BEFORE THE SECRETARY REGIONLA TRANSPORT AUTHORITY HYDERABAD

I, Aravind Carriers Ms R/B:- GKS Raja, Resident of Flat no: 55, Sundaram Block, Rama
Raja Nagar, RR Dist., do hereby solemnly and state on oath as under:-

That I am the owner of the vehicle bearing registration No: AP 28 TA 0019, having
Permit no: AP128/4/PPC/2007 valid upto 23/07/2012.

That the said vehicle is free from all charges, claims, compounding fee, tax arrears of
RTA and any case of the court against the permit of the said vehicle. If any charge, claim,
compounding fee, tax arrears and any case of the court, are noticed at a later date, I will be held
responsible for the payments and consequences thereof.

The there is no case pending against me and the permit before any court or authority.
That I am herewith surrendering the present permit of the said vehicle and request you to
cancel the same as per rules.

Sworn and signed before me Deponent.