Government of Punjab

Department Of Transport
District Transport Officer
Authorization for Affixation of HSRP Authorization No
Date.
To,
Concessionaire
Agros Impex (I) Private Limited
City Plaza, SCO #3, Bawsan Wali Chungi,
NH-21, Kharar, Distt. Mohali, Punjab-140301

Dear Sir,
You are hereby authorized to affix the High Security Registration Plates to the vehicle with the following details:
Owners Name:.

Father / Husbands Name:.

Address:.

Contact No

Registration No.....

Class of Vehicle.

Manufacturers Name..

Month & Year of Mfg...

Chasis No.

Engine No..

Colour of Vehicle

In case vehicle is fixed with HSRP Earlier:

(A) Front Laser ID

In case of old vehicle:

Whether affixed with HSRP (Y/N)..

(B) Rear Laser ID.

Date of Authorization.

Date of Receipt of Request and payment

from authority / customer..

Signature of Registering Authority

----------------------------------------------------------------------------------------------------------------------------------------------------------(This portion is to be filled at the time of actual affixation of HSRP)

City in which HSRP affixation centre is located..
Front Laser ID..

Rear Laser ID..

Gross Charges.
Date & time of collection of payment.

Payment code on Chalan.

Date & time of actual affixation.

No. of days of delay in service.

Signature of Concessionaires representative

Signature of Owner

Signature of Registering Authority