Owner: VALI SAB Mobile: 9945753798 Chassis:

MA1ZU2TBKK1C31617
FORM 20
APPLICATION FOR REGISTRATION OF A MOTOR VEHICLE
To,
The REGISTERING AUTHORITY
Hospet RTO
............................

1. Full Name of the Person to be :

VALI SAB
registered as registered owner
Son/Wife/Daughter of : NABI SAB
2. Age of the Person to be registered :
as registered owner
3. Permanent address of the Person : HOUSE NO 160,3RD WARD, OLD
to be MALPANAGUDI,HOSPET TALUK, BELLARY
registered as registered owner DISTRICT, Bellary, Karnataka-583239
(Evidence to be produced)

4. : HOUSE NO 160,3RD WARD, OLD

Temporary address of the Person
MALPANAGUDI,HOSPET TALUK, BELLARY
to the registered
DISTRICT, Bellary, Karnataka-583239
5. : BELLARY MOTORS SALES PVT.LTD
Name and address of Dealer or
BELLARY MOTORS SALES PVT.LTD, R/O NH-
Manufacturer from whom the
63,NEAR BISILAHALLI BRIDGE,, ATP
vehicle is purchased
ROAD,BELLARI,
6. If Ex-Army vehicle or imported :
vehicle, enclose proof of approval
of design by State Transport
Authority
7. Class of Vehicle If motor cycle, :
Goods Carrier
whether without or with gear
8. The Motor (a) a new vehicle (b) :
NEW
Ex-Army vehicle (c) Imported
9. Type of Body : HARD TOP
10. Type of vehicle : LGV
11. Makers Name : MAHINDRA & MAHINDRA LIMITED
12. Month and year of Manufacturer : Mar-2019
13. No of Cylinder : 4
14. Horse power : 69.95
15. Cubic Capacity : 2523.00
16. Makers Classification : BOLERO PIK-UP FB PS 1.7T XL
17. Wheel base : 3260
18. A. Chassis No(affix Pencil print) : MA1ZU2TBKK1C31617
B. Engine Number : TBK1C40587
19. Seating Cap(Including Driver) : 2
20. Fuel used in the engine : DIESEL
21. Unladen weight(kgs) : 1725
22. Particulars of Previous :
Registration and Registered No(if
any)
23. Colour or the body, wings and :
WHITE
front end
24. Model Manufactured Location : Manufactured in India
I hereby declare that the Motor vehicle has not been registered in any state in India. Additional
particulars to be completed only in the case of transport vehicles other than motor
Owner: VALI SAB Mobile No: 9945753798 Chassis:
MA1ZU2TBKK1C31617
25. Number Description
a) Front axle : 7.00 R 15 (12 PR)
b) Rear axle : 7.00 R 15 (12 PR)
c) Other axle :
d) Tandem axle :
26. Gross vehicle
a )As certified by :
b) To be refitted :
27. Maximum axle weight in (Kg.)
a) Front axle : 1135
b) Rear axle : 2290
c) Other axle :0
d) Tandem axle :0
28. a) Overall length :
b) Overall width: :
c) Overall height: :
d) Over hang: :
The above particulars are to be filled in for a rigid frame motor vehicle of two or more axle for an
articulated vehicles of three or more axles, or to the extend applicable for trailer, where a second
semi-trailer are to be registered with an articulated motor vehicle

The following particulars are to be furnished for each semi-trailer

29. AC Fitted : NO
30. Gross Vehicle Weight(kgs) : 3425
31. The vehicle is covered by valid : HDFC ERGO GENERAL INSURANCE CO.LTD.
insurance certificate or cover note Covernote No.-006602271647, Valid From 23-
of May-2019 To 22-May-2020
32. The vehicle is exempted from :
Insurance.
The relevant order is enclosed. :
33. I have paid the prescribed fee of :
rupees.............................

Signature or thumb impression of the

Date: ....... ....... ....... person to be registered as registered owner
Note: The Motor Vehicle above described is :
i. Subject to Hire-Purchase agreement/Lease agreement with
ii. Subject to Hypothecation in favour of
iii. Not held under Hire-Purchase agreement or Lease agreement or subject to Hypothecation

Hypothecation Details: (1) Hypothecation Type :HT, Financier's Name :HDB FINANCIAL SERVICES LIMITED
Owner: VALI SAB Mobile No: 9945753798 Chassis:
MA1ZU2TBKK1C31617
CERTIFICATE INSPECTION OF MOTOR VEHICLE
Certified that the particulars contained in the application are true and that the vehicle complies with the requirement of the Motor
Vehicle Act, 1988 and the Rules made there under.

Signature of the INSPECTING AUTHORITY

Name: ....... ....... ....... .......
Date: ....... ....... ....... Designation:....... ....... ....... .......
(FOR OFFICE ENDORSEMENT)

Office of the ...... ....... ....... ....... .......

Ref. No: ....... ....... ....... Dated ....... ....... ....... ....... ....... ......
The vehicle bearing chassis no and engine no has been assigned the registration number and registered in the name of and the
vehicle is subject to an agreement or hire purchase / lease /hypothecation.

Registering Authority

To,
....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... .......
....... ....... ....... ....... ....... ....... .......
Name and address of the Financier By Registered post or deliver under proper
acknowledgment