GOVERNMENT OF KERALA

MOTOR VEHICLES DEPARTMENT Table ID: 2

Form TR5(c) (See Rule 90(a) of KTC) Transaction No: D/2513/2019
Date : 27/02/2019
Office : RTO, PATHANAMTHITTA Payment Date : 27/02/2019
Name of Remitter : NITHIN K GRN : KL012322613201819E
Address : Harisreenivas
: Pramadom
: Mallassery P O Pathanamthitta
License No : 3/1048/2008
Purpose : Change of address in DL - form 7
Fee : 400
Service Charge : 55.00
Total Amount : 455.00
Amount in words : Four Hundred and Fifty Five Rupees Only
Bank Reference No: T19058200452VI128 Bank : FPG
* 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

(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: D/2513/2019
Date :27/02/2019
Payment Date : 27/02/2019
Office : RTO, PATHANAMTHITTA
GRN : KL012322613201819E
Name of Remitter : NITHIN K
Address : Harisreenivas
: Pramadom
: Mallassery P O Pathanamthitta
License No : 3/1048/2008
Purpose : Change of address in DL - form 7
Fee : 400
Service Charge : 55.00
Total Amount : 455.00
Amount in words : Four Hundred and Fifty Five Rupees Only
Bank Reference No: T19058200452VI128 Bank : FPG
* 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 applicant’s copy) IT Services NIC Kerala

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