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Sl.No. / Mandal/Date :

VEHICLE PASS
Mandal ......................................................................................

Vehicle No..................................................................................

Type of Vehicle ..........................................................................

Goods in Carrier .........................................................................

Name of the Driver .....................................................................

Mobile No. .................................................................................

Permission From.....................................To ................................

Starting Point ..................................Destination .........................

No. of persons allowed ................... (words) ...............................

.................................................................................................

Signature of Mandal Executive Magistrate &


Incident Commander

.................................. Mandal
YSR District, Andhra Pradesh State.

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