Vehicle Delivery Ackowledgement Note

Name and Address: ARN : AR02-2019- 115912384966 Date : 5-Oct-2019

ARUP DAS
AT-SUNDRABASTI
PO/P.S-JODA Delivery Note no : ISSBBL181900582-DLN
DIST-KEONJHAR
PIN-758035
Orissa India Phone No. 8280914196 PAN / GST CMXPD9718H

1 Vechile Details: 2 List of Items Supplied With Vehicle :

a. Make TATA MOTORS LTD. a. Tool Kit - Yes/ No
b. Model LPK 3118 b. Tool Case - Yes/ No
c. Colour NA c. Wheel Wrench - Yes/ No
d. Year of Mfg 2019 d. Jack and Handle - Yes/ No
e. Chassis no MAT466458K3J21124 e. Spare Wheel /Tyre - Yes/ No
f. Engine no. ISB5.9B4S180K191G63801836 f. Music System - Yes/ No
g. Reg. no. g. Bulb and Triangle - Yes/ No
h. Key no h. First Aid Kit - Yes/ No
i. Hypothication MMFSL i. Accessories - Yes/ No

3 Books and Documents 4 Documents

a. Owner's Manual - Yes/ No a. Sale Invoice - Yes/ No
b. Battery Warraty Card - Yes/ No b. Temporary Certificate - Yes/ No
c. Music Sys. Warranty Card - Yes/ No c. RTO Tax Receipts / RC Book - Yes/ No
d. Free service Coupans - Yes/ No d. Sale Letter - Yes/ No
e. e. Form 20 / 21 / 22 - Yes/ No
f. f. Insurance Policy / Cover Note - Yes/ No

I/We have taken delivery of the above vehicle in good condition from SAMAL AUTO (INDIA) PVT LTD along with the Manual and
Tools as per Manufacture's specification to my / our entire satisfaction.
I hereby grant consent for usage of all my declared information for promotional activities of Tata Motors Ltd. or any of its group
companies/ subsidiaries/ authorized dealers, in accordance with Tata Motors' Privacy Policy
I have been explained the terms of exteded warranty / emissions warranty - Yes/ No
I am availing warranty on payment of the specified amount - Yes/ No
I am not interested / not eligible for availing extended warranty - Yes/ No
For SAMAL AUTO (INDIA) PVT LTD

Signature of the Customer Date 05-10-19 Authorized Signatory

Terms and Conditions

A Telematics system is installed on select heavy commercial vehicles to provide additional services and support to Customers.
Vehicular data relating to such vehicles will be collected and retained by Tata Motors Limited.
• I/we hereby consent to the data relating to the vehicle being collected pursuant to the Telematics Services provided by Tata Motors
Limited.
• I/we consent to such data being shared with any third party.
The list of models fitted with Telematics and further terms and conditions including the privacy protection policy is available on
www.tatafleetman.com
Please quote your ARN/CRN in all future transaction