This is to certify that we: ___________________________________________________

Of:_____________________________________________________________________

_______________________________________________________________________

Hereby sold one used:_____________________________________________________

With Chasis no:__________________________________________________________

Engine no:______________________________________________________________

To:____________________________________________________________________

Of:_____________________________________________________________________

______________________________________________________________________

At the rate
of:_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

ALL THE RELEVANT RELATING TO THE

VEHICLE HAVE BEEN HANDED OVER TO THE BUYER

_______________________ ______________________
SELLERS’ SIGNATURE BUYERS’ SIGNATURE

_______________________ _______________________
WITNESS SIGNATURE WITNESS SIGNATURE