Questions that are necessarily to be listed for granting tne cover as per tne mowur vem mun 1200 rere /riferen & wafeerer fewer ersonal Details of Proposer/Owner: 1. Wee (eevee) wT RT APA (ere: a 38 ordi 4) (Proposer’s (Owner's) Full Name (in Capital Letters) Wet (ret sade OR aed CaN TAT 1 (Rr ats fea) ‘Address (where the vehicle is normally kept) ee JALAN TRANS Loli cnds ANIA LTD ZNUNL Dewna Tower Crmmdes asen Ca2icba ve- Dorr 2 (In Capital letters, with Pin code) 3 wH/Phone: ASUvody RAH/PIN: 201 0// wraia/Mobile: 344 PAH /Fax: 7a /E-Mail : 3. OREN / TATA Occupation/Business iar shai eG alo) acegie aeons 4, SRR HT TTR “daa cater’ afer Type of Cover Liability Policy Only 5. tr oat Period of Insurance nf- pc Can 6. Ter Golleen ¥. Registration Number of the vehicle aes Toteey St are Date of Registration of the Vehicle . Vehicle 2 A tel HRSS AR 6204 sll oto water wd See safe Registering Authority & Location ‘Prato, at Year of Manufacture . ord Engine Number afta 3. Chassis Number “AIGA OT WaT (Fe) Make of the Vehicle Vehicle Specifications Z lQi0ub PRU IFUL wae Aiea Model Wet or wo Type of Body ares BY TH GAT (Le) Cubic Capacity of the Vehicle (C.C) ol Cos 16200 o a)“oe Registration No. : Owner Name GOVERNMENT OF HARYANA CERTIFICATE OF REGISTRATION (Form No. 23 Rule 48) HRS5SAA6209 ; M/S JALAN TRANSLOGISTICS INDIA LTD] FatherlHusband ; NOT APPLICABLE Name Add. (Prem.) ‘Add. (Temp) 1. Class of Veh. 2. Maker's Name Dealer Name & 3. Type of Body 4.M. &Y. of Mig. = 16200 46. Gross Vehicle Weight : i (@) As Certified by Manufacturer: (b) As Registered: 17. As per Dectared by Manufacturer : Front Axle :6000 Kgs Rear Axle 10200 Kgs ; CHOUDHARY NIOHAL SINGH MARKET,NiFt * BILASPUR CHOWK GURUGRAM , CHOUDHARY NIOHAL SINGH MARKET,N BILASPUR CHOWK GURUGRAM , HEAVY GOODS VEHICLE ASHOK LEYLAND LTD ‘Add, ; HIMGIRI AUTOMOBILES PVT. LTD. DOUBLE-DECKED TRANSPORT VEHICL# 5/2016 5.No, of Cylinders : © 6. Chassis No. : 7. Engine No. 8. Fuel used 9. Horse Power : (BHP) . MB1A3EFD9GPBU1746 . GBPZ121046 . DIESEL 7 Other Axle : Additional Particulars of alternative of Additional Semitrailer 419, Type of Body : 20. Uniaden Weight : 21. No.,Description and Size of tyres on each axle 22. Registered Axle Weight (in espact of each axle) 23. Hypothecation Lease agreement with: Name : Adresse BANK LTD Previous Detail f any’: Registration No. Name : Address : 11-Nov-2016 Validity of FC fe os A Ss This Certficateis valid from: ww \&tee eam sities ec omoanay Mi Depreciation Premium: S380, —_ NOTE: WARRANTED Taar cas = a = E OF OFONCUR OF THE preNnO CRO THS DocaNe Tate ATCMATOLY CRC TEN, earn coe ‘Sees Brace = 18 eta Praia ono Computson Excess :€ 1.009 srocod cea :¥ 0 aa Vsunay Exes 0 Bele he ees Re te naarhg OS NOG TORE (Botte Motor vehi At 18 Te Pa Cres aan ee tee ee Stn 11 (0 ops of ny oe aelnnt spr eerie one lim o eres of clams arsng out z Tyrer nes — free [PS Potey is stjocie 0 IM Enorsemort Nartars ad besa alaciea was ae an il mortar wore: The eerod ret iar he vet wed or nen cre ann ‘Sezadance wih ts shade Ary poyart rate 9 te carTony oy eaeon a sro lame sonerng ne Cate aaa to Carey wan ie sees 26.1980 recowratie rom he rere: See the Snae andes AVONGANES OF CCERTAN TERMS ANO RIGHT OF RECOVERY: For eps rapessen comer arson wire pons, ‘Gntne: Urczn0W81—66860)001713, ROA Reg. No 8 | Wie ery erty rat he poh wih | wets ty conteaa olreaarte of ae t Dotabrs of rai 1 1 1 i cease ‘Auras Signatory Nationa te ne en eerste SEE Sta Baty PAE ThE em