BAJAJ

Mamhv nf Cnetoly of
FORM 22
SEE RULES 47(R), 115, 124(2), 126A and 127(1), 127(2)}
INITIAL CERTIFICATE OF COMPLIANCE WITH
pAufethobin MaulaoturerB SAFETY STANDARDS OF COMPONENTS ANDPOLLUTION STANDARDS,
ROAD WORTHINESS.
BAJAJ
mlselo
a wn

Reglstered& Hesd Offlce!

Bujo) Auto Ltd., Akurdl, Pune-411035.
NON Certifod thet the followlng vohlokle complles wlth tho provlslons of the Motor Vehlcles Act, 1988,
and the rules made thereunder, Inoluding the followMng
POLLUTING Brand neme of the vehlolo
mass omisslon norns:

VEHICLE DISCOVER 12

Ouo Chesele number

Englne numbor/molor number
(In case of battery operated
vohlolos))
MD2A1SBZ06WL084/4
J2GL46477
8ub-rulo No. of rule 116 115 (14)(F), (6).
Chassls No. Emieslon norme
(Bharat bMARAT STAGE-I11.
Engine No. MD2A1 SBZ06HL O8474 8tage-l/l/I/Bharat (Trem) Stage-ll otc.) SIGNATURE OF MANUFACTURER
Date JZZN6146477
2t.02.2016 Date 26.02.2016 FOR BAJAÁUTO LIMITED
 AX PAYMENT
htps:/aperarsport.is' APCFSTONLENE Dealer AllinOnePrimasç»

ORIGINAL
ANDHRA PRADESH TRANSPORT
DEPARTMENT
FORM C.R Tem
Temporary Certificate of
(Rules 86 and 87 of the Andhra Pradesh Registration
Motor Vehicle Rules, 1989)
Temporary Registration Mark : AP27URTR9886
Name of the Owner
Display Name on RC Card PUSHPALEELAKAKUMANU
Date Of Birth PUSHPALEELA K
06-04-1992
Father/Husband/ Rep. by Name BABURAO
Nationality Indian
Address
MADDIRALA
D.NO: 1-72
MUPPALLA
MUPPALLA MADDIRALA MUPPALLA
NG PADUCM), PRAKASAM(DT)
Description of Vehicde
Class of Vehicde MOTOR CYCLE
MCYN
Maker's Name
Type of Body BAJAJ AUTO LTD
: Solo
Seating Capacity :2
Colour
EBONY BLK RED DKL
Engine No
JZzWGL46477
Chassis No
MD2A15BZOGWLO8474
Maker's Class
:DISCOVER 125 BSII
Fuel Usedd
PETROL
Vehicde to be Registered at
RTA PRAKASAM
-APO27
Under the provisions of the Section 43 of
the Motor Vehides Act, 1988 the
vehide desaribed above has been
registered by me and the registration is

AP27URTRI886
valid Fromn
:09-05-2016 Valid 07-06-2016
Tax Paid Rs Upto:
4740
TR Fees RS
30.00
HPA Fees Rs. : 100.00
Transaction No
: NETO12925690
Date:09-05-2016
This Vehide is
UNDER HYPOTHICATION WITH BAJAJ
FINANCE LTD

Date
ONGOLE
ONGOLE
10-05-2016
Lnd
anoONO
Signat nd Designation
of the kegstering Authority
Please collea the following documents from
the dealer free of charge:
1) Wclcome letter from the Transport
form 20 (in duplicate if covered Deportment, Temporary registration certificate, Tax receipt,
by hypothecation), Form 21, Form 22, Insurance Papers

2 of 7
5/10/2016 3:14 PM
TAX PAYMENT
htps://aptransport.in/APCFSTONLINE/Dealer/AllinOnePri
TIRUMALA MOBIKES PVT LTD
CHIMAKAURTHY EYE.HOSPITAL
COMPLEX,KURNOOL ROAD,,ONGOLE, PRAKASAM

FORM 21
(See Rule 47 (a) & D)
SALE CERTIIFICATE
Certified that DISCOVER 125 BsIII has been
delivered 09-05-2016 by us to
on
1Name of the buyer
PUSHPALEELA KAKUMANU
2 Permanent Address
Termporary Address
D.NO: 1-772 D.NO: 1-72
MUPPALLA
MUPPALLA
MADDIRALA MUPPALLA MADDIRALA MUPPALLA
MADDIRALA MUPPALLA MADDIRALA MUPPALLA
NG PADU (M) NG PADU (M)
PRAKASAM (DT) PRAKASAM (DT)
AP
The vehicie is hetd under
AP
agreement of Hire Purchase/Lease/Hypothecation with, BAJAJ FINANCE LTD
Details of the vehicle are glven below :
1 Class of Vehicle
MOTOR CYCLE
Maker's Name BAJAJ AUTO LTD
3 Chassis No.
MD2A15BZoGWL08474
4Engine No. JZZwGL46477
5 Horse Power / Cublc Capacity 9.00/125.00
6 Fuel Used
PETROL
7 No. of Cylinders

8 Month & Year of manufacture

02-2016
9 Seating Capaclty (including driver) 2
10 Unladen Weight 119.00
11 Maximum axel welght & number & Descriptlon of tyres (In case
of Transport vehicle)
2.75-17
a) Front Axle= b) Rear Axle=
6PR
c) Any Other Axle GPR d) Tandem Axle=

12 Colour of Body EBONY BLK RED DKL

13 Gross Vehicle Welght 249.00
14 TVDe of Body
15 Blinkers / Indicators Fitted
Solo
RU
S30ONOo

Auh SInatory
(TIRUMAMoBIKES PVT LTD)

5/10/2016 3:1
 XPAYMENT

GOVERMENT OF ANDHRA PRADESM

TRANSPoRT DEPARTMENT

TAX RECELPT
Transaction Number NETO12925690 Date
ULW 119.00 v o e AmOu
GVW 249.00 inyoie Date
Seating Capacity Class f yeice
Temp Regn No AP27URTR9S86 4740
Chassis No
Engine No
MD2A15BZOGW LO8474 HPA Fee 1000
zzwGLA6477 TR FEe 20
Tax Type
ToBe Registered At RTA PRAKASAM
Penalty
TR Servie harge
Name Of Customer
PUSHPAMLEELA KAKUMANU Co

AUTHO oRY

Dear PUSHPALEELA KAKUMANU

Please collect the following doauments from the dealer free of charge
Welcome letter from the Transport
2) Temporary registration certificate. Department
3) Tax receipt.
4) Form 20 (in duplicate if covered by hypothecation).
5) Form 21.
6) Form 22.
7) Insurance Papers.

With Regards
AP Transport Dept

of 7
 FORM 21
TI 275735%2060 See Rule 47 (a) and ()]
3757356206 SALE CERTIFICATE
TIRUMALA MOBIKES PVT LTD(11713)
PLOT NO. 49, WooD COMPLEX,BY PASS ROAD, ONGOLE 523001
Ph: 08592-283189
saie ietter o : n17122016000303
TO BE ISSUED
8Y MANUFACTURER 1 DEALER OR OFFICER OF DEFENCE DEPARTMENT.
WITH APPLIATON POR
( IN CASE OF AUCTIONED VEHICLE ) FOR PRESENTATION ALONG
REGISTRATION OF
A MOTOR VEHICLE.
Sertified That D'SCOVER 125 DRUM has been soid to PUSHPALEELA KAKUMANU
on 09-05 2016
Name of the buyer PUSHPALEELA KAKUMANU
SonwiefDaughier of: D/O BABU RA
Perene Address DO: 1-72MUPPALLAA
aDDIRALUPPALLANAGULUPFALAPADU
Prakasam 523181
Iemporan Aadress
97018298
Pire to

Tte vehicie s eid under

agreement of Hire Purchase
Hypothecation With &AJAJ FINANCE LTD
Ongole
The detais of vehice are given below:

1. Ciess of Vehice : MOTOR CYCLE WITH GEAR

2 aker s Name BAJAJAUTO LTD
3ChessisNumber MD2A15BZOGWLO8474
4 ngne Number : JZZWGL46477
S ePower : 8.09 kW at 8000 rpm
6. Cubicapecy :124.6
7 Fueled Petrol
.o Ainders 1
M o r d year oh Manfecture :06/02/2016
19. sexingpckicd Driver) :2
11. niaen wegt Kiy meigir) : 119

12. havam b e Megn and oumber and Descripton of Tyres (io case of transport vehicle)

:2.75 x 17, 41P

: 100/90- 17,55P

13. Co oiostie Body EBONY BLK RED DKL

14. m veiice Weig :249
1. T e s Solo with Pillion
16. Wieel Be 1305
17, o T r e :2
18. Tani Capachy 8
19. Trase Cerciticate No. : RJO6-TC-0128/9527

PRIORITY NO For TIRUA MOBIKES PTD11713)

ONGON4
Signare
 VAT INVOICE
375756276
375725626 TIRUMALA MOBIKES PIT LTD(11713)
PLOT HO. 49, WOOD COMPLEX,BY PASS
ROAD,
ONGOLE 523001,Ph: 0P92-203189
ND
Name
CUS-117137769
PLSHPALEELA KAKUANr Bill No VS1117122016000303
sDn
Dauger ofwrYe f:D/D BABU RAD Bll Date :09/05/2016
DND: 1-72 MUPPALLA,
WADDIRALA MUPPALLA Borking No. VA117132016000262
PhoTe
NAGULUPPALAPADU, Prakasam-5Z31E1 Chassis No :
MUZA158ZUGWLIA74
P. NaTE
970 BE291 Engine No JZZWGL4T7
Bzjaj Firance Ltd Coior : EBONY BL PED DKL
SasnersDD P BABU

DSD 75RM kmourt s

DSDER-13 DRUN
VL 145 5,99200

6,562 34

TOTAL AMOUNT
D.16
MDUNT N WORDS 52,661.00
RSFFTY TWD THOUSAND SIX HUNDPED SICTY ONE ONLY.

Remariks

19 Pease chedk
the ahicie and all the documents before
taking the delivery
2) Gonrs ance soid
anmot be taken badk or
exdhanged
3) Al Disputes subjet to Ongoie Jurisdiction
only
41 tae eczived the
vehice in the good condition with toois

For TIRU
LTD

Sg Cusumer rHis hgent

A SPory
 RTO COPY

TIN 37573562060
TAX INVOICE
CST :37573562060 TIRUMALA MOBIKES PVT LTD(11713)
PLOT NO. 49, WOOD COMPLEX,DY PASS ROAD, ONGOLE
App. No. : CUS-117137769 923001,Ph: 08592-283189
Name BIll No
:
[CUS-117137769] PUSHPALEELA KAKUMANU :VSI117132016000303
Address : D.NO: 1-72 MUPPALLA, MADDIRALA DIIlL Date :09/05/2016
MUPPALLAA
NAGULUPPALAPADU, Prakasam-523181 Dooking No. :VSA117132016000262
Phone :9701882918 Chassls No.
H.P. Name
:MD2A1502OGWLO8474
Bajaj Finance Ltd Engine No. JZZWGLA6AT7
Color :EBONY BLK RED DKL

DESCRIPTION K
DISCOVER-125 DRUM
DISCOVER-125 DRUM
Amount
45,992.00
VAT 14.5%
Round Off
6,668.84
0.16
AMOUNT IN WORDS RUPEES FIFTY TWO THOUSAND TOTAL 52660.84
SIX HUNDRED SIXTY
AND PAISE EIGHTY FOUR
Purchase Invoice No. ONLY
:0340010285 26-02-2016
E& 0.E

Value Added Tax Act. 2002 is in For TIRUMALA MOBIKES PVT

underthe Maharashtra Value Added force on the date on which the
sale of the goods I/We
LTO(11713)
me/us and that the transaction of Tax Act. 2002 1s in force the hereby certify that my/our Registratlon Certificatlon
sale covered by this tax fnvofce date on which the sale of the goods
on
sales while filing of retum and has been effected
by speciffed In thls
tax Involce ls made by
the due tax ,if any,
payable on the sale has been pald or me/us and
shall be
ft shall accounted for In the turnover of
be
pald.

Invoice/ Insurence/Owners Manual/Free

Delivery Note
Service Coupon/Tax Certificate/Tool Kit/Battery recelved the above
Complete with tools,Accessories to my satisfactlon. mentioned vehclle

Sign of Customer Or His Agent

Aut Sgnatby
 1ORJ2006PLC029979 IRDA Registration Number - 137
Shriram General Insurance Co. Ltd.
SHRIRAM IN PARTNERSHIP WITH THE Sanlam GROUP
General Insurance8 Regd.&Corpt. Office: E-8, EPIP, RICO Industrial Area, Sitapura, Jaipur-302022 (Raj)
E INSURED.. REST ASSURED Phone +91-141-3928400, 3951111, 3996700 Fax: +91-141-2770692 93
Website www.shriramgi.com, Toll Free No.. 1800-300-30000 1800-103-3009
Package Cover Only NewRenewal of SGI/Renewal of Others
Product Name-: Pvt.Car/Two wheeler/GcCV (Public Carrier/Pvt Carier) /PCCVID-Type. S.No. P 443598
imdCode. ************"********

Reference Number Date of issue:.. lo.. AM/PM

Ineured Namepuskpaleclo.aktma..loBabty Rao
**********I**************"**************"************"
Insured
Address p p.palla...Maddiolalq|.UPD.ala, **********************"****"

nauppalajoadlA
Tel...... . s .

Mbbile. 29 Occupation .*** ****************

************* **********

Registration Number Make Model CCIGVWYear of Mfg Seat Cap

incl. Driver Chassis No Engine No
AL DTS 12S 9o161t MD 2AISB 20G|J2 2W7
Vehicle IDv IDV Elect IDV Non Elect DV IDV
Accessories Accessories SideCar CNGILPG Unit Total IDV

LuaSua |Make Year Make Year

Period of Insurance (Start Time)HHMJ M o f o l g | g g N O3/lC E

A. Own Damage B. Liability CASH/CHEQUE/DD

Basic OD TP Premium (Strike out whichever is not applicable)
Elec. Accessories PA to Owner Driver| |Amount
L.L to Paid Driver
Non Elec. Accessories
CNG/LPG Kit Passenger Cheque /DD No.

Discount Employee
Loading
Total Chequel DD Date:
| Net Premium (A+B):
NCB
Total
S.T Bank Name.
Final Premium 213
Following excess are over and above compulsory excess
Additional Excess: Rs . . *******************Voluntary Excess Rs .
Frevious insurer . . . NCB.. . D a t e of expiy of Prev. Policy...
********"********* °************************
we further undertake that if this NCB declaration is found to be incorrect, all benefits under the policy in respect of section 1 of the policy will
stand forfeited.
Hypothecation/Hire Purchasel Lease. . . a i a j . . Anc.e D.
******a* *****"******* *********************
Whether the use ofthe vehicle islimited to own Premisés No
The Policy Provides Third Party Property Damage (TPPD) of Rs 1 Lakh (Two Wheeler) and 7.5 Lakhs (other class of vehicles)
Do you wish to restrict the above limits of the stautory TPPD Liability limit of Rs. 6000/- only ? Yes / No
Do you wish to cover legal liablity to? Yes/No
Vehicle belongs to GovM. body Yes / No
A) Driver/Conductorl Cleaner (No. of Persons) *****************************

B) Other Employees (No. of Persons) ******************** *****************

C) Non Fare Paying Passenger (No. of Persons) ****************** ***************

Claims lodged during the preceding 3 Years (Give Details). *******'********''**'*""********** * * *******************************************************
Has Insurence Company ever dedined the proposal or cancelled & refused to renew (if yes, reasons thereof ) or imposed Special Conditon in ExCeSsS

(f Yes, reasons thereol). .sses

DECLARATION
WE hereby declare that the statment/s made by me/us in the proposal form are true and hereby agree that thls declaratlon shalr pT ha basis on
payment of anyb
Co Ltd. and any false declarratlon will lead to non are anoeUon ot
Conlract between me/us and the Shriram General Insurancealso declare that If any conditlon/s or alteration/s carrled oUafér submissior this
polecy at any stage even after the Issuance of pollcy. IWE hereby
proposal form then the same shall be conveyed to the insurer Immedlately and they will accept or reject the
same at thelr sole diecretionl_.Na
declare that the above stated asset is/are bought out of legal funds and l/We have an insurable interest in the assets to be nureThe proposal is
being relained for re vlew and consideration amount would be used only if the proposal is acepted
Note: Submission of this proposal form even alongwith any mode of payment ls not to be taken as an admisslon of liabilihepolsytslssued .

Place ... saass Name&Slgnatureof Proposer Name&Signature of Authorlsed Representatlive of So

Customer Copy
Book Dispatch to Branch on 2 MAY 2016 Book Valid upto