SERVICE REQUEST FORM FOR DUPLICATE NOC

Date: ................... Loan A/c No.: ............................... Customer Name: .......................................................

Vehicle Detail: ..................................................................................................................................................

G.S.T No : ....................................................................

I / We hereby request you to issue a Duplicate NOC in respect of the above mentioned vehicle.
The following documents are enclosed with the Application form:
1. Self-Attested Signature Proof 2. RC Copy / Insurance Copy 3. Charges as Applicable

Current Address: ..............................................................................................................................................

..............................................................................................................................................

Telephone No.: ................................. Mobile No.: ................................. Email: .............................................

I/We hereby confirm and inform KMPL that the said NOC appears to have been irretrievably lost /
misplaced by me / us and has therefore request to issue a duplicate set of NOC in favour of the Customer.

1. I/We hereby irrevocably agree and undertake to:

a) Indemnify KMPL and keep KMPL, its Directors and Officers indemnified, saved and harmless
against any loss, damage, costs, charges and / or expenses suffered or incurred by KMPL directly or
indirectly on account of issue of duplicate set of NOC.
b) Hold KMPL harmless and to keep fully indemnified against all claims, demands which may be made
in respect of the original set of NOC by any person or persons claiming to be holder of the original
NOC or in any way interested therein: and
c) Pay and make good any such damage, loss, costs, charges and expenses to KMPL immediately upon
demand being made on the Customer by KMPL.

2. I/We hereby agree to sign and execute all further papers and documents as KMPL may require.

3. The original RC and the vehicle is in my custody only.

Name and Signature of Customer: ................................................................................................................

Place: ....................................................................

Authorization to Bearer

With regards to my service request as detailed above, I / We, hereby Authorize Mr./Ms. .................
............................................................... whose signature is attested below (along with signature
proof document of the Bearer) to interact on my / our behalf with the Customer Service Staff to
collect NOC / handover payments as may be required to effect the service as required by
Kotak Mahindra Prime Ltd.

Signature of Borrower.
Name: .......................................................................................................................................................

Signature of Authorised Representative.