Tax Invoice
Invoice Number :- TN10000124V01482 DO No:
Reference Invoice Number :- VEHINV-TN100001-2425-01482 Invoice Date:- 08/11/2024
Supplier Details (Ship From): Ship To(Place of Delivery):
Legal Name: KEERTHI MOTORS Legal Name: KEERTHI MOTORS
Dealer Name: KEERTHI MOTORS Dealer Name: KEERTHI MOTORS
Address : NH 7 , KRISHNAGIRI BYE PASS ROAD , HOSUR HOSUR Tamil Address : NH 7 , KRISHNAGIRI BYE PASS ROAD , HOSUR HOSUR Tamil
Nadu 635109 Nadu 635109
Pin Code: 635109 Pin Code: 635109
State: Tamil Nadu
GSTIN No:
33AAGFK9541G1ZB
Phone: 4344246428 Email: keerthihondahosur@yahoo. State Code: 33
com
PAN No: AAGFK9541G CIN No:
GSTIN:
33AAGFK9541G1ZB
State: Tamil Nadu State Code: 33
Customer Care No: 7373026600
Place of Supply Bill To (Details of Recipient)
Legal Name: KAVITHA W/O CHINNA ELLAPPA Legal Name: KAVITHA W/O CHINNA ELLAPPA
Customer Name: KAVITHA W/O CHINNA ELLAPPA Customer Name: KAVITHA W/O CHINNA ELLAPPA
Address : D NO 3/136 KAKKANUR SEVAGANAPALLI HOSUR Tamil Address : D NO 3/136 KAKKANUR SEVAGANAPALLI HOSUR Tamil Nadu
Nadu 635103 635103
Pin Code: 635103 Pin Code: 635103
Email Address: Email Address:
State: Tamil Nadu State Code: 33 State: Tamil Nadu State Code: 33
GSTIN No: UIN No: GSTIN No: UIN No:
Phone(M): 7339546353 Phone(O): Phone(M): 7339546353 Phone(O):
Customer GST No: PAN Number: Customer GST No: PAN Number:
Cust/Enq Category: Individual / Individual LS Order No: Service No:
Booking No: VEHBK-TN100001-1-2425-01534 Purchase Type: Finance LS Order Date:
Battery No: 00 Booklet No: 00 Whether Supply is service or not:
Invoice Type: Tax Invoice Invoice Type Code: INV Key No: 00
Reverse Charge: Not Applicable Supply Type: Transaction mode:
Salesman Name: Prasanth M Mobile No: 9566408878 E-Way Bill No:
Hypothecation With: BAJAJ FINANCE LIMITED E-Way Bill Valid Upto Date:
Model(Model Code) HSN Code Type / Variant Colour Frame no. Loyalty ID Engine no.
ACTIVA MAT AXIS
ID/ ACTIVA DLX
(SCV110P8) 87112019 GRAY ME4JK158JRG057178 JK15EG7057346
METALL
Description Qty UOM Unit Price (Rs.) Tax % Amount(Rs.)
Basic Price 1 Nos. 65,199.99 67,546.00
Discount 0.00
Taxable Amount
IGST 0.00 % 0.00
CGST 14.00 % 9,456.44
SGST/UTGST 14.00 % 9456.44
CESS 0.00 % 0.00
Ex Showroom Price (Rs.) 86458.88
Concession 0.00
Total Amount 86459.00
Discount Remarks:-
S.no Scheme Name
Customer Temp Address :
Assessable Value: 83,455.99
Amount in words Rupees Eighty Six Thousand Four Hundred Fifty Nine Only.
If reverse charge applicable then specify amount of tax
Declaration :
I/We hereby certify that my/our registration certificate under the -HOSUR Jurisdiction is in force on the date on which the sale of goods specified in this Tax Invoice is made by me/us and that the transaction in the turnover of sales while filling of the
return and the due tax, if any payable on the sale has been paid or shall be paid. Also I/We hereby give consent that all personal or other information (information's) provided herein or otherwise can be used for the business purposes or for
performance of agreement between us, if any and shall not be disclosed to any third party except to the extent its disclosure is essential as per the applicable laws or for any business requirement. The above said information may be shared or
transferred with HMSI or its Dealers or group companies within or outside India for improvement of product, service quality, marketing promotion, development of our products, services, etc. However, the same shall be transmitted, handled &
destroyed as per the applicable law or in a manner that will preserve its confidentiality. Further, all or any of the information's provided herein or otherwise can be withdrawn/corrected by giving notice.
Customer Signature
Payment Receipt No : RCT-TN100001-2425-01553 Payment Method : Cash Payment Receipt Date: 08/11/2024
For KEERTHI MOTORS
Authorized Signatory
Note : Service Schedule for your BSVI model is available on next page.
Free Service Schedule Kms* Days*
1st Free Service 750-1000 15~30
* Kms or Days,
2nd Free Service 5500-6000 165~180 whichever comes
earlier
3rd Free service 11500-12000 350~365
Paid Service Frequency Every 6000 Kms or Within 6 months
Please Note : Applicable for Domestic BSVI Vehicle Only
Delivery Note
(Invoice/Form 21/Form 22/Owner's manual/Free service coupon/Tool kit)
Received the above mentioned vehicle complete with tools, accessories & necessary documents to my satisfaction
Invoice Number: TN10000124V01482 Invoice Date: 08/11/2024 Frame No: ME4JK158JRG057178
Customer Signature with Date Authorized Signatory with Date
*Strike out whichever is not applicable.
FORM 20
APPLICATION FOR REGISTRATION OF A MOTOR VEHICLE
[See Rule 47]
(To be made in duplicate if the vehicle is held under an agreement of Hire-Purchase/ Lease/ Hypothecation
and duplicate copy with the endorsement of Registering Authority to be returned to the Financier
simultaneous on Registration of motor vehicle)
To
THE REGISTERING AUTHORITY
1. Full name of person to be registered as registered KAVITHA
owner Son/Wife/Daughter of
W/O CHINNA ELLAPPA
2. Age of the person to be registered as registered owner
3. Permanent address of the person to be registered as D NO 3/136 KAKKANUR SEVAGANAPALLI HOSUR
Registered owner (Evidence to be produced) Tamil Nadu 635103
Mobile #
7339546353
4. Temporary address of the person to be registered as Mobile #
registered owner
5. Name and address of the Dealer or Manufacturer from KEERTHI MOTORS
whom the vehicle was purchased NH 7 , KRISHNAGIRI BYE PASS ROAD , HOSUR
HOSUR Tamil Nadu 635109
Contact #
4344246428
6. If ex-army vehicles or imported vehicle, enclose proof.
If approval of design by the State Transport Authority and
7. Class of vehicle
(If motor cycle, whether with or without gear)
8 The Motor vehicle is
(a) a new vehicle NEW VEHICLE
(b) Ex-army vehicle NA
(c) imported vehicle NA
9. Type of body FULLY BUILD
10. Type of vehicle ID
11 .Maker's name Honda Motorcycle & Scooter India Pvt. Ltd
12. Month and year of manufacturer September 2024
13. Number of cylinders 1
14. Horse power 8 bhp
15. Cubic capacity 109.51 cc
16. Maker's classification or if not known ACTIVA (ACTIVA DLX-OBD2)ID
17. Wheel base
18. Chassis No. (Affix Pencil print) ME4JK158JRG057178
19. Engine No JK15EG7057346
20. Seating capacity (including driver) 2
21. Fuel used in the engine PETROL
22. Unladen weight 106
23. Particulars of previous registration and registered
number (if any)
24. Colour or colour of body, wings and front end MAT AXIS GRAY METALL
I hereby declare that the Motor Vehicle has not been registered in any State in India.
Additional particulars to be completed only in the case of transport vehicles other than motor cab.
25. Number, description and size of tyres
(a) Front axle
(b) Rear axle
(c) Any other axle
(d) Tandem axle
26. Gross vehicle weight
(a) As certified by the manufacture .........................................................................................Kg
(b) To be registered .................................................................................................................Kg
27. Maximum axle weight
(a) Front axle ...........................................................................................................................Kg
(b) Rear axle ............................................................................................................................Kg
(c) Any other axle.....................................................................................................................Kg
(d) Tandem axle.......................................................................................................................Kg
28.(a) Overall length .................................................................................................................
(b) Overall width ..................................................................................................................
(c) Overall height..................................................................................................................
(d) Over hang........................................................................................................................
The above particulars are to be filled in for a rigid frame motor vehicle of two or more axles for an articulated vehicles of
three or more axles, or, to the extent applicable for trailer, where a second semi-trailer or additional semi-trailer are to be
registered with an articulated motor vehicle.
The following particulars are to be furnished for each semi-trailer.
29. Type of body........................................................................................................................
30. Unladen weight.....................................................................................................................
31. Number, description and size of tyres on each axle .............................................................
32. Maximum axle weight in respect of each axle .....................................................................
33. The Vehicle is covered by a valid certificate Insurance certificate or Cover note of insurance under Chapter XI of the
Act................ .No............... Date................of............... (Name of Company) valid from ................to..............
34. The vehicle is exempted from Insurance.
The relevant order is enclosed..............................................................................................
35. I have paid the prescribed fee of rupees ..............................................................................
Date Signature or thumb impression of the person
to
be registered as registered owner.
Note : The Motor Vehicle above described is :
(i) Subject to Hire-Purchase agreement/Lease agreement with
(ii) Subject to hypothecation in favour of BAJAJ FINANCE LIMITED
(iii) Not held under Hire-Purchase agreement, or lease agreement, or subject Hypothecation
Strike out whatever is inapplicable, if the vehicle is subject to any such agreement the signature of the
Financier with whom such agreement has been entered in to is to be obtained
Signature of the financier with whom an
Agreement of Hire-Purchase, Lease or Signature or thumb impression
Hypothecation has been entered into of the registered owner
CERTIFICATE
INSPECTION OF MOTOR VEHICLE
Certified that the particulars contained in the application are the true and that the vehicle
Complies with the requirements of the Motor Vehicle Act, 1988 and the Rules made there under.
Signature of the INSPECTING AUTHORITY
Name
Designation
(For OFFICE ENDORSEMENT)
Ref. No.
Office of the
Dated
The vehicle bearing chassis number and engine number has been assigned the registration number /
and registered in the name of and the vehicle is subject to an agreement of hire purchase
lease/hypothecation.
Registering Authority
TO
Name and address of the financer
By registered post or deliver under proper acknowledgment.
Specimen signature or thumb-impression of the person to be registered as Registered Owner and Financier are to be
obtained in original application for affixing and attestation by the Registering stamp and attestation shall fall upon each
signature.
Specimen signature of the Financier Specimen signature of the Registered Owner
(1) --------------------------------------------------------------------- (1) ------------------------------------------------------------
(2) --------------------------------------------------------------------- (2) ------------------------------------------------------------
(3) -------------------------------------------------------------------- (3) ------------------------------------------------------------
Form 22
[See rules 47 (1)(g)]
ROAD-WORTHINESS CERTIFICATE
For
Compliance to Emission and Noise Standards
(To be issued by the Manufacturer or Importer or Registered Association in case of E-rickshaw or E-cart, along with the vehicle)
It is certified that the following vehicle complies with the provisions of the Motor Vehicles Act, 1988, and the rules made
thereunder:
1. Model / Commercial Name of the vehicle : ACTIVA
2. Chassis number : ME4JK158JRG057178
(Example:- Vehicle Identification Number (VIN) or ATIN or PIN / Trailer Identification Number etc.)
3. Engine number (Motor number, in case of Battery-Operated Vehicles) : JK15EG7057346
4. Applicable Emission norms : BS VI
(Example:- Bharat Stage-IV / VI / TREM-III/ Equivalent, as permitted under the act, Select NA for Battery Operated
Vehicle)
Emission, Sound Level for Horn and Pass by noise values of the above vehicle model, obtained during Type Approval
5.
Testing as per Central Motor Vehicle Rules, 1989 are given below:
(i) Type Approval Certificate No. : CARN 1199 F01 E05
(ii) Type of Fuel : Petrol
(Example:- Petrol / Diesel / CNG / LPG / Dual / Biofuel / Hybrid etc.)
(iii) Emission values for vehicles: :
TABLE
Positive Ignition Engine or Compression Ignition Engine Vehicles
Pollutant Units Value
Sr. No.
(as applicable) (as applicable) (upto 3 decimal places)
(1) (2) (3) (4)
1. Carbon Monoxide (CO) mg/ km or mg/kWh or g/kWh 316.086
2. Hydrocarbon, (THC/HC) mg/ km or mg/kWh or g/kWh 46.583
3. Non-Methane Hydrocarbon (NMHC) mg/ km or mg/kWh or g/kWh 43.114
4. Oxides of Nitrogen (NOx) mg/ km or mg/kWh or g/kWh 24.431
(iv) Noise level (as applicable):
(a) Horn (for all vehicles other than agricultural tractors and construction equipment vehicles) as installed on the
vehicle: 101.5 dB(A);
(b) Pass by or Bystander's position: 72.6 dB(A);
(c) Driver-perceived or Operator's ear level (as applicable for agricultural tractors and construction equipment
vehicles): ....Not Applicable.... dB(A);
For Honda Motorcycle & Scooter India (Pvt.) Ltd.
(Facsimile Signature of Manufacturer or Importer or Registered
Association, in case of E-rickshaw or E-cart)
DEALER: KEERTHI MOTORS
FORM 21
(See Rule 47 (a) & D)
SALE CERTIFICATE
Certified that Honda ACTIVA (ACTIVA DLX-OBD2) BS VI has been delivered on 08/11/2024 by us to
1.Name of the buyer : KAVITHA
W/O CHINNA ELLAPPA
2.Permanent Address :
D NO 3/136 KAKKANUR SEVAGANAPALLI HOSUR Tamil Nadu 635103
3. Temporary Address:
4. Mobile No. : 7339546353
The vehicle is held under agreement of Hire Purchase/Lease/Hypothecation with BAJAJ FINANCE LIMITED ,
Details of the vehicle are given below :
1. Class of Vehicle SCOOTER
2. Maker's Name Honda Motorcycle & Scooter India Pvt. Ltd.
3 Chassis No ME4JK158JRG057178
4. Engine No. JK15EG7057346
5 Horse Power /Cubic 8 bhp / 109.51 cc
Capacity
6. Fuel Used PETROL
7. No. of Cylinders 1
8. Month & Year of September 2024
manufacture
9. Seating Capacity (including 2
driver)
10. Unladen Weight 106
11. Maximum axel weight & number & description of tyres
(In case of Transport vehicle)
a) Front axle : N.A. b) Rear axle : N.A.
c) Front axle : N.A. d) Tandem axle : N.A.
12. Colour Of Body MAT AXIS GRAY METALL
13. Gross Vehicle Weight 280
14. Type of Body FULLY BUILD
15. Blinkers/Indicators Fitted YES
For : KEERTHI MOTORS
Authorised Signatory
STRIKE OUT WHICHEVER IS NOT APPLICABLE.
Registered NH 7 , KRISHNAGIRI BYE PASS ROAD , HOSUR HOSUR Tamil Nadu 635109
Office:
