FORM. (Application for surrender of permit and clearance certificate) To ‘THE SECRETARY, ‘THE REGIONAL TRANSPORT AUTHORITY STATE Sir, Me propose to surrender the state carriage / public carriage / private carriage / contract carriage’/ permit in respect of my/our vehicle arid request that a clearance certificate be granted to.me/us. We giveri below the necessary particulars. 1. Fullname & address of the permit holder (in block letters) Registration mark of the vehicle covered by the permit ‘Authority by which the permit was issued 4, No. ofthe permit and date of issue 5. Route or area for which the permit is valid 6. Goods which the vehicle is permitted to carry (in the case of a goods carriage) 7. (a) Passenger capacity (in the case of a stage carriage) ~. {b) Big, Medium Baby, Tourist or Luxury coach (in the case of contract carriage) 8. Date of expiry of the permit 9. (a) Place(s) at which the business is/was carriedon (b) Place where the vehicle may be found for inspection ... 410. Reasons for surrender of the permit (State briefly) Me enclose. prescribed fee. We enclose the permit ofthe vehicle. We will produce the permit and the certificate of Regn. of the vehicle on receipt of further intimation. ‘ We deciare that to the best of my/our knowledge and belief the information furnished in the application is correct, complete and it truly stated, ash/chalian/cheque/money orderireceipt for Rs. being the Place : Signature of the: applicant (s) Date Note: (2) Strike out inapplicable entries or altemative throughout. {(p), Where the space provided under or against a column is found inadequate particulars “should be appended quoting the number of the column concerned.