541024H1K21981
: ISBE5.91804071K63631422
Seating Capacity 3(lncluding Driver)
Type of Body :tanker
Manufacturing Year 2017
Category of Vehicle HGV
Inspected on Certificate will expire on : 25-Nov-2025
:24-NoV-2023 Next Inspection Due :27-Sep-2025
Date
Printed on
:24-Nov-2023 14:26:10

Inspecte by(PHQRURFITNESS
CENTERJ
Siereffetority
MIS Dhotpufness Center
 The Oriental Insurance Co. Ltd.
Servicing Office of Insurer : DivisionalOfice Shree Krishna Plaza, 100 Ft. Road'shobhagpura,
Udaipur, Rajasthan (State Code:08) -313011, PH-0294-2980013 Website:
www.orientalinsurance.org.In
PAN : AAACTO627R.GSTIN: 08AAACT0627R3ZX Insurer's IRDA Registratlon Number: 556
Tollfree Helpline : 1800-11-8485 Emall:abhishek.gurjar@orientalinsurance.co.in CIN:
U66010DL1947GO1007158

GOODS CARRYING VEHICLE PACKAGE POLICY-CERTIFICATE CUM POLICY SCHEDULE CUM RECEIPT
(FORM S1 OF THE CENTRAL MOTOR VEHICLE RULES, 1989)
Pollcy No. 242596/31/2024/TMc/40779 Pollcy Issued On 20-NOV-2023 (18:00)
Insured Name MR. DEEPAK GARG
Own Damage Period 24-NOV-2023(00:00) To 23-NOV-2024(Midnight) Motor LJability Perlod 24-NOV-2023(00:00) To 23-NOV-2024(Midnight)

Schedule of Premium (Amount in Rs.)

Own Damage Premium (A)
Basic Premium Deductibles
Vehicle 7,169 Voluntary Deductibles (O) (IMT-22A)
Additional GVW Loading 2025 Anti Theft Device (IMT-10)
Trailer o AA Membership (IMT-8)
Non-Elec.'Accessories 2644
0 No Claim Bonus (25%)
Elec. Accessories (IMT-24) o Sub Total (Deductibles) 2,644
CNG/LPG Kit (IMT-25) 0
Sub Total (Basic Premium)
9,194
Add On Coverages
Geographical Area Extension (IMT-1) 0
IMT -23
1,380
IMT -34 0
Overturn Cover 0
Sub Total-Addition 10,574 Net Own Damage Premium (A) 7,930
Liability Premium (B)
Basic Third Party Liability 44,242 PACover For 0 Persons of Rs. 200000 Each (IMT-16)
Third Party Liability For Bi-Fuel Kit 0 Legal Liability For Paid Driver (IMT-28) 50
Third Party Liability For Geographical Area Legal Liability For Cleaner/ Conductor/Helper (for 4 200
Extension persons) (IMT-29)
Third Party Liability For IMT -34 0 Legal Liability For 0 Non Fare Paying Passenger 0

Third Party Liability For Trailer 0 Legal Liability for Employees (for Opersons) (IMT-29)
PA Cover For Owner Driver Of Rs. 1500000 (IMT 320
PA Cover For Cleaner /Conductor / Helper
200000 Each (IMT-17)
PA coverfor Paid Driver of Rs 200000 (IMT-17) 0 Net Liability Premium (B) 44812
Note: In case of dishonour of the premium cheque, this document stands
automatically cancelled 'ab-initio Total Premium (A+B) 52742
> Consolidated stamp duty paid to state exchequer.
> The policy is subject to compulsory deductible of Rs.1500 IMT 21 IGST (12% of Basic TP + 18% of rest of Premium) 6840
> Geographical Area-India
> The insurance company will display terms & conditions on its website
www.orientalinsurance.org.in which can be accessed by you online.
Gross Premium Paid 59582
"Subject to IMT Endt. Nos.& Memorandum:21,23,28

Addon Unique Identification Number (UIN) Details Add On Premium

Hypothecation Details: ----NA---

POSP Name:.ANAND BANSAL, POSP PAN Number: AKYPB6507B

SAC:997134, Description of Service :Motor Velhicle Insurance Services, Place of Supply :UTTAR PRADESH(State Code:09), Receipt No/lnvoice No:TMC24040779
Iwe hercby certify that the policy to which this certuficate relate[ as well as this certuticate of insurancc ure issucd in accordance wih the provisions of Chapter Xand Chapter Xl of Motor
Vehicle Act, 1988

For & On Behalf of The Oriental Insurance Co. Ltd.

Dealer Code : KANHIYA MOTORS TASS CVBU - 208258400

Authorized Signatory
In case of any claim or assistance required please contact our help line at 1800 209 0060 and you may also reach us at
support@tatamotorsinsurancebrokers.com
 The Oriental Insurance Co. Ltd.
Servicing Offlce of lnsurer :Divislonal Offlice Shreo Krishna Plaza, 100 Ft. Road Shobhagpura,
Udaipur, Rajasthan (State Code:08) -313011, PH-0294-2980013 Webslte:
www.orlentalinsurance.org.In
PAN : AAACTO627R. GSTIN: 08AAACTO627R3ZX Insurer's IRDA Reglstratlon Number: 556
Tollfree Helpline :1800-11-8485 Emall: abhishek.gurjar@orlentalinsurance.co.ln ClN :
U66010DL1947GO1007158

GOODS CARRYING VEHIcLE PACKAGE POLICY-CERTIFICATE CUM POLICY SCHEDULE CUM RECEIPT
(FORM S1 OF THE CENTRAL MOTOR VEHICLE RULES, 1989)
Policy No. 242596/31/2024/TMC/40779 Pollcy Issued On 20-NOV-2023 (18:00)
Insured Name MR. DEEPAK GARG
Period 24-NOV-2023(00:00) To 23-NOV-2024(Midnight)
Own Damage Period 24-NOV-2023(00:00) To 23-NOV-2024(Midnight) Motor llabilty

Proposal No. &Date : PCVBU9997918, 20-NOV-2023 CPA Cover Perlod :24-NOV-2023(00:00) To 23-NOV-2024(Midnight)
Insured Add. :S/O-MR RAJENDRA PRASAD,R/O-NAGALA UDAIYA. Previous Insurer :O1C
ROAD,KHERAGARH,AGRAT/A-MANGROL ROAD, MANIYA, AGRA, UTTARprevious Policy No. : 242596/31/2023/TMC/29174 24-NOV-2022 10 23
PRADESH (State Code:09) -282001 NOV-2023

BROKER DETAILS
IRDA Lic. No. U50300MH1997PLC149349
375 CIN No.

Broker Category Composite Broker Validity

|13-MAY-23 To 12-MAY-26
Name & Add.: TATA MOTORS INSURANCE BROKING AND ADVISORY SERVICES LTD. 1ST FLOOR, AFL HOUSE, LOK BHARTI COMPLEX, MAROL
MAROSHI ROAD, ANDHERI (EAST), MUMBAI - 400 059
Contact us at: 1800 209 0060 or write to us at: support@tatamotorsinsurancebrokers.com
Make Model Variantcubic Capacity Manufacturing Year Seating capacity
TATA LPT 3718 CR BSIV 2017 5
TATA MOTORS TATALPT 3718 5883
10X2

Registration No. RTO Invoice Date GVW Chassis No, Engine No.
ISBE5.91304071K636
RJ 11 GB 1108 DHOLPUR 31-0CT-2017 42000 MATS41024H1K21981
31422

Vehicle Type Vehicle Sub clas Built Type DV.of chassis JDVof Body Elec. Accessories

A1- Public Carrier-GCV Tanker Fully Built 1,620,000

Non-Elec. Accessories CNG/LPG Kit IDV of Traller Total IDV

1,620,000

NOMINEE DETAILS
Name of Nominee Age Relationship with Insured Name of Appointee Relationship with Nominee
PRAMOD GARG 38 BROTHER --N.A- --N.A-

PAYMENT DETAILS

Premium Paid :59582 Cheque No.: 427032 Cheque Date: 20-NOV-2023

Bank Name:3003TM100091708/00/000 Bank City : KHERAGARH AGRA

For & On Behalf of The Oriental Insurance Co. Ltd.

Dealer Code: KANHIYA MOTORS TASS CVBU - 208258400

Authorized Signatory

Incase of any claim or assistance required please contact our help line at 1800 209 0060 and you may also reach us at
support@tatamotorsinsurancebrokers.com
 TRANSPORT DEPARTMENT,RAJASTHAN
FORM 47
(See Rule 87(2) of CMVR-1989]
AUTHORIZATION CERTIFICATE OF N.P. (GOODS)
1.National Permit Authorization Number NP/RJ/5/112023/52976 Dated: 10-Nov-2023
2.Name of Permit Holder DEEPAK GARG
3.Address PIA-NAGALA UDAIYA
ROUD,KHERAGARH,AGRA,U.P.,DHAULP
UR-328001
4.Registration Mark of Vehicle RJ11GB1108
5.Date of Registration 16-Nov-2017
6. Maker &Model TATA MOTORS LTD
7.Engine Number ISBE5.91804071K63631422
8. Chassis Number MAT541024H1K21981
9. Validity of NP Authorization 16-Nov-2024
10.Validity of Basic Goods Permit 16-Nov-2027
11 Type of Vehicle 203
12.GVW(in Kgs) 42000
13.Unladen Weight(in Kgs) 12500

14.Seating Capacity 3

SI No. |History

This authorization is issued on 10-Nov-2023 and valid throughout the territory of India upto
16-Nov-2024. Certified that the National Permit holder has paid the consolidated fee of
16500/- through Internet Banking vide Transaction ld: 2311107758601611, Bank Reference
No iU11230024324 dated: 10-Nov-2023 at.
Printed On: 10-NoV-2023 16:37:37 PM

Bharatpur, RAJASTHAN

Signature valid,
Digitally signedb
vahan.parivàagov.in
Date: 2023.11Y0 16:47:37 IST
 Transport and Road Safety Department, Rajasthan Page 1 ofI

POLLUTION UNDER CONTROL CERTIFICATE

[Approved by Department of Transport, Government of Rajasthan, Jaipur]
18678405
MOVK ON (Rule 115 of CMV Rules 1989)

Pucc No : D27 RJ09110976

Vehicle No: VALID IN ALL INDIA
RJ11GB1108
Customer Name: Photo of Vehicle
DEEPAK GARG
Customer Mobile :
9999999999
Year of Regn :
16-11-2017
Type of Vehicle : TRUCK
Make : Tata Motors
Model:
TRUCK
Test Date :
Time :
04-10-2023
03:40:25 PM
RJ1L
GB11081
valid UpTo :
03-10-2024
Center Name : Rayka Pollution Mobile Van
Center Address: |Center,(RJ14-GC-2032)
Licence No : Barkhera,Chittorgarh
|Test Result :
RJ09-26/27
Pass

Flushing cycle
Prescribed 1/m(Light Hartridge
Avg RPM Min RPM Max Limit for Diesel
Temp vehicle
Absorption Units
Co-effic'ent) (HSU)%o
793 2806 00 Free
Acceleration DS 2.15 65
Sr. No. RPM Min RPM Max Km HSU% Temp II & III
Free
Acceleration BS 1.62 50
1 IV
4990 0.16| 06.7 00
Free
2 6550 0.00 00.1 00 Acceleration BS
VI 4/3 0.7 / 1.5 26 / 48
3 1375 0.00 00.0 00 wheelers
Mean 0.05 02.2 Validity Six Months for Bharot Stage III or below
Get Cerificate renewed within the expiry date. and one yearfor Bharat IV/VI vehicles.

Certificate ericg
Seal of Testing Station Testing Station Code Authoed Signatory
D27RJO9
CERTIFICATE IS ONLY VALID IF SMS RECEIVED FROMi REILITRANSPORT DERTr. KINDLY DESTROY THE INVALID CERISTT
Transport Dept. Govt. of Rajasthan Transport Dept. Govt. of Rajasthan
Veh Reg No: RJ11GB1108 Veh Reg No : RJI1GPI108