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GOVERNMENT OF KERALA MOTOR VEHICLES DEPARTMENT Form TR5(c) (See Rule 90(a) of KTC) Office Payee Name Address

: SRTO, KAZHAKUTTOM : SIDDHARTH DAS : QTE.NO:E-40 : V.S.S.C HOUSING COLONY : PALLITHURA P.O TRIVANDRUM License No : 22/4506/2006 Purpose : Issue of duplicate DL - form 7 Fee : 200 Service Charge : 50 Total Amount : 250.00 Amount in words : Two Hundred and Fifty Rupees Only Bank Reference No: IK28397784 Bank : STATE BANK OF INDIA
* This is a computer generated document and does not require any signature * Any modification or misuse of this receipt is an offence which shall attract legal action and punishment

Table ID: 2 Transaction No: A/15702/2013 Date : 22/05/2013

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(Office Copy. Please attach with the application)

GOVERNMENT OF KERALA MOTOR VEHICLES DEPARTMENT Form TR5(c) (See Rule 90(a) of KTC) Table ID: 2 Transaction No: A/15702/2013 Date :22/05/2013

Office Payee Name Address

: SRTO, KAZHAKUTTOM : SIDDHARTH DAS : QTE.NO:E-40 : V.S.S.C HOUSING COLONY : PALLITHURA P.O TRIVANDRUM License No : 22/4506/2006 Purpose : Issue of duplicate DL - form 7 Fee : 200 Service Charge : 50 Total Amount : 250.00 Amount in words : Two Hundred and Fifty Rupees Only Bank Reference No: IK28397784 Bank : STATE BANK OF INDIA
* You are instructed to submit the Online application with required documents at the counter of RT office/Sub RT Office within 3 days, belated applications shall not be entertained. * Department is not responsible for the delay in service due to short remittance of fee,tax,service charge,cess,inaccurancy in application and documents submitted. * This is a computer generated document and does not require any signature * Any modification or misuse of this receipt is an offence which shall attract legal action and punishment (Acknowledgement and applicants copy) IT Services NIC Kerala

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