GOVERNMENT OF UTTAR PRADESH

Transport Department KANPUR NAGAR

FORM 23
CERTIFICATE OF REGISTRATION

Registration No :UP78GV4623 Registratlon Date :13-Jan-2022

Description of Vehicle : MOTORCAR Purpose For Printing RC :NEW
Dealer's Name &Address :PHYTRON MOBILITY PVT LTD, 26 GF NIHO SCOTTISH MALL, SEC 48.
Owner Name :DEVENDRA KUMAR Son/wifeldaughter of :VIJAY SHANKAR SHARMA
SHARMA
FullAddress: (Permanent) :K-301 VISHWA BANK COLONY KANPUR, SAHAR BARRA KANPUR NAGAR. UTTAR
PRADESH, KANPUR NAGAR., UTTAR PRADESH-208027
Full Address: (Temporary) :K-301 VISHWA BANK COLONY KANPUR,SAHAR BARRA KANPUR NAGAR, UTTAR
PRADESH, KANPUR NAGAR-UTTAR PRADESH-208027
Fitness UpTo 12-Jan-2037
Owner Serial No
Tax UpTo :One Time
Detailed Description
Class of Vehicle :MOTOR CAR Link Vehicle No
Ownership :INDIVIDUAL Norms
Maker's Name :BHARAT STAGE VI
:TATA MOTORS LTD
Front HSRP No
:BA2501667237 Rear HSRP No :BA2501667238
Type of Body :5 DOOR STEEL SHELL
No of Cylinders
Month/Year of Manuf. :12/2021
:3
Chassis No
Engine No
:REVTRN11PYXKCO986 Fuel
:MAT627130MLP94757
Horse Power(BHP) :PETROL
:118.19 Cubic Capacity :1199.00
Maker's Classification :TATA NEXON XZA+ 1.2 RTN Wheel base
BS6
:2498
Seating Cap(in all) :5
Sleepar Cap :0
Standing Cap :0
Colour Unladen Wt (kgs) :1241
:CALGARY WHTE Laden/G Wt (kgs) :1651
Other Criteria
AC Fitted :YES
Vehicle Purchase As :Fully Buit
Additional Particulars of all transport vehicles other than motor cabs
(Gross Vehicle Weight)
By Manuf.
As Regd.
Description
a) Front: Weight(in kgs)
b)Rear:
c) Other:
d) Tandem:
The motor vehicle above described is subject to
Purchase dt :29-Dec-2021
Hypothecation in favour of w.e.f..
OTT Date Sale Amt :1064900/
:13-Jan-2022
Amount/Rcpt No :106490|
TaxUpTo :One Time UP78R22010002222
Tax Exempted or Not Vehicle is Govt./ Pvt. :PRIVATE
:NOT EXEMPTED Date of Approval
Other State/Transfer/Conversion Details :13-Jan-2022
Previous Owner
Old State Previous RegNo
Transfer Date Entry Date
This certificate is valid from Conversion Date
13-Jan-2022 to 12-Jan-2037
Date : 22-Feb-2022 12:11:13 Registefg Authority
Taxation Particulars /Advance Registration Mark Fee Details Sgty Registerg Abthority
KANPURONè 2àFeb-2022
N 1773208
Uttar Pradesh
 Insarance Co. Lid.
rCO Tokin General
r ce oInsurer: SCO-10Ist FloorSector -l4, Old Dellhi Gurgaon Road, Gurgaon, Harau
IOO-TONO
122002.
/Stute (Code 06) -1. PH. Website: www.iffcotokio.co.in
(SACIZ573H. GSTIN: 06AAACI7573H1ZG Insurcr's IRDA Registration Numbcr: 106
Helnline 124-4108790, 4108791, 4108792 Email: CIN:U74899DL2000PLC107621

BUNDLED COVER WITH ONE YEAR TERM FOR OWN DAMAGE AND THREE YEARS
OTOR THIRD PARTY INSURANCE POLICY FOR PRIVATE CARS-CERTFICATE CUM
POLICY SCHEDULE (UIN-IRDAN10
I106RP0010V01201819) aho
(PORM Si OF THE CENTRAL MOTOR VEHICLE RULES,1989)
I8I40382 Pollcy Issued On 29-DEC-2021 (11:15)
I'olic No.
MR. DEVENDRA KUMAR SHARMA
IsurdNamc
To 28-DEC-2022(Midnioh) Motor Labllty Perlod
sn Damarr erdod 20-DEC-2021(|1:15) 29-DEC-2021(I1:15) To 28-DEC-2024(Midniyht)
PPVBUI|185891, 29-DEC-2021
IUpNo, & Date
eunvHAY SHANKAR SHARMA K 301 VISHWA BANK COLONY KANPUR 29-DEC-2021(11:15) To 28-DEC-2024(Midnight)
CPA Cover Perlod
dd. SAFIAR BARRA, KANPOR, OTTAR PRADESH (State
NA
Code09).208n
(nsurcr
Previous Policy No. NA
Broker Detalls
ie. No.: 375, CIN No.: US0300MHI997PLC149349 Broker Category: Composite Broker. Validity:
MOTORSINSURANCE BROKING AND ADVISORY SERVICES LTD, 1ST 13-MAY-20 Tu 12-MAY-23
1NDI (EAST), MUMBAI - 400 059 FLOOR, AFL HOUSE, LOK BHARTI COMPLEX, MAROL MAROSHI ROAO
Make Modcl Sub Model Cuble Capacity Manufacturing Year
TATA MOTORS NEXON
NEXON (P) XZA+ NEW 1199
Seating capacity
2021
5
Body Type Registratiun No. RTO Invoice Date Engine No.
COMPACT SUV Chassis No.
KANPUR NAGAR 29-DEC-202|
Vehicle DV CNGILPG Kit
REVTRNIIPYXKCO986 MAT627 130MLP94757
Elec, Accessories Non-Elec. Accessories Total IDV
1,011,65S
1,011,655
Schedule of Premium (Amount in Rs.)
Owa Damage Premium (A)
Basic Premium
Vehicle Deductibles
9.685 Voluntary Deductibles (0) (IMT-22A)
Non-Elec. Accessories
Elec. Accessories (IMT-24) o Anti Theft Device (IMT-10)
CNGLPG Kit (MT-25) o AA Membership (IMT-8)
No Claim Bonus (0%)
Sub Total (Basic Premium)
Geographical Area Extension (IMT-1) 9,685 Handicappcd Discqunt (0%)
IMT 23 Premium 0 Sub Total (Deductibles)
0
Add On Coverages (Refer Note S)
S172|
Sub Total-Addition
Liability Premium (B) 14857 Net Own Damage Premium (A)
14857
Basic Third Party Liability
9534|PA Cover For5 Persons of Rs. 40000 Each
Third Party Liability For Bi-Fuel Kit
o PA cover for Paid Driver of Rs
(IMT-16)
Third Party Liability For Geographical Area Extension 2,00,000 (IMT-17)
PACover For Owner Driver Of Rs. 1500000 (IMT 0| Legal Liability For Paid Driver (IMT-28)
150|
15) 975| Legal Liability for Employees (for 0 persons)
Net LiabilityPremium (B)
(IMT-29)
10959
Note: 1.Warning that in case of dishonour of the premium cheque, this
document stauds
automatically cancelled 'ab-Aaitio Total Premium (A+B)
2.Consolidated stamp duty paid to slute exchequer. 25816
3.The policy is subject to compulsory deductible of Rs.1000 (IMT-22)
IGST (18) 4647
SAdd-on: Luss of Key(Key Replaçcments-I Ycar:S06), Nil Depreciation North New(Nil Depreciatlion-1
Year:4553);Towing uplo 7500(Towing-1 Year:l 13)
6.The insurance company will display terms & conditions on its websilc
be acccssod by you online. www.iffcotokio.co.in which can
*Subiect to IMT Endt. Nos.& Memorandum:722,16,28
FX-SHOWROOM PRICE: 1064900 Gross Premium Paid
Nominee Detalls 30,163
Name of Nominee
DEEPTI SHARMA Age Relationship with Insured Name of Appointee Relationship with Nominee
37 DAUGHTERBank Name: NON C¯C HDROO
Puynent Details : Cheque No.: I10371589391, Cheque Date: 29-DEC-2021, -N.A
Hypothecation Details: STATE BANK OF INDIA -kanpur- KANPUR HDFC CCAVENUE, Bank City:
MIISP Nane: PHYTRON MOBILITY PVTLTD, MISP PAN No:
SAC:997134, Description of Service :Motor Vehicle lusurance Services, AAKCPI881F, MISP Code: TMIBASLMISPIAAKCPI8%1F
Place of Supply :UTTAR PRADESH(State Code-00)
Vwe herebycertify that thc policy tu whiclh this certificate relatcs as well as this
Vehicle Act; 1988 certificate of insurance are issued in accordanco with the povisiogs ochapter Xand Chaptër XIof
Motur
For &On Bchalf of IFFCOTokio Genral nsutance Co, Ltd.

ioid onloçisdfàny éluim or assistance required plcase contact our help lino at 1800 209 0060 and you may also reach us at supportatnibas. Auuhorized Signatory
for poTCy 1S5uaT
C:: ifHO CLAIMÁ
BÜLUS
in
is Dared Incorrecti.
Covs3 Under cun
Please Call Phytron Mobility Pvt. Ltd.
For Insurance Renewal
9811823238, 9811303068
or Claim Assistance
165122, 9811169863