Na EET SONERNUEN 3F Bak rte ARCHANA COSWAM ons frfarDos,osriara7s iter | FOMALE arma Pater srt ELECTION COMMISSION OF INDIA ver Iouivty carp Prk ro Elects Name aT “Husbands Name Be See Female 11.2007 8 og Ags as on'.1.2007 |card fete ewer meet JN DENTEREATIN WATHORT CF FH ager Assease: wo: rie rrrtemt, Seacrest 150, Ferrite, FAT NT sess ahr eT, qa war 280121 9248 1711 9024. Aadhaar-Aam Admi ka Adhikar ‘ores or on> J Mzeaouss = 7 ‘ae eas mae er = fa Address = oe SieBot Ais ra yoni odor Mice oa same Ro fetes techs fer are LE Screen Sa Facsimile Signause of lector Resistation Officer or 347. Mathura ao es ace ature Da ae otis weet dent # wee er ‘oe 2 e 2Oe Fea oT OE “This ead can te uod ws an dati Cad under ditforent Government Programmes, #8408 oxosia007Customer Acknowledgement & Dealer Verification Form ‘A Customer Acknowledgement Ne hereby undertake that We have purchased xEV vehicle(s} (details of which are given below Under the FAME Inia scheme of Government of India and have received the Incentive amount as per the scheme, - [Si No [Particuire Provice Details [Name of hisnufacturere Hero Electric Vehicies Pvt Lid. 2)Vehicle Model OPTIMA+ [Nadel Variant {Chasis No. OsiakOO5T S]Deare Name JAGGI MOTORS MATHURA {6[Deaier invoice No 7 7[Oeaier invoice Amount S|incentive Amount adjusted in purchase price “10,000.00 We also confirm that logo of NMEM FAME- INDIA is available on the purchased vetticle. (customer Name [Customer Address. ARCHNA GOSWAMI B Doalor Verification We JAGGI MOTORS MATHURA ‘oeaaaTEITI ‘on (Signature of Customer) authorized daaier of Hero Electric ‘Vehicles Pvt. Ltd. da verify the sale of above said vehicle to the above named purchaser. ‘We also confirm that the benefit of Rs. 10000 (Rupees TEN THOUSAND ‘only} on account of FAME INDIA Scheme Incentive has actually been given to the purchaser in the form of reduced purchase price We have also verified the ID and Address proof of the purchaser ahd confirm to bafedrrects Dste Pisce 22015 MATHURA, Higher’. at ses? (Signature of is Se 4 iGation Dealer Name (Affoe the official seet)Rota Invoica (Caan ttemo HERO® Dealership Name sac wOTORS Common aoes GBP 84 COLLEGE MATHURA raino srs Comte comaenan louraner sme arcrnacanan oe: separ: ere Saint lem vuxniuen tenis eter scan contest roy [ise ocre = oie ose wcoeur: rent gnatA eeere) ce soe.o0 omsinno,: estan stoynen: ssa tous “ena ta ss nezreoroaeo sos mesmo ecenrve 0080 Jemwavene carieuarsi08 ese cocoa sown sco [ype of Dasiary: SLA VRLAY AGA SLA RUA INoke orBastey: ANTEX Ino or saat: ' Net rayatie Amour Jeuocer (nord): THIRTY THOUSANDS FOUR HUNDRED MINTY RUPEES ONLY