| Form A |
Form A |
Form A |
Form A |
| (See rules 5 and 6) |
(See rules 5 and 6) |
(See rules 5 and 6) |
(See rules 5 and 6) |
| R. No. ____ |
R. No. ____ |
R. No. ____ |
R. No. _____ |
| Name of bridge |
Name of bridge |
Name of bridge |
Name of bridge |
| Receipt for payment of toll |
Receipt for payment of toll |
Receipt for payment of toll |
Receipt for payment of toll |
|
1. Description of mechanical vehicles with registration number-
|
1. Description of mechanical vehicles with registration number-
|
1. Description of mechanical vehicles with registration number-
|
1. Description of mechanical vehicles with registration number-
|
| 2. Whether laden, or unladen or with or without passengers |
2. Whether laden, or unladen or with or without passengers |
2. Whether laden, or unladen or with or without passengers |
2. Whether laden, or unladen or with or without passengers |
| 3. Time and date of outward journey - |
3. Time and date of outward journey - |
3. Time and date of outward journey - |
3. Time and date of outward journey - |
| 4. Name of driver and/or owner - |
4. Name of driver and/or owner - |
4. Name of driver and/or owner - |
4. Name of driver and/or owner - |
| 5. Amount of toll paid - |
5. Amount of toll paid - |
5. Amount of toll paid - |
5. Amount of toll paid - |
| 6. Date and time of return Journey |
6. Date and time of return Journey |
6. Date and time of return Journey |
Date and time of return Journey |
| Signatures of Toll Inspector |
Signatures of Toll Inspector |
Signatures of Toll Inspector |
Signatures of Toll Inspector |
| To be filled in case of return journey. |
To be filled in case of return journey. |
To be filled in case of return journey. |
To be filled in case of return journey. |