.

MMIBIAN POUCE
-
IN TRANSIT VEHICLE VERIFICATION FORM
:

ESIIIIATED DEPARIURE DATE FROII BOI{OID'AREA

.':
TO
-2, r.. -! crL--r-
A: PARTICULARS.OF VEHIGLE

B. PARTICiJLARS OF PERSbN THAT TENDERS T}IE VEH1CLE FORCLEARANCE

COMFAN/
STREEI AODRESS

OFF]CE TEL Nq

ZsJ-!l-/rc
DATE

FOR OFFICE USE.

IlRank)g:2.l-...........=_
cerirfy qEtt have physicalfy hsp€drd dle above

PLACE
Pplt P$ -t
OATEStAlilP.

above meotionedyeh,cle has not been repcrted as stole[

fl NCB vorilicai]on number:

SIG'.IATURE
Dri: s;r.!i?
l,e hi:,. i:r rlin i.nn is oii,v valij irr T (s."eo).:).s
as."eol arvs irom d.is ci Nca r. an.jii.r d:rr