ESTIMATE GST.NO.09BJEPS8564D3ZQ DATE- S.K.AUTOMOBILES KATAHARA HANDIA PRAYAGRAJ Registretion no.UpfA37 MOB.9919717447 mob.No.9.3.53..9278 ATS.. ..A. CUSTMER'S NAME: as M9ER AM ADDRESS.:-... Sr.no QUNTY LIST PRICE... 1 5600-0 2 3C LH 2800 3 600 4 39000 5 9140R 8800 6 AC 500 7 8 9 10 11 12 13 14 15 TOTAL AMOUNT 8 8110 3eaT . SMIIETaTa ---PAGE END--- OBAJAJAIanZO 11190 Relation eynd In MOTORINSURANCE CLAIMFORM 0S2913G18200005546 PIIMN WN 935329278 WART MIBIWARI HANDIA ALLAHACAD 212461 UP70FA3TG 30623 5714 SUNILKUMARYADAV MP7620760039601 199120241849 Relatton With JFrend nivementYe TdertnsuredbankNfFT.details forclaims paymentandihereby aqreetosubrmut the originalcancelledcheuue with myname imprinted oncheque forNEFTprocessing.ifcaim umests.orbankdetails.oranvothermfomation does y ar suggest admission of cla and or lability by the xumens/iniorma miscion ofctaimtombyme/us andmy ommy inobilenumberthmugh emal ID and St the discharge vouchesubmtong dischargevooch -31159 ---PAGE END--- Duly itedandsingedelaimfonn imorance-Policy/Covemotecopy CopyotRegstrafionookTax ReceiptPleae Copyot MororDriving Licence[with oniginalof the persandnvingthe vehic wheretheVehicleistoberepared Police PanchannmaTIRIncaseofThrParty properydamage/Death/BodyInjury) ReparBllanpaymenreceiptserheobiscompleed AML/KYC doumontss porguidetines Claims Discharge Cum SatisfactionVouchersigned ointatagachedbelow Pecnn Fitnessand Load Challan(withoriginalin case of CommercialVehicle torThet.Cam Dulyonanasing-dam iginalPolicy docunen Origina Regisration Book/CeriicatePenessCertificateTaCmificaead Challan Polic Panchnama/FIR FinalInvestigationReporfromthemagistratecouundersuction173Cr.PC/Noniaceable Report. Aliesetsof Keys/ServiceBooklet/WeraneyCerdgnriginalpurtJiaseinveice wiedgedroproriemrator sadnTenonatinq theftandintoumingNON.tsr bhvehde omad30signedbyenrendy3ignedbytheinanemaybeundated andblank Tetterfundrtakiog Suthogation&Disrhorge Voucher onsei tovards agreedclaim settiementvaluefromyourselfand Financier. NOctiomtheFananceraf caimisnobesettedinvou favou Adationaldocument inspecificcainsshallbemrimatedeparetey & & Bajaj Allianz Ceneral Insurance Company Limited CLAIM DISCHARCE CUM SATISFACTION VOUCHER 0C-1-1302-1026-0060065 "lairmNos TTBAIAIALLIANZCENEPALINSURANCECOMPANYLIMITEDTHUMofR ds FUL&FINAL SETTLEMENT OF CLAIM under Policy Numb m respect of damage to / loss ol lamfuilysalsfedwiththe Fol&Finalsettlementwithrespectromyclaim. 4R9 svent Signatuepliasor MATyI PhoneNumber/Addressofissuanteor ---PAGE END--- UNDERTAKING To. M/s Baja Allianz General Insurance Company Ltd Reference Claim no Policy No Name of insured Vehicle Regd No. Date of Accident Time of Accident I above named Insured do hereby state,declare and undertake as follows and firmly bound my self unto you The Bajaj Allianz General Insurance Company Ltd.,and state to indemnify you in the whole sum amount in consideration of you having paid the said amount to me in the following.circumstances: That the vehicle bearing Regd No bearing chassis No was owned by me and insured with your Company vide above policy for the period from to for a sum insured of Rs. That the said vehicle met with an accident on date & time mentioned above. Based on my request the quantum of loss to the vehicle has been evaluated by the designated surveyor for Rs as full and final as per the terms and condition of the policy and the same is agreeable to me. FurtherI do hereby undertake that:- will fully utilize the claim amount paid in advance by you to get the vehicle repaired within 21 days from the date of payment and bring back the vehicle to the shape and condition prevailing before the accident. I will produce the vehicle after repair along with the bills and other documents to prove that vehicle have heen repaired and restored to the original shape and condition prevailing prior to the arrident I will not make any claim again for the damages already claimed against above claim in any form what so ever in the remaining period of the policy. i confirm that there is no involvement of any Third party bodily injury and/or death and/ or pronenv damare.arising out of this cause of action I will nat make any profit out of the claim settled in any form what so ever. Iwl not rarse any legal issue with regards to the settlement agreed upon Sgnature of the insured Date: Place: bgnatufe of the witnets Date Place 3-1S9 Scanned with CamScanner ---PAGE END--- (WITHOUT PREJUDICE) SURVEY ASSESSMENT OF VEH.NO: The summary of assessment: Labour Charges Parts Amount Less Depreciation Less Salvage on Metal Parts Less Cormpulsory deductible Less Voluntary deductible a mentioned in Palicy Net Amt.assessed (Balarce amount to be collected (rom fhg insured (Works Manager) (Surveyor) I am satisfied with the repairs and discharge Bajaj Allianz General Insurance Company of all claims present orfuture under the policy no "(Insured) The payment of above claim is to be made to the INSURED/DEALER (Please tick whichever is applicable) Nolablity s ttachd on the Insurancc Company the premuminrespect of the pollcyis not Scanned with CamScanner A341Sg ---PAGE END--- JAllianz Self Declaration of KYC Document Submission Affix Passport Size Recent Photograph For Institute/Company Partner And To, Sign Across CompanyIFirms Representative G.E.Plaza,Airport Road Yerawada,Pune411006 Company Representative/Officer Name Designation Name of Payment Receiver Company Firms Address City State Pin Code Telephone No Mobile No (Please tick the relevant document in the list below) Proof of Identity (any one) Proof of Residential Address (any one) Memorandum &Articles of Association Land Line Telephone Bill Resolution of the Board for Accounts Co/Firms Electricity Bill Power of Attorney/Letter to Transact business C Co/Firms Registration Certificate Copy of PAN Card,allotment letter Co/firms Registration Certificate Partnership Deed Memorandum &Articles of Association The documents provided as proof of identity and proofs of address have been self-attested.I have also attached my recent photograph above. Place Date Signature of the Representative/Officer Baja Allianz General Insurance Company Ltd.GE Plaza,Airport RoadYerawada. Pune 411 006 Tel+9102066026777 Fax+910206026791 4159 ---PAGE END--- GOVERNMENT OFUTTAR PRADESHhps//vahan.parivahan.gov.in/vahan/ LYS Transport Department Prayagraj RTO FORM23 CERTIFICATE OF REGISTRATION Registration No UP70FA3761 Description of Vehicle Registration Date 25-Sep-2019 M-CYCLE/SCOOTER Purpose For Printing RC Dealer's Name & Address NEW UNITED AUTOMOBILES,S3 LEADER ROAD,UNITED TOWER Owner Name PINTOO YADAV Full AddressPermanent Son/wife/daughter of RAMMILAN WARI NIBI WARI HANDIA,PRAYAGRAJ,UTTAR PRADESH-21103 Full Address:(Temporary) WARI NIBI WARI,HANDIA.PRAYAGRAJ-UTTAR PRADESH-211003 Fitness UpTo 24-Sep-2034 Tax UpTo One Time Owner Serial No Detalled Descrlption Class of Vehicle M-CYCLE/SCOOTER Link Vehicle No Ownership INDIVIDUAL BHARAT STAGE IV Norms Maker's Name BAJAJ AUTO LTD Front HSRP No AA2004661656 Rear HSRP No AA1003367360 Type of Body SOLO WITH PILLION Month/Year of Manuf. 04/2019 No of Cylinders Chassis No MD2A76AY1KRA66589 Engine No PFYRKA38173 Fuel PETROL Horse Power(BHP) 848 Cubic Capacity 115.45 Maker's Classification PLATINA 110 Wheel base 1255 Scating Cap(in all) 2 Standing Cap 0 Slecpar Cap 0 Unladen Wt(kgs) 116 Laden/GV Wt(kgs) 246 Colour EBONY BLK BLUE DKL AC Fitted NO Other Criteria Vchictc Purchase As Fully Buil Additional Particulars of all transport vehicles other than motor cabs (Gross Vehicle Weight) As Regd. By Manuf. Weight(in kgs) Description aFront: bRear cOther d) Tandem: The motor vehicle above described is subject to Hypothecation in favour of BAJAJ FINANCE LTD PRAYAGRAJPrayagraj.Uttar Pradesh-211003 w.e.f.18-Sep-2019. 50662/- 18-Sep-2019 Sale Amt Purchase dt 5067/UP70D19090004870 Amount/Rcpt No 18-Sep-2019 OTT Date Vehicle is Govt/Pvt. PRIVATE One Time TaxUpTo 25-Sep-2019 Date of Approval NOT EXEMPTED Tax Exempted or Not Other State/Transfer/Conversion Details Previous RegNo Previous Owner Entry Date Old State Conversion Date Transfer Date Signatue o egghority as1Oct-2019 Date 15-Oct-2019 1008:26 Taxation Particulars/Advance Registration Mark Fee Details 101519100 411032 15 ---PAGE END--- 10% EE E TA ---PAGE END--- P E B ---PAGE END--- SBI -KIOSK BANKING Identity Card 295 90323731751 Namber 38482954274 SBIN0001160 nNn PINTOOYADAV iddle Name 0o LestName RAMSAJEEVAN Adtress: VARIHANDIA D DIST-ALLAHABAD Viage Namet VARIHANDIA 2 20 Pincoder 212401 Ko wsine SUSHEEL KUMAR Mr aT KO Encation: KATAHARA -1A3508 Har ---PAGE END--- O ring n F2020180038801 18231120 eitknesven Da03/165s SYNK RUNAR YADAV TALBNNAOUR UP70 20160038601 24112016 tOWG 4/11/2016 up JACDNSHPUR RANDIR ALAHRBAD. y S ALLAHABAD ---PAGE END---