GOVERNMENT OF ODISHA

[ CUTTACK RTO ]

VEHICLE PARTICULARS

Application No: OR231026V6164346 Registration No: OD05BM1973

Registration Date: 01-Mar-2021 Previous Registration No :
Owner Serial No: 2 Owner Name: KANHA INFRA
Son/Wife/Daughter of: NA
Present Address: TARINI BIHAR,KAPALESWAR,CHOUDWAR,Cuttack,Odisha-754071
Vehicle Class: Crane Mounted Vehicle Vehicle Maker: XUZHOU CONSTRUCTION
MACHINERY GROUP CO. LTD, CHINA
Body Type: MOBAIL CRANE No of Cylinders: 6
Month/Year of Manufacturing: 4/2016
Chassis No: 20070130 Engine No: 887051555
Horse Power: 245.00 Seat(including driver): 2
Unladen Wt(kg): 41000 Laden Wt(kg): 41000
Registration Valid upto: 29-Feb-2036 Tax Amount: 0
Tax Paid upto: Cubic Capacity: 2900.00
Color: YELLOW Fuel: DIESEL
Fitness upto: 29-Feb-2036 Vehicle Model CRANE
Vehicle Norms CEV STAGE IV Floor Area 0.000
Vehicle Status Active Wheel Base 0
Last Change of Address done on:
Last Alteration of Vehicle done on
0 Insurance From The New India Assurance Company Limited vide policy certificate/covernote no 55030031220200004905 is valid from 18-Mar-2023 to 17-Mar-
2024.
HP Details:

NOC Details:
Black List Details:

Mobile No: 9668572767

Email Id:
Particular Fee Rs. 200/- paid vide cash receipt no OR231026C6373846 dated 26-Oct-2023.

Other State/Transfer/Conversion Details

Previous Owner : Previous RegNo : MH03DK8435
Old State : Maharashtra Entry Date : 27-Apr-2023
Transfer Date : Conversion Date :

Additional Particulars
Number,Desc & size of Regd. Axle Weight(in kgs)
a) Front:
b) Rear:
c) Other:
d) Tandem:

Printed On: 26-Oct-2023 12:57:47

Note: This is a computer generated document. Authority Signature is not required. The document can't be used a MV document in the Vehicle.
Firefox https://vahan.parivahan.gov.in/vahanservice/vahan/ui/eapplication/for...

TAX RECEIPT

Transport Department, Government of Odisha

Registration Authority CUTTACK RTO, Odisha

Application No. / Receipt No. : OR240317V0668134 / OR240317C8404011 Vehicle Class: Crane Mounted Vehicle

Received From: KANHA INFRA Payment Date: 2024-03-17 12:33:33.000000

Transaction Date: 17-Mar-2024 12:35 AM Vehicle No: OD05BM1973

Bank Reference Numbe

Chasis No: 200XXXXX 113216745551
r:

GRN No: 37F407A98A

Transaction Identification Numb

ORY2403176147405
er

Rebate+/
Amount(I Penalty(I Surcharg Total(In
Particular Period Exemptio Interest Amount1 Amount2
n Rs) n Rs) e(In Rs) Rs)
n

MV Tax 01-Apr-2024 to 31-Mar-2025 38000 1900.0 0.0 0 0.0 0.0 0.0 36100

Total 0.0 0.0 36100

GRAND TOTAL (in Rs):36100/- (THIRTY SIX THOUSAND ONE HUNDRED ONLY)

Verify the receipt by clicking Status>>Verify Receipt on Vahan Online Services portal at https://parivahan.gov.in/vahanservice

For further query ,Please go to the zone RTO : CUTTACK RTO, Odisha

Note::- This is computer generated slip, Signature is not required. Can be verified from QRcode

Note::-** Exemption, if any is added in Rebate column

1 of 1 17-03-2024, 12:39
 Form 59
[See rules 115 (2)]
Pollution Under Control Certificate
Authorised By :
Government of Odisha

Date : 21/08/2024
Time : 14:47:48 PM
Validity upto : 20/08/2025

Certificate SL. No. : OR00501660004639

Registration No. : OD05BM1973
Date of Registration : 01/Mar/2021
Month & Year of Manufacturing : April-2016
Valid Mobile Number : ******2767
Emission Norms : CEV STAGE IV
Fuel : DIESEL
PUC Code : OR0050166
GSTIN : 21BCVPB1912N1ZM
Fees : Rs.177.00
MIL observation : No

Vehicle Photo with Registration plate

60 mm x 3O mm

Measured Value
Pollutant (as Units (as
Sr. No. Emission limits (upto 2 decimal
applicable) applicable)
places)

1 2 3 4 5

Carbon Monoxide (CO) percentage (%)

Idling Emissions
Hydrocarbon, (THC/HC) ppm

CO percentage (%)
High idling
RPM RPM 2500 ± 200
emissions
Lambda - 1 ± 0.03

Light absorption
Smoke Density
coefficient
1/metre 1.62 0.69

This PUC certificate is system generated through the national register of motor vehicles and does
not require any signature.

Note : 1. Vehicle owners to link their mobile numbers to registered vehicle by logging to https://puc.parivahan.gov.in

Authorised Signature with stamp of PUC 0perator

60mm x 20 mm
 THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)

POLICY SCHEDULE CUM CERTIFICATE OF INSURANCE

Commercial Vehicle Liability OnlyPolicy

UIN Number - IRDAN190RP0004V01200203

Policy Number :55030031230200004383

POLICY ISSUING OFFICE: BUSINESS CHANNEL/CPSC User: CLAIM CONTACT:
CUTTACK D.O. I (550300), NAME: DIRECT BUSINESS - (1D7830444) Cuttack Non Suit Claim Hub (559001)
CUTTACK D.O. I , BADAMBADI , KATHAJODI Mr. Ankush Mishra - (NIAAG00162516), ADDRESS: Mahashraman, 1st floor, Cantonment Rd,
ROAD, CUTTACK , PHONE NUMBER: / / 8655169095 Cuttack - 753001 , , , ODISHA , 753001.
ODISHA , 753012. LAND/FAX NUMBER:/ PHONE NUMBER: 123456 /
PHONE NUMBER:6712312142 / 6712320142 / EMAIL:ankush125mishra@gmail.com / MOBILE NUMBER:
6712312143 Email: ch559001@newindia.co.in
FAX NUMBER:6712316006 / NA
Email:nia.550300@newindia.co.in

INSURED DETAILS
Insured's Name KANHA INFRA Customer ID PO90853284 (PAN No
:AYLPP5214A)
Insured's Address TARINI VIHAR. KAPALESWAR, CHOUDWAR, CUTTACK,,, Contact Number / / XXXXXX9095
KALINGCHHAK ,ODISHA, 754071
Email
GSTIN 21AYLPP5214A1ZY

POLICY DETAILS
Period of cover 18/03/2024 12:00:01 AM to 17/03/2025 11:59:59 PM Receipt Number 10000089230300334455 -
12/03/24
Previous Insurer THE NEW INDIA ASSURANCE COMPANY LTD. Previous Policy Number 55030031220200004905
VEHICLE DETAILS
Geographical Area / Zone: India/C Year of manufacture: 2016
Type of Commercial D - Misc-Special Type Sub Type: CRANES
Vehicles:
Name of the Financier: Chassis no./Engine no.: 20070130/887051555
Type of fuel: Diesel Cubic capacity ( cc): 0
Type of body: Open Gross Vehicle Weight 0
(GVW):
Make/Model: JCB CRANE/3DX Registration no. OD-05-BM-1973
Seating capacity including 1 Variant: XUZHOU CONSTRUCTIOM
Driver: MACHINERY MOBILE
CRANE
Automobile Association Colour: YELLOW
membership:
Cover Note No/Cover / Name of registration Cuttack
Note Issue Date: authority:

INSURED DECLARED VALUE (Rs)

Vehicle Trailer Non-Elec Acc Electrical Acc Bi-fuel kit Total Value
0 0 N/A N/A N/A 0

SCHEDULE OF PREMIUM
Own Damage Liability
Basic OD Premium 0 Basic TP Premium 7267
(+)LL to paid driver conductor cleaner employed for
oprn 50
Calculated OD Premium 0 Calculated TP Premium 7317
Total OD Premium (Rs) 0 Total TP Premium (Rs) 7317
Net Premium (Rs) 7,317
GST (Rs) 1,318

Policy No. : 55030031230200004383Document generated by QR_RENEWAL at 2024/03/12 16:24:15.

Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.
Give your valuable feedback on https://www.newindia.co.in/portal/policyFeedbackGen.
For redressal of your grievance, if any,you may approach any one of the following offices- 1. Policy issuing office 2. Regional office 3. Head office.In case, you are not satisfied with our own grievance redressal mechanism; you may also
approach Insurance Ombudsman. For details of our office addresses and addresses of office of Insurance Ombudsman, please visit our website http://newindia.co.in.
Página 1 de 3

Page 1 of 3
 THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)

Total Payable (Rs) 8,635

Total Payable in Rs(in words): RUPEES EIGHT THOUSAND SIX HUNDRED THIRTY-FIVE ONLY
GSTIN(Issuing Office) 21AAACN4165C2Z2
SAC 997134 (Motor vehicle insurance services)
Limitation as to use:The policy covers use only under a permit within the meaning of the Motor Vehicles Act, 1988 or such a carriage falling
under sub-section (3) of Section 66 of the Motor Vehicles Act, 1988.The policy does not cover use for: a)Organized racing b) Speed testing
Limits of Liability:Limit of the amount the Company's Liability Under Section II 1(i) in respect of any one accident: as per the Motor Vehicles
Act, 1988. Limit of the amount of the Company's Liability Under Section II 1(ii) in respect of any one claim or series of claims arising out of one
event: Up to Rs. 7,50,000
For individual covers (OD) in RS:0 Compulsory excess in Rs:NA
Imposed excess in Rs:0 Voluntary excess in Rs:0
Persons or classes of persons entitled to drive:Any person including the insured provided that a person driving holds an effective driving
license at the time of the accident and is not disqualified from holding or obtaining such a license. Provided also that the person holding an
effective Learner's License may also drive the vehicle and that such a person satisfies the requirement of Rule 3 of the Central Motor Vehicles
Rules, 1989.
PA cover for Owner Driver
Name of Nominee Age of Nominee Relationship with the Name of the Appointee (if Relationship to the
Insured Nominee is a minor) Nominee
none 0 none none none
PA cover for named persons
Name CSI Opted(Rs.) Nominee Relationship
NA NA NA NA
Premium and GST Details
Rate of Tax Amount in INR

Premium Rs 7,317
SGST 9 659
CGST 9 659
IGST 0 0

In witness where of this policy has been signed at CUTTACK D.O. I on this 12/03/2024
WARRANTED THAT IN CASE OF DISHONOUR OF THE PREMIUM CHEQUE, THIS DOCUMENT STANDS AUTOMATICALLY CANCELLED ABINITIO
This policy is subject to the Terms, conditions and exceptions applicable to Package/Liability policy attached/available on the web site
http://newindia.co.in; IMT Endorsement Number(s) printed herewith attached 21,40,47.
Important notice:
The insured is not indemnified, if, the vehicle is used or driven otherwise than in accordance with this schedule. Any payment made by the
company by reason of wider terms appearing in the certificate in order to comply with the Motor Vehicles Act, 1988 is recoverable from the
insured: see clause headed "AVOIDANCE OF CERTAIN TERMS AND RIGHTS OF RECOVERY". It is clarified that in case the declaration regarding
the ncb or other previous policy details made by the insured, is found to be incorrect, all the benefits (including claim) under section-1 of this
policy, will stand forfeited.
Anti Money Laundering Clause: In the event of a claim under the policy exceeding Rs 1lakh or a claim for refund of premium exceeding Rs 1
lakh, the insured will comply with the provisions of AML policy of the company. The AML policy is available in all our operating offices as
well as Company website.
I/We hereby certify that the policy to which this Certificate For and on behalf of The New India Assurance Company Limited
relates as well as this Certificate of Insurance are issued in
accordance with the provisions of Chapter X and XI of M.V. Act,
1988.
Date of Issue: 12/03/2024

Policy No. : 55030031230200004383Document generated by QR_RENEWAL at 2024/03/12 16:24:15.

Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.
Give your valuable feedback on https://www.newindia.co.in/portal/policyFeedbackGen.
For redressal of your grievance, if any,you may approach any one of the following offices- 1. Policy issuing office 2. Regional office 3. Head office.In case, you are not satisfied with our own grievance redressal mechanism; you may also
approach Insurance Ombudsman. For details of our office addresses and addresses of office of Insurance Ombudsman, please visit our website http://newindia.co.in.
Página 2 de 3

Page 2 of 3
 THE NEW INDIA ASSURANCE CO. LTD.
(Government of India Undertaking)

(Mr. GYANENDRA MOHANTY)

[S DIVISIONAL MANAGER]

Duly Constituted Attorney(s)

We hereby declare that though our aggregate turnover in any preceding financial year from
2017-18 onwards is more than the aggregate turnover notified under sub-rule (4) of rule 48,
we are not required to prepare an invoice in terms of the provisions of the said sub-rule.

Tax Invoice No : 55030023P0005821

IRDA Registration Number: 190

NIA PAN NUMBER: AAACN4165C

Policy No. : 55030031230200004383Document generated by QR_RENEWAL at 2024/03/12 16:24:15.

Regd. & Head Office: New India Assurance Bldg., 87 M.G. Road, Fort, Mumbai - 400 001. TOLL FREE No. 1 800 209 1415.
Give your valuable feedback on https://www.newindia.co.in/portal/policyFeedbackGen.
For redressal of your grievance, if any,you may approach any one of the following offices- 1. Policy issuing office 2. Regional office 3. Head office.In case, you are not satisfied with our own grievance redressal mechanism; you may also
approach Insurance Ombudsman. For details of our office addresses and addresses of office of Insurance Ombudsman, please visit our website http://newindia.co.in.
Página 3 de 3

Page 3 of 3
 GOVERNMENT OF ODISHA
[ CUTTACK RTO ]

VEHICLE PARTICULARS

Application No: OR231021V2849247 Registration No: OD05BM1944

Registration Date: 31-Dec-2021 Previous Registration No :
Owner Serial No: 2 Owner Name: KANHA INFRA
Son/Wife/Daughter of: NA
Present Address: TARINI BIHAR,KAPALESWAR,CHOUDWAR,Cuttack,Odisha-754071
Vehicle Class: Crane Mounted Vehicle Vehicle Maker: ALL TERRAIN CRANE
Body Type: CRANE No of Cylinders: 6
Month/Year of Manufacturing: 1/2017
Chassis No: WO9200635NWG48005 Engine No: 444901400029258
Horse Power: 0.00 Seat(including driver): 2
Unladen Wt(kg): 80000 Laden Wt(kg): 80000
Registration Valid upto: 30-Dec-2036 Tax Amount: 0
Tax Paid upto: Cubic Capacity: 5883.00
Color: YELLOW Fuel: DIESEL
Fitness upto: 30-Dec-2036 Vehicle Model KRUPP KMK 6200
Vehicle Norms Bharat Stage III (CEV) Floor Area 0.000
Vehicle Status Active Wheel Base 0
Last Change of Address done on:
Last Alteration of Vehicle done on
0 Insurance From Tata AIG General Insurance Co. Ltd. vide policy certificate/covernote no 63008876660000 is valid from 16-Sep-2023 to 15-Sep-2024.
HP Details:

HDFC BANK LTD, LINK ROADMADHUPATANACUTTACK,Cuttack-753012

NOC Details:
Black List Details:

Mobile No: 9668572767

Email Id:
Particular Fee Rs. 200/- paid vide cash receipt no OR231021C8126487 dated 21-Oct-2023.

Other State/Transfer/Conversion Details

Previous Owner : Previous RegNo : MH01DX2564
Old State : Maharashtra Entry Date : 20-Apr-2023
Transfer Date : Conversion Date :

Additional Particulars
Number,Desc & size of Regd. Axle Weight(in kgs)
a) Front:
b) Rear:
c) Other:
d) Tandem:

Printed On: 21-Oct-2023 15:39:54

Note: This is a computer generated document. Authority Signature is not required. The document can't be used a MV document in the Vehicle.
 1
0

Product Code: 3008 UIN: IRDAN115RP0015V01200203

Reference No.: W350411966

Date: Sep 16, 2024
SUSHIL KUMAR PANDEY
NA TARENI VIHAR KALPESHWAR CHOWDWAR CUTTACK
CUTTACK
ORISSA 754071
Mobile No: 93******68

Sub: Risk Assumption Letter

Dear SUSHIL KUMAR PANDEY,

We value your relationship with ICICI Lombard General Insurance Company Limited and thank you for choosing us as your preferred insurance provider.

Please find enclosed Policy No. 3008/360143022/00/000. The same has been issued based on below mentioned details, provided by you at the time of policy
purchase.

Insured & Vehicle Details

Name of the Insured SUSHIL KUMAR PANDEY
Period of Insurance Sep 16, 2024 to Sep 15, 2025
Vehicle Make / Model KRUPP GERMANY / KMK 6200
RTO City ORISSA-CUTTACK
Vehicle Registration No. OD05BM1944
Vehicle Registration Date Dec 31, 2021
Engine No. 444901400029258
Chassis No. WO9200635NWG48005
Current Year NCB(%) 20%
Vehicle Usage CONSTRUCTION
Previous Policy Details
Previous Policy No. 63008876660000
Previous Policy Period 16-09-2023 to 15-09-2024
Previous Year NCB(%) 0%
Previous Insurer Name TAIG
Previous Policy Type Comprehensive Package
1
The commencement of coverage of risk under the policy is subject to realisation of payment of premium in full. In case the premium is not realised due to
cheque dishonour or any other reason, the insurance cover shall be void ab-initio.
1
We have issued the policy basis your confirmation that you hold a valid PUC and/or Fitness certificate, as applicable.

Government of India has mandated electronic toll payments using FASTag to reduce vehicular traffic at toll plazas. Customers are advised to comply with the
direction of the government and get their FASTag from Point of Sale locations at Toll Plazas or from Issuer Agency. Please visit http://www.fastag.org/ for
details.

Please check the policy details for accuracy. Should you find any discrepancy / require any changes in the Certificate of Insurance cum Policy Schedule, please
contact us immediately at our toll free number 1800 2666 or email us at customersupport@icicilombard.com, so that we can rectify the same. Absence of any
communication within a period of 15 days of the date mentioned on this letter, would mean that the issued policy is in order and as per your proposal.

Important Points:
a. Any accidental loss, damage and/or liability caused, sustained or incurred, while vehicle not being registered permanently will not be covered.
b. Any minor scratches to the vehcile, paint fading, wear and tear arising out of normal use and requiring touch-up or minor repair under routine maintenance
will not be covered.
c. Any liability of whatsoever nature caused by, contributed by or arising due to the vehicle being driven by a person without having valid driving license will not
be covered.

( Please visist www.icicilombard.com for the policy wordings, for complete details on terms and conditions governing the coverage and NCB)

The information provided is merely illustrative and shall not be construed to be an evidence of existence of a contract of insurance. The Risk Assumption Letter
is to be read in conjunction with the policy and shall be considered null and void without the same.

The Compulsory Personal Accident cover has not been opted in this policy on account that, the vehicle to be insured is not owned by an individual.
CORP/SUP/OPI/2014/1777

Sep 16, 2024

 1
CERTIFICATE OF INSURANCE CUM POLICY SCHEDULE 0

Miscellaneous Vehicles Package Policy

Product Code: 3008 UIN: IRDAN115RP0015V01200203

Name of the Insured : SUSHIL KUMAR PANDEY Policy No. : 3008/360143022/00/000

Address : NA TARENI VIHAR KALPESHWAR CHOWDWAR CUTTACK, Period of Insurance : Sep 16, 2024 18:20 to
CUTTACK, ORISSA 754071 Midnight of Sep 15, 2025
Telephone No : - Mobile No: 93******68 E-Policy No. :
Email Address : KA***********@GMAIL.COM Policy Issued On : Sep 16, 2024
Nominee Name : - Named Passenger's Nominee: Covernote No. : 360143022
Relationship : - RTO Location : ORISSA-CUTTACK
Age : Hypothecated To : -
GSTIN No. (Customer) : Category :
Servicing Branch Name : Bhubaneshwar Invoice No. : 1009241377298
Servicing Branch Address : Plot no.29, Third Anuj Building Satya Nagar, Bhubaneshwar Orissa 751007

Politically Exposed Person (PEP)/close relative of PEP: No

Vehicle Make Vehicle SubClass Model Model Type of CC Mfg Yr Carrying
Registratio Build Body Capacity
n No.
OD05BM19 KRUPP FULLY
CRANES KMK 6200 Open 1 2017 2
44 GERMANY BUILT
Chassis Engine No. Trailer Trailer Body IDV Chassis IDV Trailer Electrical / Non Electrical CNG / LPG Total IDV
No. Chassis No. Registration No. (`) (`) (`) Electronic Accessories (`) Unit (`) (`)
Accessories (`)
WO920063
44490140002 2,59,00,000
5NWG4800 0 0 2,59,00,000.00 0.00 0.00 0.00 0.00
9258 .00
5
Premium Details
OWN DAMAGE(A) (`) LIABILITY(B) (`)
Basic OD Premium 67,806.00 Basic Third Party Liability 7,267.00
IMT-23 Loading 10,171.00 Total 7,267.00
Overturning Loading 28,490.00 Add:
Sub Total 1,06,467.00 Legal Liability to Paid Driver 50.00
Less: Sub-Total 50.00
No Claim Bonus 20% 21,293.00
Sub-Total Deductions 21,293.00
Total Own Damage Premium(A) 85,174.00 Total Liability Premium(B) 7,317.00
Total Package Premium(A+B): 92,491.00
% 9
CGST
` 8,324.19
% 9
SGST
` 8,324.19
Total Tax Payable in ` 16,648.00
Total Premium Payable In ` 1,09,139.00
Geographical Area: India Applicable IMT Clauses: 23 , 47
Compulsory Deductible: ` 0.5% Voluntary Deductible: ` 0.00

Premium Collection No. 1216212977 Premium Amount (`) 1,09,139.00 Receipt Date 16-09-2024
GSTIN Reg.No 21AAACI7904G1ZZ HSN/SAC code 997134 / GENERAL INSURANCE SERVICES
We hereby declare that though our aggregate turnover in any preceding financial year from 2017-18 onwards is more than the aggregate turnover notified under sub-rule (4) of
rule 48, we are not required to prepare an invoice in terms of the provisions of the said sub-rule.

CORP/SUP/OPI/2014/1777

Sep 16, 2024

 1
CERTIFICATE OF INSURANCE CUM POLICY SCHEDULE 0

Miscellaneous Vehicles Package Policy

Product Code: 3008 UIN: IRDAN115RP0015V01200203

Limits of Liability: (a) Under Section II-I(i) of the policy: Death of or bodily injury & (b) Under Section II-I(ii) of the policy: Damage to Third Party Property- Such amount as is
necessary to meet the requirements of the Motor Vehicles (Amendment) Act, 2019 ; PA Cover for Owner-Driver under Section III: CSI 0.00/-. The Compulsory Personal
Accident cover has not been opted in this policy on account that, the vehicle to be insured is not owned by an individual. Limitations as to Use: The Policy covers use
only under a permit within the meaning of the Motor Vehicles Act,1988 or such a carriage falling under sub section(3) of Section 66 of the Motor Vehicles Act,1988. The
policy does not cover 1) Use for organised racing, pace making, reliability trails or speed testing. Driver's Clause: Any person including the insured: Provided that a person
driving holds an effective driving license at the time of the accident and is not disqualified from holding or obtaining such a license. Provided also that the person holding
an effective learner's license may also drive the vehicle and that such a person satisfies the requirements of Rule 3 of the Central Motor Vehicles Rules, 1989. Important
Notice: The insured i s not indemnified if the vehicle i s used or driven otherwise than in accordance with this schedule. Any payment made by the Company by reason of
wider terms appearing in the Certificate in order to comply with the Motor Vehicle Act, 1988 i s recoverable from the insured. See the clause headed "AVOIDANCE OF
CERTAIN TERMS AND RIGHT OF RECOVERY".In consideration of the premium for this extension being calculated at a pro-rata proportion of the annual premium, it is
hereby declared and agreed by the insured that upon expiry of this extension, this policy shall be renewed for a period of twelve months, failing which the difference
between the extension premium now paid on pro rata basis and the premium at short period rate shall become payable by the insured.
For Legal interpretation, English version will hold good. Disclaimer: Please visit www.icicilombard.com for the policy wordings, for complete details on terms and
conditions governing the coverage and NCB. This document is to be read with the policy wordings. The policy is valid subject to realization of cheque. We accept premium
only via legally recognized modes. In case of dishonour of premium cheque, the company shall not be liable under the policy and the policy shall be void ab-initio. In case
of any discrepancy with respect to the policy, please revert within 15 days from the policy start date. This policy is underwritten on the basis of the information provided by
you and as detailed in the Risk Assumption Letter shared with you along with the policy. On renewal, the benefits provided under the policy and/or terms and conditions of
the policy including premium rate may be subject to change. Grievance Redressal: For resolution of any query or grievance you may contact us on our toll free no. 1800
2666, or visit any of our branch offices. You can also write to us at customersupport@icicilombard.com. For detailed grievance redressal mechanism please visit the
"Grievance Redressal" section on our website www.icicilombard.com.
The Company reserves the right to cancel this Policy immediately upon becoming aware of any mis-representation, fraud, non-disclosure of material facts or
non-cooperation by or on behalf of the Insured; the Company is not obliged to refund the premium paid under this Policy
I/We hereby certify that the Policy to which this Certificate relates, as well as, this Certificate of Insurance are issued in accordance with the provisions of Chapter X and
Chapter XI of M.V. Act, 1988. In witness whereof, this Policy has been signed at Mumbai on Sep 16, 2024 in lieu of Covernote No. 360143022. The stamp duty of ` 0.50
paid vide deface no. CSD0220242018 dated Apr 10, 2024.
Policy Issuing Office: ICICI Lombard General Insurance Company Limited, ICICI LOMBARD HOUSE, 414, Veer Savarkar Marg, Near Siddhi Vinayak Temple, Prabhadevi,
Mumbai 400 025.
Warranted that the insured named herein/owner of the vehicle holds a valid Pollution Under Control (PUC) Certificate and/or valid fitness certificate, as applicable, on the
date of commencement of the Policy and undertakes to renew and maintain a valid and effective PUC and/or fitness Certificate, as applicable, during the subsistence of
the Policy. Further, the Company reserves the right to take appropriate action in case of any discrepancy in the PUC or fitness certificate.

Agency Code : CA0106

Agency Name : IDFC FIRST BANK LTD

Agent's Contact No : 2260014332

Contact Person :

D:/CLICK/images/Gaurav_Arora.png

CORP/SUP/OPI/2014/1777

Sep 16, 2024

Firefox https://vahan.parivahan.gov.in/vahanservice/vahan/ui/eapplication/for...

TAX RECEIPT

Transport Department, Government of Odisha

Registration Authority CUTTACK RTO, Odisha

Application No. / Receipt No. : OR240317V0168888 / OR240317C4404517 Vehicle Class: Crane Mounted Vehicle

Received From: KANHA INFRA Payment Date: 2024-03-17 12:45:09.000000

Transaction Date: 17-Mar-2024 12:47 AM Vehicle No: OD05BM1944

Bank Reference Numbe

Chasis No: WO9200635NWGXXXXX 113216757406
r:

GRN No: 37F407AA4D

Transaction Identification Numb

ORY2403176149084
er

Rebate+/
Amount(I Penalty(I Surcharg Total(In
Particular Period Exemptio Interest Amount1 Amount2
n Rs) n Rs) e(In Rs) Rs)
n

MV Tax 01-Apr-2024 to 31-Mar-2025 77000 3850.0 0.0 0 0.0 0.0 0.0 73150

Total 0.0 0.0 73150

GRAND TOTAL (in Rs):73150/- (SEVENTY THREE THOUSAND ONE HUNDRED AND FIFTY ONLY)

Verify the receipt by clicking Status>>Verify Receipt on Vahan Online Services portal at https://parivahan.gov.in/vahanservice

For further query ,Please go to the zone RTO : CUTTACK RTO, Odisha

Note::- This is computer generated slip, Signature is not required. Can be verified from QRcode

Note::-** Exemption, if any is added in Rebate column

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 Form 59
[See rules 115 (2)]
Pollution Under Control Certificate
Authorised By :
Government of Odisha

Date : 04/01/2025
Time : 14:16:34 PM
Validity upto : 03/07/2025

Certificate SL. No. : OR00501660005320

Registration No. : OD05BM1944
Date of Registration : 31/Dec/2021
Month & Year of Manufacturing : January-2017
Valid Mobile Number : ******2767
Emission Norms : Bharat Stage III (CEV)
Fuel : DIESEL
PUC Code : OR0050166
GSTIN : 21BCVPB1912N1ZM
Fees : Rs.177.00(Including GST)
MIL observation : No

Vehicle Photo with Registration plate

60 mm x 3O mm

Measured Value
Pollutant (as Units (as
Sr. No. Emission limits (upto 2 decimal
applicable) applicable)
places)

1 2 3 4 5

Carbon Monoxide (CO) percentage (%)

Idling Emissions
Hydrocarbon, (THC/HC) ppm

CO percentage (%)
High idling
RPM RPM 2500 ± 200
emissions
Lambda - 1 ± 0.03

Light absorption
Smoke Density
coefficient
1/metre 2.45 0.06

This PUC certificate is system generated through the national register of motor vehicles and does
not require any signature.

Note : 1. Vehicle owners to link their mobile numbers to registered vehicle by logging to https://puc.parivahan.gov.in

Authorised Signature with stamp of PUC 0perator

60mm x 20 mm