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(a) Particulars ofthe registered owner of the vehicle :
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(i) Name
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(ii)Father's/Husband's Name
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____________________________________________________ |
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(iii) Address
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PresentAddress
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PermanentAddress
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____________________________________________________ |
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(iv) Nationality
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____________________________________________________ |
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(b) Particulars ofthe vehicle
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(i)Registration Number
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(ii)Type of the vehicle
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(iii)Maker's name
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(iv)Year of manufacturing
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(v)Engine No.
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(vi)Chassis No.
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(c) Seatingcapacity (including driver) of passenger vehicle
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____________________________________________________ |
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(d) Particulars ofinsurance policy against third party risk.
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(i)Policy Number
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____________________________________________________ |
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(ii)Name insurer
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____________________________________________________ |
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(iii)Date of expiry
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____________________________________________________ |
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(e) Particulars ofcertificate of fitness of the passenger vehicle
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____________________________________________________ |
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(i)Certificate Number
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____________________________________________________ |
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(ii)Validity date: From______to_______
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(f) The startingand terminal points in each country
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(i)Place of starting
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____________________________________________________ |
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(ii)Place of termination
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____________________________________________________ |
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(iii)Stoppages
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____________________________________________________ |
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(g) The routes tobe followed by the vehicle_______
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(h) Number oftrips allowed
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Signature,designation and seal of the competent authority
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Signature,designation and seal of the countersigning authority
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