PR.

SESSIONS
THEHON'BLE
BEFORE OF
COURT
AT BANSWARA
BANSWARA

CriminalMisc.ApplicationNo. Z.OZL

(U/sa38of Codeof Criminal Code,1 9 7 3 )

Procedure

DURGABRIJESHKUMAR MAHESHKUMAR SHARMA

AGED ABOU4 T 4 H i n d ua d u l t ,
R e s i d i nagt P a d m a v awt ia r dn o ,0 7 ,
B / s .A . K .N . D h a mS c h o o Pl , a n n aM, . F .

vls

Stateof Rajasthan
(Noticemaypleasebe $ervedthrough
TheA.P.P. Cour.t,
Sessions At Banswara)
Opponent

APPLICATION FORAN]ICIPATORY BAIL

u / s 4 3 8 O F T H E C O D EO F C R T M T N A L
PROCEDURE, 1973 IN RESPECI' OF
P R O P O S E D F . I . R . R E G I S T F R EAD T
K U S H A R G IB I AERI N C
N O .0 1 5 4A i ' 2 0 2 1
P O L I CSET A T I OKNH U S H A L G H, A R

MOSTRESPECTFU
LLYSHEWETH;

-ihat
1. t h e a p p l i c a n t s r e s i d i r r ga t t h e a d d r c s sm e n t i o n i . i

c a u s et i t l e o f t h e a p p l i c a t i o nA.p p l i c a nits w o r k i n gw i t h t h e

school(workingasteacher).
Government And havinghisfamilyat

r h ea c l C r e m
s sc n t i o n ei:nctj h e c a u s e
t i t l eo f t h e a p p l i c a t i o n .

3
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strr \
"arC /I
q.ramr
#M
2. The facts :

i z .A r v i n dP r a n a mwi a sg o t
2 . L .T h a tt h e a p p l i c p n tb' sr o t h e r - i n - l avw

r f a p p l i c a nvti z ,U s h a b e nT,h a t ;d u et o h i sj o b
m a r r i e dw i t h s i s t e o

andhiswife Ushaben
Mr. Arvindbhai for purposeful
wereresiding

at Banswara,
theywereresiding
object.However, As
at Rajasthan'

t h e U s h a b e ns i s t e r - i n - l aowf a p p l i c a nat n d M r . A r v i n d k u m a r

Pranavi with brotherof applicant.

weremostlyconnected

was not so closelyconnected

2.2Thatbrotherof the complainant

w i t h h i sb r o t h e a . n t h e o t h e rh a n db r o t h e ro f t h e
r n dh i sf a m i l yO

c o m p l a i n a nwt a s c l o s e l yc o n n e c t e dw i t h t h e i n - l a w sf a m i l y .

However,he never relied or closely connectedwith the

c o m p l a i n a not f h i s f a m i l y .l t i s f u r t h e r n o t e d h e r e t h a t t h e

complaintwas not even given correspondent

addressof the

mentioned
address contraryMr. Arvindbhai
of Banswara had was

g i v e nc o r r e s p o n d eandt d r e sw
s i t h c a r a s s u r a n cceo m p a n yo f M r

DevkinandS
a nh a r m a .

2.3lt is further submittedherein as the Brother-in-law

of the

complainant
wasaffectedwith Covid-19,
however,Mr. Arvindbhai

P r a n a mwi a ss h i f t e df o r h i st r e a t m e nftr o m B a s w a rtao G u j a r a t .

H e w a s u n d e rt f e a t m e n a
t n d a t t h a t p o i n to f t i m e n o n eo f h i s

f a m i l ym e m b e cr o m p l a i n a a
nnt da n yo t h e rr e l a t i v edsi d n o t c o m e

t r t l o o ka f t e r ,o r t a k ec a i ' el.- l o w c v c ci ,o m p l a r ni st a b s o l u - f' u

alst:
 .fffir
,,6d{.Jc
GUJ*NAT

and frivolous,that the kev to house were with son of

hiswife,
lt is furthernotedhereinthat the applicant
complainant.

visitedKushalghar.
brotherandsisterin lawwerefrequently

( bi r o t h eor f c o m p l a i n a nwt )a sn o t
2 . 4 M o r e o v ewr ,h e nM r . A r v i n d b h a

i n p o si ti o n w h e rlrleft to Gujar atfr om Banswar ahe was Cov i d

P a t i e n ts, o t o s a yt h a t t h e c o m p l a i n a nht a sc l e a r l yf a l s es t a t i n gr n

t-lR,

2.5Itis furthernotedherethat the Mr. ArvindPranamiwas passed

of applicantwas
thereafter,sister-in-law
away an 291A4/202I,

the
irass away on AZ|05|2AZI,in both the circumstances,

a p p l i c a n ti s a b g o l u t ei n n o c e n t .A s d e c e a s e dM r . A r v a i n d b h a i

i a sn o t i n c l i n e dt o g i v c a n y c o n s e n s utso h i s f a m i l ' 'ar r r d

P r a n a mW

h o w e v e r c, o m p l o i n a nwt a st a k e d i s a d v a n t a goef s i t u a t i c l n sA' t n o

p o i n t o f t i m e a p p l i c a n t a k e w a y a n y o r n a m e n t so r a n y o t h e r

v a l u a b l e sa s a l l e g e dt h e f t . B u t c o m p l a i n a nat n d h i s f a m i l yt r y i n g

t o t r a p a p p l i c a n ta n d h i s i n - l a w sf a m i l y i n f a l s e a r t d f r i v c l i o u s

ca se s.

2 , 6T h a t t h e a p p l i c a n t ' b
s r o t h e ra n d s i s t e r - i nl-a w , w e r e r e a c h e da t

K u s h a l g h aor n 3 0 / 0 4 1 2 0 2 La, s t h e M r . A r v r n d b h aPi r a n a r nai n d

w e r es t a t e da t K u s h a l g h tai rl l
h e n c ea p p l i c a nat n d h e r h u s b a n d

3 0 1 0 5 / 2 0 2 LD. u r i n gt h i s t i m e a p p l i c a n tf u r t h e r r e a c h e da t

K u s h a l g hoanr 0 B / 0 52 0 ) - 1a,n ds t a y e dt h e r ea n do n L 6 l A 5 l 2 0 2 t ,

c o m p l a i natn dh i sf a m i l ym e m b e rw
s e r ev i s i t e dm a n yt i m ed u r i n g
 Thephotocopyof oneof the saidvisitarealso
thisperiodof tim1e.

herewith.
appended

2 . 7A s t h e b r o t h e ro l ft h e a p p l i c a nwt e r es t a t e dt h e r ea n d h e n c eh e

the copy
bill of the houseof Kushalghar,
hasalsopaideleCtricity

of the screensfrot of said systemgeneratedmassageis also

producedherer,ryith.All family membersof applicantw(:rfF

'of
before the death
residingat the Khushalghar Smt. Usha

P r a n a m( is i s t e r ) .

2 . 8H o w e v e ra,p p l i c p natn dh i sr e l a t i v ews h o a r e i n - l a w sr e l a t i v eof

s

(Lt. Arvindbhaifranami)are totallyand absoluteinnocent.B y

lookingto the fi;"stinformationreportthere is clearcut casen o

p r i m a - f a cci a
e s ei s m a d eo u ta g a i n st ht ea p p l i c a n t .

hereinof L t.
2.9lt is furthernot$dthat familymembercomplainant

was take away and as a matter of fact

ArvindbhaiPranlami

s i g n a t u roef t h e f a m i l ym e m b e r
b r o t h e r - i n - l ahwp sa l s oo b t a i n e d

for receiving and they takeway. However,therewas

ornlaments

no ornaments
arfdvaluables in the house.Moreover,
available Lt.

U s h a b e nh a s n g v e rg i v e na n y c o n s e n t o t h e c o m p l a i n a notr

anybodyelsefor same.

suBMtsstoNs
Theapplicant
mQstrespectfully
submitsthat;

A. Thereis no prim[ faciecasemadeout againstto be Applicantin

the future F.l.Rn

. o r t h e r o l e o f t h e A p p l i c a nitn t h e a l l e g e d
 , a\l
I i-.li

,ili)
6f, . o s p e c i f i ca l l e g a t i o nas r e
o f f e n c ei s r e v e a l e dt o b e i n t h e F . l , R N

i n l h c F . iR .a g a i r t st lt " l cp r c s e t rAt p p l i c a nct ' i t h t 'lrl t i l . ' ,

containcd

p r e s e ne
t v e n to r o t h e r w i s e .

t a s w o r k e dt g o t h a n d n a i l w i t h t h e s i n c c ' r i t a
B. The applicanh ynd

, 1- r . i B t r i i i - rl,l i c . l c , y a , Luy{ t l ' r c. . r p p i i - .i , i;i,

i i i t e g r i t yc f t l r c l t i g l t t : . n

. t h e p a s t , t h e a p p l i c a n th a s n o t g i v e n a n y
u n q u e s t i o n a b l eI n

o p p o r t u n i t yt o t h e m a n a g e m e nfto r a n y c o m p l a i n t .U n d e rt h e s r :

c i r r - u n r s t a n c es si n, r p l yb c c a u s rt l i c t h e f t h a : o c c u r r c di r c t t - L
r ii.:

v e h i c l eo f a p p l i c a n t ,h e a l l e g a t i o ntsh a t h a v es u b s e q u e n t icyo i l l o

u p a r e t o o f a n t a s t i cf o r i t t o b e p a l a t a b l ea n d b e l i e v et h e t o u c h

s t o n c o f p r r : b a b i l i t vt .i r d r . r l h e s c c l r c u , ' n s t a n cteh'iss I i o r i ' b l r '

C o u r ts h o u l de x e r c i s etsh e d e s e c r a t i o on f g r a r r t i r r B
g . rr l i n f a v 0r . l

o f t h e p r e s e nA
t pplicant.

C . i h a t t - f t c c - r n i e r r t oi of nl l r t :i . l . Ri i s c l Is u g i l c s L et hdc r cc ] i rr: { - ; r l r i r i

i n s t a t e m e n t sO. r r es i d ec o m p i a i n a nsta y i n gt h a t a i l w e r c c j o r r i i i

a n d l o o k i n gb y n e p h e wo f t h e c o m p l a i n a natn d o t h e rs i d r w
. ithout

a n y l t r c u s " s t a ncdoi ,m p l a i n a nf itl l i n gt h i sc o m p l a i n tM. o r e o v r : tr l,' i e t

a l i e g e do r n a m e n t so f v a l u a b l ew e r r :r r o t et h e r e .

D . S t a t e m e not f t h e F . l . Rc. l e a r l ys u g g e s t i nt g
h a t i s a f t e rt h r : u g t r t

conrplatn
a tn crj r u i trhn a i a f i dien t en t i o no n t h e p a r to f c o r n p l a i n a n t ,

h o w e v e rf.a l s eF . l . Ri .s p u n i s h mnet w i t h o u t r a i l .

E . W h e r et h e r e i s c l e a rc o n t r a d i c t r l rsyt a t e m r . ' n il n: ; F . l , Rr. r t tr , r ' e (llo

r-r;>fOdiailtIer] UBdirrJti.
 ,iAT
"^riA

F. The applicantwifi gavensincereco-operation.

The searchwas

u n d e r t a k eant t h $ h o u s eo f t h e a p p l i c a nN
t .o t h i n gw a sr e c o v e r e d

or discovered.Nothing objectionablewas traced out and

t h e r e f o r et h
, e r ei gn o h a r mi n e n l a r g i ntgh e A p p l i c a notn B a i l ,

G . T h e a p p l i c a ni ts f e s i d i n gw i t h h i s f a m i l y T
. h e a p p l i c a nits a l a w

. h e a p p l i c a nht a s
a b i d i n gc i t i z e na n d h a s a s p o t l e s sc a r e e r T

t h e q u { l i t yo f h o n e s t ya n d h a sa c c o r d i n gpl ye r f o r m e d
inherited

And thereforeal$othis courtshouldexercise in

the desecration

favourof the appficant.

H . T h ea p p l i c a nhta $n o C r i m i n aal n t e c e d e n tTsh. e r ei s n o r e a s o nt o

he involvement
b e l i e v eo r a s s u m lb y a n ys t r e t c ho f i m a g i n a t i ot n

d f f e n c ea r r dt h e r e f o r t ' a i , , r - ,
o f t h e p r e s e nAt S p l i c a ni nt t h e a l l e g e o

n enlarge
H o n ' b l et h e C o u r lst h o u l de x e r c i steh e d e s e c r a t i ot o the

A p p l i c a notn B a i l l

t . T h ea p p l i c a nstu $ m i t tsh a tt h e a l l e g e od f f e n c easr et r i a b l eb y t i i c

c o u r to f M a g i s t f a t eN. o n eo f t h e c h a r g e sm a d eo u t a r e e i t h e r

p u n i s h a b lwei t h i m p r i s o n m e nwti t h l i f e o r d e a t ha n d t h e r e f o r e

a l s oB a i il s r e q u i r Btdo b e g r a n t e d .

J . Evenotherwiseplsothe commission
of the allegedoffencesby

t h e a p p l i c a ni st a l s oi m p r o b a b l e .

K. l f t h e A p p l i c a ni st r e l e a s eodn B a i l t, h e A p p l i c a ni st n e i t h e rl i k e l y

t o f l e e t h e t e r m so f g r a n t i n gt h e B a i ln o r i s l i k e l yt o c a u s ea n y

h u r d l e sd u r i n gt f r ec o u r s eo f a n y i n v e s t i g a t i oi n ,q u i r ya n d t r i a l .
..AT

T h eA p p l i c a ni st f l o t l i k e l yt o j u m pt h e t e r m so f t h e B a i l T
. h e r ei s

no likelihoodof fleeingthe causeof justiceor otherwise.The

is not gr,irilty
applicant for the offences
to be allegedto havebeen

committedor corfrplaint
mayfiledthereof.And therefore,it is a

of Hon'bleCourtshouldbe usedin
fit casewherethe desecration

favourof the prespntApplicant,

L . l t i s m o s tr e s p e c t f u lsl yu b m i t t etdh a t h i sn a m ei s n o t i n F . l . Ra, sa n

a p p l i c a ntth e r e f o r et h e r e i s n o n e e dt o b e p e r s o n a l / c u s t o d i a l

interrogation Agencyand hencethere is no

by the Investigating

and hence there are no

need of any cugtodialinvestigation

groundsfor othqrwisedenyingthe desecration

of Bail to the

Applicant.

M . T h ea p p l i c a nstu b m i t tsh a tt h e a p p l i c a nsth a l sl t r i c t l ya b i d eb y t h e

t e r m so f t h e B a i l ,

N . Theapplicant leaveto add,alter,deleteandlormodifythe

crat/es

contentions
raisedhereinabove.

6 . A p p l i c a nht a s n Q t p r e f e r r e da n y a p p l i c a t i o fno r g r a n t i n gb a i l

beforeanyotherpourt.

7. The Applicant,{herefore,most respectfullyprays that, this

C o u r tm a Nb/e p l e a s etdo :
Hon'ble

AND FORTHISACTOF I(INDNESS THEAPPLICANT

AND JUSTICE SHALLAS

I N D U T YB O U N DF O R E V EPRR A Y .

Place:-Ahmedabad
Date:- 0310612A2I R I J E S H K U MS
AHRA R M A
 VERIFICATION

I, DURGA
BRIJESHKUM
MAARH E S H K U MSAHRA R M AA G E DA B O U I 4 5

H i n d ua d u l t ,R e s i d i n g
a t P a d m a v a twi a r d n o . 0 7 , B / s . A . K , N , D h a m

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, . P .d o h e r e b vs t a t eo n s o l e m na f f i r m a t i c lt nl i a t w h i r i r , .

s t a t e dh e r e i n a b o v a
e r e t r u e t o m y l < r r o w l e d gaen d b e l i e fa n d I b e l i e ' ' . , r ,

t h e s a m et o b e t r u e .S o l e m na f f i r m e da t A h m e d a b a o
d n t h i s 3 R t 'J U N E ,

202r

ponent
 B E F O RTEH EH O N ' B L E
P R "S E S S I O NCSC I U
RI OT
BANSWARAAT BANSWARA

C r i m i n aM
l i s c .A p p l i c a t i o nN o . 2021

( U / s+ l g o f C o d eo f C r i m i n aPl r o c e d u r C
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A G E DA U O U T 4 5 l ' l i n d ua d u l t ,
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. . . .A p p l i c a n t

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Petitioner/s
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Respondent/s
Opponent/s
Defendant/s
k R/y/L-\
I I w e , t h e u n d e r s i g , d o h e r e b ya p p o i n ta n d r e t a i n M R .
CHAITANYA M. VYAS & MR. AKASH N. SHAH Advocates,to
act, appearand to pl d for me/us in the above matterin all
p r o c e e d i n g /tsh a t m a y b e t a k e n i n r e s p e c t o f a n y a p p l i c a t i c l n
connected,therewith nd the deposit and receive money on
my/our behalfin the s matterand in application for reviewand
to compromise, settlea d / or withdrawor to the withdrawal of the
said matteror any p i n g / s a r i s i n g t h e r e i n , l o r c p rc s u rr t ,
me/usand to takeall e c e s s a r ys t e p so n m y / u s b e h a l fi n t h e
above matter. l/we a ree to ratify all act/s done by my/our
abovenamed advoca s in pursuance of this authority I
vakalatnama.

In wiinesswhereof| / haveset my / o u r h a n d / st o t h r sw r i t i n g
o nt h i s yof 20

ACCEPTED signaturett, -{

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 t0

BEFORETHE H ,BLEPR.SESSIONS
COURT
OF
BANS ARA AT BANSWARA

Criminal isc.ApplicationNo. 2021

(U/s438of of Criminal Code,1973)

Procedure

SHARMA

. . . ,A p p l i c a n t

vls

Stateof RAJASTHAN
(Noticemaypleasebe se through
T h eA . P . PC
. i t yC i v i la n d ssionsCourt,
At Ahmedabad) . . .O p p o n e n t

--- I S TO F D O C U M E N T S
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t-sR. II t*ti*h;--- lilc I Page
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(qmrq{t q5{Tsrugt): 31t05t2021 17'14;{n
(Rrtq1 (nw):
(c)GeneralDiaryReference EntryNo. Date & Time '31t05t2021
033 1 47.1A.^A qr
4 t ' ' Et ) A , ) ^ 17
(tffirqqrdcrf;; 14 00
FRf (frnt6 gq qsq)
4. Typeof Information
(qq-a1fir*fi'R):
5. Placeof Occunence (Tcqr€qn):
1.(a) Direction ftomp.S.
anddistance BeatNo.
(ni t Rrn*< qg1: T{, 1 nnft (fr-sr{
):
(b)Address(rnrT):
KUSHALGARH,
KU GARH.327801
1cIn case,outsidethelimitof thispolice then
(uRwrnfi{r*qrfltfr)
Namoof P.S District(State)
(qffirilqrq): (frqrfirwr)):
6. Complainant/
Informant
1Ml
(a) Name(qrq: ASHV|NI
(b) Fathe/sName(ftm mrmr;: LAL ANDPRANAMI

(c) Date/Yearof Birth

1o q o (d)Nationality(n$rfl:
(wvftft/a$:
(e)UIDNo(qwr{frd.):
(f) Passport No.(wcfr3t.):
Dateof lssue Placeof lssue
(Erfr.rdStftft): (qrft fi{i fir Frn):
(g) ld details(RationCard,Voter tD Card. UIDNo.,Driving License,pAN)
(q-E{r{R-c<urt
uqr;rnr€,
qil{rflI c-fln q?f,qr{q-r,qftIn n.r€ {i.
ts,tfl),
1 S.ruo.I tdType mber
t
L_-__-
i I __

(h) Occupation
(ar6il-0;
(i) Address(vm):
, S.No.(tr. AddressType
q.) (trilrsr rrr<)
I t '+dqmq-ar DORA,BAGIDORA,
{Rtr-/T qTq-4ffl, TTG-{a{T{, .ttTT-f,

lqrfr qf,T IBAG DORA,BAGIDORA,

mftiq{T, qi{qrgT,{t\{Fenq-,

(j) Phonenumber
(Kqqrqq.): Mobile(*-+rqq q.):

7. Detailsof known/suspected/unknown full particulars

(nml$fuqlBrflrd
sIftW Frgt k{(ur sRr
Accuqed
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oTrfrfr\rdt Sfrii-wr):
S.No. Name Alias Relative's
Name Address
, (m,it')--,qry1
- ,(YTq) (Rqt-{R{r qrr) (q-rr)
1 TRAJESH KUM AR 1. DHAM M OHAL LA
i
lr r taT.MAHESH PAN N A,
, _ L..
lnRursn
J - PIIABUA ---@r{rrnT,qErr!"lr,j+1lq
2 I KUMAR ounvuoHALLA pArlxn
lfrar:MAHESH lr.-tiTfl-.fr
ISHARMA q;{t,qqt,}T?.q
yirr,.,lrr.1
3 REKHA 1. DHAM M OHAL LA
lq- fr ' nnlr SH PAN N A,
,fp4ef{i rl;;Il,r{.1t,}l r.jTrJ?eT,
qlr.1
4 DURGA qdr :BRtJESH 1 . D H A M M O H A L LPAA N N A .
4;nartfr q-il.r]-"Jl,H,-.rr y{rT'+rT
Jl
iDEVKINANDAN nmnunANDAS i 1 .B U T B H W A NVI E J A L P U R
AHAMADABAD,
AHAMADABADA,Tq;Tq{,
l,{ewil4l? r,tdr,r_l,l rl .T,.+IT
r.l
RAJANI .TzfiDEVKINADAN 1 , B U T B H W A NVI E J A L P U R
AHAMADABAD,.]] A'rr .zT'7T >JNl;i
 Nc,R.Bt\q.fr,qK.fr

8. Reasonsfor delayin reportingby the nanUinformant

(fM I qffrnili arcrftfrt tft t Ef tmr<ur):
9. Particulars
of properties
of interest( separate
sheet,if necessary)
qft eil-qsfiS,
(rrs{fudTrsqfrmrR-q-{vr( Ysq-s 6u:
sTcrir
ivpe twqR Description iValue(lnRs/-)
(R-d{sr) r(Xvq(rit))
10.Totalvalueof propertystolen(lnRs/-)
1*ftgtriqRnrgvqw6fl y:
11.Inquest
Report
/ U.D.caseNo.,if any qftn fi*8 i q.*.no-<vr
r., qR *{ &:
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contents(Attach sheet,if necessary)
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13. Action taken i Sincethe aboveinfornra revealscommission
of offence(s)
u/s as mentioned
at ltem No.2
Xfr scn-rnqFffirfrt q-m
(ft G mr4Er$: { fr wv-auqn-{t6Tafi$r qs {.2 ii sdq Ercr* nqn il:
(1)Registered
thecaseandtookupthei (rfr-{urq-Snin r{r *{ qtq + ftq ft=qlqqr):
or ({T)
(2)Directed(Nameof l.O.): Qr I
NDRA SINGH Rank
FfqeTffi6T?Trq): H C 64 (qq): T?zr 'il ralT

No(d.): 664 to takeupthe I (fr qf{ BTqt qffit ti t ftq frtq Rqr.r+r)or(O
(3) Refusedinvestigation
due to
(qlq*ftq,
or (* mrrqi+n ft-q[,qr)
(4)Transfenedto P.S.1q6;. District(&-w):
on pointofjurisdiction
(* ffirrc * {mirkr).
F.l.R.readoverto the complainant/informanr ittedto be correctlyrecordedand a copy givento the
complainant/informant free of cost.

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R.O.A.C,(3r|{.*.q.fi.1
 I,C,R,F&{.*,om,fr
Ll.F.-tffiWqfqFrf-l

14.Signatureffhumbimpressionof thecompla Signatureof Officerin charge,policeStation

1lM I qs-{rs-dt* qwnn<i r{TItmrR (srmr
crt-O* aeanrl

rt__ Signature/

15.Dateandtimeof dispatch to thecourt Nameftq;: PRADEEP

KUMAR
(Enrffi t *qq"fr A-qis fiq rrq):
Rank (F{): I (tnspector)
No(t.):
 _N:C,R.Bt\r.fr,sTR
fr
Attachment
to item7 of FirstInformation
Report(rvqql-{r O"a t nqqs):
l.l.F.-lr\rfrWql-qFrf-l
Physicalfeatures,deformities-
and otherdetailsof
-#-Autor,
the suspe f known/seen
(Tift'q/qftStr ff cnfrR-d
R*v-6,9A-tAil.n )
sra/terrrqr))

i Hiigtt(cms.l Complexion(trr ) ldontification

Mark(s)
1 (F<G.o) (q-{qnR-d)
/
I

Eyes Habit(s) DressHabit(s)

(dd) (qr<*) (c-f,{rdrl
1 1 12 t ?

iLangu-jooiateci
(qrvrdft) i _ _
j BurnMark r-eucooirmi Others
Tattoo (q-q)
i (q+gq.Fr (r4qqn 1 t1tgq6r)
I
i ft{m)
is ;^
to
1rj
I
2A

lhese fieldswill be enteredonly if complainantiinformant

gives , a"a prni.rfrrti,Orrr rn"-rrrp".r"a.rr"O
(T{ *{nSESfr'qlrrqt qRfffil "aa "t.
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I tLrt v t-t\\J\r, \Jgr tgr cat il ttlJt al lvli \rwl I lPCll ly ! | iltgv

cum PolicySchedule
of Insurance
Certificate
Car PackagePolicy

Vehicle Details
l--- i1':vo"!l!':
MAI{LJ II it'olrcN
y o. 2 3 1 12 0 3 31 2 9 5O E O0I 0 0
(DlIsEt.)
swrFl-LDl lPeriodo{ From 26 Feb,202'100:01hrs
RJ.27.C0"0436 llnsurrn,:e To 15Feb,202223:59
UDAIPUR Dale 02rc212121
MR ARVINDKUMARPRANAMI ll..uun""
AMIKRUPASOC,NR-CIIAMI.JNDA RA No. 586258 llnvo'ccNo :'03312950801000
C/OD P SHARMA,ISHWAR
C/OD P SFIARMA.ISHWAR AMIKRI,JF]A SOC.NR"CI]AMUNDA RA )apacityA/Vatts 1248 Seats 5 ]Custonrerld 101380538477
\ r l 3
I W A YC R O S S I N ( l . i A lI ) l l F lA r l l l l lD A I ' I A D 8 0 0 5 1
Y CAI l\,4arulact!r(! 2014 i . J o d yl y p e llAlC|jBACK
IAHTvEDABAU I Not trr )vrdi-.4
380051
I GUJARAT' Iel.8094133221 No. 23UA74
l Detalls.Iundlransfel

L__
For the vehicle (

-
L i a b i l ' t t yP o l i c ! , P e r i o d
To Date& Time

Q w [ O a r i ] a E oP r e r n i u u t i ) i L i a b i l i t yP r e m i u m i b )
BasicOrvr0amaqe EasrcThrrdFa{l i-reijr:ri;
Add;Frbrefank .?Ej
LL to Pordurr!e.ilN4.l
Tolal Ba6icPremium PAfalef li f Ornef i'rver 0l
'I
o Daie 2ii l2l2i-.'22r
i r A C O l e ri l r f . . l . l a i r e t i i e i s i r s i i l t j l l u u i : : " t l t l 0 r l , i ' e f ! i r ; . , r i ' l ' i i
Net LiabilityPremium(b)
.uni
ri(i5c
TotalPackagePremiumia+b)
145rj
GST18%r Centraliax 9% ( {725 I ' Sla1eTax9'.?I 1725)
4209 11501
TolalPremiurn

l q ''
''i.rbn - r
irq,,
foundincorrecl,
lf declaration underthepresentpolicyLnrespectof own
benefits

with:STATIBANi<Or $lKANfR & JAIPUR

Hypothecated{lMT-7)
'i'lt
P0iic! illversuseci tnevehlcliirr aiiypiirri0s{i c I iir6n al l'1ra ".r Rewaia fr (-la|ra'Jefl qnLrd-q iililri-r tn3', sarm0is or 1-"isair:ilr! il!.iar, i'i.
i tlMlTATl0NS AS I0 USE..
4 r ' 0 F r ' 1 r I r u i r ri r f - " ' - r r ' l i ' . ' r " 1 ?
l R e | a D l | l y l . : 3 i : l G i A n! 1! u r i . : i rnsceo n ' e c l r c n ' ! l i h l " ' 1 c li 'ris d l P e r s o n s o r C l a s s o f P e r s o n s e n t l t l e dt c d r ! v e
] e ) S p e e r l t e s t i ni g -'l
'- -i '' 'i-
ard is n0i 1 squalrfie0 ff(rnirilcJ : ; i , f O t r l t s i i r f r g S U C h 3 i i : e l \fl r a v t j i r ! - : l l s a ' l l ' , a l l l t l a i - i : r i l i - i - r i i j r r r : i l r l e l r l l : ' i r " " - l :": ' ' 1 "
I effectivedrivinglicenseal the lrme ol i!:e accicleni
V e h 1 i r r i i s r i ; ' ' . t i ; r ' l l ' 1 i 1 : l r i : i p f : l ' : r - , ) i ' i i i r : ' i' r i ' f l i r " l r j l ! i r { r r 3 i r r i ' r1 '
i i r a tsucna p e r s 0 n s a t i s i l t
e h-s( r e { l u , ' e m e n i sRo u
i l e 3 0 i l h e C * r r l r a l \ ' l r d ; r R i r i e s 1 9 3 9 L i r n i l s o ' f L i s t l i l l t y
I
je0li0fi : - i i r r t ! i t i t e r r o l i c y - D a [ ] s ! - e I i 1 r c P : i f i v F l l i i e r l y { a s r ] ( l c l l . } . 1 1 . / . . c t , , e r r 4 ( l t ; r s i : . t . r o l i f i r r J f r . 'i fr i' e ' a i l i i
I necessaryio nreellhe r€qililenlenisof ihe fujotcrVeirlclesAct l 968.2 i.indel
I i50C000Terms, Conditions& Exclusions: As perlhe lrrdran [.'1cll'rarrii/r ncr:lni

rt insu.ance are'ssuedin accordance rvithlhc prrvisionof charrlor X Xl ol IV V A111!E8 " Tr l sr;nlr 'illv {ri { I 5n
! , We nerebyc€rriily thatlhelOlicylc wnichlhu.:Di||ialerelalcsas wella* iheL
ro CSDl362i?C20113C2 dated a s p r e s c r i b ei nd G o v e r n m e n i cl ,l4 a h a r a s h l f a O r d e rlN r l"e1r,i t r c0 q r h J a n u a r y 3 f r 8 " l
l uod r a f l ' 2 0 1 7 ' C R 9 r - 1 1dv. 1
paid iry DemandDraft. vide Rscsrpiicnailsn
if thevehicleis usei or cnvcn lhanin accordance withihisSchedllcAnyDaynentmadeby theCompany ily feasr:nc! \!i.tr icri',, .ltfalng rnine
IMPORTANT NOTICE:TheInslredis notindemniiied
'AVOIDANCE {lF CERTAIN TERMSANDRlGl-iTOF RE(lO!ERv" Disclaimer: l|e i.,iii:v
V.ihrcieAct. 1986 !s recoverable
Certrfiaatein orderi0 complyrtlh the fu1olor fiom ine see rheclauseheaded
Ieseri!s lrtii i Il,l iii i-afri]fl ri A'rlil {
sh3llbe V0idhOn inceDl:cr ir lrtllrS nc1 fPaliseCbirheCii'rrlafy lii.: {jvcnl aJfTrsf8prBSefi!altir:iraud 0 n.Jn-disiiosuteilf nlal€rial iaal lhc C{intan?
ri the Dron'iurir
PiSase ntie thai lhe inSure(jvi'ni{,lt v,'iji ifijrfls0scteai anc 3 iililarl /''as pri:pdr{:rl 1n|t.ll.i]t'x.siill1ji-1.]f.|3u{j:ii]ln(j!fnclijesq]enl]:],].,l]itr

ily you,whir.fis alaiiableilih lhe ciiilDanyIn r'art 'ri I

prcvioeil
| oasrsiherofcrmatlon
.epar]c}',l't0j1ier,'il:linq0l|,"|eVan|n10rmalil1nin:5e1].1i(JV'lne|nsUIe{:]sr"ol'les1ilj1.]l{ii:i]
'15 underrele.se{,irar/:je
I comoanv wt'ntn (lavs.GSI icr lhrl lnvO;iersnoll)ayaole oes

I
olaiarrvonp i;Snllel excirrd, naYaranlllilra
Branch:206.$ecil, shri0per rhnedaoad
I
girllficaiglrnake
on ww* ii,,rarno*-, ,", Ooll;ycutry;lJX & ii:j
'-nriilEt:rrc!rs.1;'
.]ueres 0ailrs Ji, i'''2,1 i73tb234 r c 1- i 2i 62111
ior UlarmiPoiroyrelacc 6ilJr,lr' r,efpSecr,un
c-ooe llbils4
r-rsr.l
I{I)KIN(; IVT LTI) For IIDFC I;RGO General InsuranceConrpany L td l
l - l l - 4 ( r ? l t ll 0 l . / . , . .

f ) , r l yC o n s t ' t u l 0 dn t l o I a c Y

liitLsttf I l r c k ( l t t t t t t ,I l c t r r r r l l r t r t l \ l l , d

UIN:|RDAN125RP0001V02201415. ServiceAddress:
Customer D 301 3rdlloor'
HDFCERGOGeneral InsuranceCompany lmiled. IRDAIRegNo 146 '400 0/8
Oflice:lsl Floor,HDFC District
EasternBusiness (MagnelMall),LBSMarg,Bhandup(West),lVumbar
CIN: U66030MH200?PLC177117. & Corporate
Regislered
Munrbai - 400020 62-346234| w\e hdf'r0fqo:on-
CustomerSeryiceNo . t91 ??'6?3462341+91-120
1651166 Reclamation,
Backbav Marg.Churchgate.
tl T.Parekh
 r t|'.rt \/ t*t\\J\J \Jqtrstqt rttttJ]Gtttl.C \r'\,tttpciltJ || I ||tgl'a

Proposal
FormcumTrans policy
LetterForPrivateCarPackage

-l
Vehicle Details Proposal Details
I\4ARUTI No. 2 0 2 10 2 0 2 0 0 5 7 3 6 6 ,

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fVRARVINDKUMAIII]RANAMI No 586258 i Invorcc\o 2033'r;19508C 1lutr
Capaorty 1248 S{lals
C/OD P ShARMA,ISI.IWAR RA i C u t
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Details: FundTransler
lD : abc@abc.com
For the vehicte (( N .o n -E l e- c l r0i c a-lA c c . ( { ) Electrical Acc
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0wn Damago Premium{a} (rj L r a b r l i l yP r s n r i u m i b ] r?

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Tank 50
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I TotalBasicPremium 4209 PA Coverici OwnerDriverof 1500ii00i CPACcverPotrcyPenr{!irom i1;,1,/;ri"r_!ri; I .\2b

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IaDaie 25.C2i'!i)'22
PA Coverfor Un'l.lamed
Net LiabilityPromium(b)
TotalPackigePrernium(a+bi
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trch ifor 5 Pr:rsln: rI'fl ,1rir
Perscnscl 10i.j000 ?5(
384i]
f1055
II NetOwnDamagePremllln CST 18qi; Csnlrallax 9'n i I 7?5j ' SiateIar 'j9" r 1725) 145(l
la) --: =':=- 9i'05
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I ll declarahon
{oun0Incorecl.boncf.ts
-' tre p'esnnlotlicy:r fesDcclof owr dirage s
- undcr
EomineeT6i6wnerir-ivei- [,l'isrtsnanrana,ii,Snbit:
lHyp"rt*""t"dffirt4 *iuGrnre SANKoF BffiNER& JArpu[
BrokerName: MARUTIINSURANCE pW LTD BrokerCode:
BROKTNG 4460Tel No. : 91"1146781101

P r o h i b i t i o no f R e b a t e s{ S e c t i o n4 1 o l I n s u r a n c eA c t , t g 3 8 a $ a m e n d e d }: 1 pers04 -shallallow0r ciler t0 aljow, eilhe. direclly cr t4directli. as an indjaement i0 .lity'

Fe.:0r) l{r lake Oiti or fenew t,r
r0nlnLe 3n insura'rc€ !n respectCi an)'k,id of riskrelaling to lives0r pfcperlyIn Indja rebaleol lhewholeof parlci theccmmrssiofi payable 0r anyrebale0f ihe pferrruir. sno!v,]{ri lfe oolicy..0r shaliany
personlaling 0!t 0r rerewincor coniinuing a poltcyacceptanyrebaie.exudptsuch 3s nav be alioweiiin ac{rcrdancB wilh the pi.rttisi}eiprospsilJsesor tablesnf lne rnsrrgr:proviCed lfralaaca.fdance bv drr
Insurance agentrf commission in connec|on wjtha polrcyof lifeinsurance lakenoil by 0n r:s cwn lire shil'.ot he ceemeajtc be Jcaspiance ci a rebale 0f orenrun,,v:irrn :he rt,lrinq .ri lhis si,ib,secl,crif
rl lre lirir af suchtiteFtanaf Iro it.stir:i.ce tc0nr !.ti:tttesihe orcscrihcc foidiliansesl :nirc in:i hs tS a b,rn: ir,: InsUrania.lgeri ilrpjoveC b,y'thajfsurel
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L Anypersonmal(ing delJUll,r Lompiyrc$iii :ir cro!tsi0nsai tnts:ertircnsrzll {te|r.10; n !!ircn tP.:li! ra! EXietailc lar lahn rrJc€es
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i ! hefebydeclarethattheinsuredpersLrn{s) |siedrnprcposalFormrv,liab,deto ihefolk T&C
i r ; li\{tl hn,tby dedarelhathi slaier'ltenls lai-1etrJmei!s afrjtrueta,lhehesli,l f j,,i
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u/ -^, v\,!i t,r I j! I r,! ktli;*iedgeandbelicl:|i:].w.he|i)ij'J!|e'.,i|..lll::sJijl]]a|nr.lsh;]|l|ij.l1l..',i,..:],l.]ili
I iIDFCERG0CeneralInsurance t)cmpa,ry Li4riir.0.
I 2) l,'Weelsodeclare ihai,if an.vadfirlicns 0r ahe,rttcrsarc carriedcul ailcrge :iui,mrssrcn )fInisprolxrs.rl Fofir.IhBfiths semcw0,Jld br conveyeC t{rthcirsurer:iimnaci;lf)1!
lll"ie6lsoshallende;lvor
I .31 {o pro{lJrctherenewal notce anc pass!"rntre sami i1rHDFCi G e r * r a l , n ; l r . " C e , m I r € 0 r a l e li,ri t r l r t h e ' e C + : p n l i L . h ' C n e w a lf l I , C F
s e r 5 r l r ! v hlir,: ( t r l , 3 t ! j r . , : j w r l ' . , r - , rr:i rt lsf f ; r , j r t tllrqr . , u , ; r , r r , ^ r . r i , I r n y je. ', p e r s i i r s i l e s i t
la;{ry llf0l)i!5alftr
informaiiOr cOncernrnE anyiaclmaleflaltnereiOiommiisa fraUdulent actwhrcnwiilrendel Itolicv v':rcanieal Ihe CJn0an! s sOledrsr:relloilari iesull r0 a cenral .ji rniiir;i.,ie ,flr!rii
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I GSTIN:. l'Jo1o(Comprchensrvr: ar( TPr Fcr|ol[\, is!]!.]c ir lte namei:rfiorpir;lg cntiil ptopricirr HLF parlnL'rsf,' lrlva:e {0mparv e10) CSTIN rs pnlted on lhe Dnlcy 0as,:,lho.lijl.ritlr
f,rari,ji:l (lirrrr{tIDii.:V
I rsSUAnCS. FOrariysuDscraronl Cnaln(jas Jr ticttlrtf 1:;r :l !gl ifi xli erlridi::ir irit lne Ol --Vissu;nce cl C0llij! stre,:,Lrlrlinijnqes 3heil fie.tctritC aui li rDlrlh ircsl. polr'r'tss,.t:-.'r;.' !fii lj ':i it I ;i ei.Ijt
| 5) I I we ieclareariJccn'irflhavrfga validPUC
6) I understand iheProposal No 20210202005i:J66 is issrjedto me basrson abOveInicrn
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I TranscriptDeclaration: In cascCrsagrcerlcnt
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or objeciion or anyctherchan0es wrl., 5 C C : :I t , n [ 0 r n a I c r i n c : . . : r u x : : .' n c n l t - n \ 1 .: . . : : / ; j ) ? ( 0 t . , ] . . ; . r . , ( i . r r l i ; l i f , t I , ilai,j t',).ii;l i'.,'
.itii,
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I changesCisagreemenl to ihec0nienl01tfrislranscflp! c,ryoumayaisOsendusematl0r r ier .j0resir0n0erc€ al ii'teroliOwtnd[:elarl: #ir I i1 fjetica 01 i! 0a.l..j11ifl i ) d j t l a t , l a ! u ' I e r c 0 i i ' : : t . , . . . a . tt t ) t ; r . ,

IIDFCERGO General Insurance C0mpany l-imiledIRDAI RegNo.146 UIN:|RDAN125RP0001V02201415 CustomerServiceAddress:

D 301 3rrtl:k)or
C I N : U 6 6 0 3 0 M H 2 0 0 7 P L CR1e7g7i 1s 1
t e7r.e d & C o r p o r a t e O f f i c e : l s t F t o o r , H D F C H o u sEastern
e llusinessDistricl([lagnel[,4all), iwcsl) Mumbai. 1]al: /i
l-BSN4argUhandup
165/166 Backbay Reclamation, H.T.Parekh Marg. Churchgate, Mumbai - 400t)20 CuslomerServiceNo +9122.623462341+91-120 62346234I ww hdfcoroo;oq;
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