Traffic Police West Bengal
(Infringement report under Motor Vehicles Act, 1988 and Rules made thereunder)
Office Name : Jangipur
Challan Date : 28-04-2024 [Link]
Vehicle Class: M- Challan no: WB120595240428175916
Cycle/Scooter(2WN)
Vehicle no WB94M9421 Chassis no: .........
Book no ......... Engine no / Motor No: JC85ED20*****
Owner's Name: H*T*M*S*
Form no: .........
: *******006
Owner's Address N*T*N*A*A*,*D*U*I*A*,*S*M*E*G*N*,*M*r*h*d*b*d*-*4*2*2
Driver's name H*T*M*S*
Father's name F*R*K*S*
Age ........
DL no. No DL Validity .........
Place of incident MW5V+93P, NH12, Ratanpur, Jafrabad, West Bengal 742202, India
Circle Name Samsherganj PS
Circle Address Samsherganj
Document Impounded:
No Document Impounded
Offences Charged with:-
1: 129/194D MVA Without Helmet # ( 129/194D )[Fine - 1000]
:- 1000/-
Penalty specified against above offences charged (in numerals and words): 1000/-
Rupees: One Thousand Rupees only
/ Remarks: ........
.........................
The temporary authorization of impounded document shall be valid till (date)...................... or till the validity of the original document,
whichever is earlier.
For Online Payment
[Link] / Signature : ..................................
Name and signature of Officer
Subhankar Chatterjee
(2samsh3b5_ps@[Link])
Sub Inspector
(Bond under sec 213(5)(e) of Motor Vehicles Act,1988)
................. ......................... ..................... 1000
I solemnly affirm that I shall be present at.............(place) on the specified date.............. and time........and, in case of failure to do so,
shall be responsible to pay Rs 1000 in favour of Government of State.
