eS Madhya Pradesh Transport Department Form 20 [See Rule 47] Application for Registration of a Motor Vehicle (To be made in duplicate if the vehicle is held under an agreement of Hire Purchase/Lease/Hypothecation and duplicate copy with the endorsement of the Registering Authority to be returned to the Financier simultaneously an Registration of motor vehicle). To ‘The Registering Authority, BHOPAL RTO VID : 6919132 1 Full Name af Person to be recisterted as registered owner ‘SHUBHAM CHAURASIYA s/o SURESH KUMAR 2. Age of the person to be registered as Registered owner 43 Years (Proof of age 0 be attached) 3, Permanent address ofthe person to be registered as C/O MANISH THAKUR,NR CENTRANR CEN Registered owner(Evidence to be produced) SCH-3 HNO-01 SHRI KRISHNA ENCLAVE, BHOPAL 4. Temprory address of the person to be registered as C/O MANISH THAKUR,NR CENTRANR CEN Registered owner SCH-3 1H NO-O1 SHRI KRISHNA ENCLAVE, BHOPAL 5, Name and address ofthe Dealer or manufacture from whom the vehicle was =“ GALAXY BHOPAL VEHICLE PVT LTD BPL. purchased {Sale Certiicate and the certificate of road worthiness is Issued by the ‘manufacturer to be enclosed) 6. Ifex-army vehicle, er imported vehicle, enclose proof If locally manufactured Traller/Semi-traler,enclose the approval of design by the STA and note the proceedings No. and date of approval 7. Class of vehicle MoTOR CAR Gifmotor eycle, whether with or without gear) 8. The motor venice is New Vehicle 2) new Vehicle b) Ex-army Vehicle c) Imported Vehicle 9. Type of bocy SALOON 10, Type of Vehicle MOTOR CAR 411, Maker’ s Name 412, Month and Year of Manufacture FORD INDIA LTD ocToBeR-2018 12. Number of Cylinders 4 14. Horse Power 76 38. Cubie Capacity 1498 16, Maker's Classification or if not known wheel-base 47, Chassis Number (Affix pencil print) FREESTYLEL.S D TITANIUM MT BS4 MATGXXMTKGIRZGESS 48, Engine Number 3R26693 49. Seating Capacity (including Driver) an 20. Fuel used in the engine DIESEL 21. Unladen Weight 1460 22. Particulars of previous registration and registered number 23. Colour er colours of body, wings and front end CRED Thereby declare that the vehicle has not been registered in any State in India. 24. The vehicle is covered by valid certificate of insurance Uneer Chapter XI of the Act Insurance certificate or cover nate No. BXO19329 date: 13/05/2019 of BHARTI ‘AXA GENERAL INSURANCE COMPANY LTD (Name of Company Valid from 13/05/2019 to 12/05/2022 25. The vehicle is exempted from Insurance, The relevant order is enclosec 26. have paid the prescribed fee of rupees (FINE Before Submission) htps:dpes.mpranspert orgIDPESIDealer/Form20 aspx?dala=6919182 42sr28r2019 Dealer Point Enrollment System Date: 28/05/2019 ‘Signature of the Registered Owner ‘SHUBHAM CHAURASIYA Note : The motor vehicle above described Is. (1) Subject to Hire-Purchase/Lease agreement (2) Subject to Hypothecation in favour of HOFC BANK LTD (3) Not held under Hire-Purchase agreement or Lease agreement or subject to Hypothecation, Strike out whatever is inapplicable, 1f the vehicle is subject to any such agreement the signeture of the Financier with whom such ‘agreement has been entered into Isto be obtained, Signature of the Financier with whom an agreement ofthe ‘Signature of the Registered owner Hire-purchase, ease or Hypothecation has been entered Into. SHUBHAM CHAURASIYA CERTIFICATE OF INSPECTION OF MOTOR VEHICLE Certiied that the particulars contained in the application are true and that the vehicle complies with the requirements of the Motor Vehicle ‘Act 1988 and the Rules made thereunder, Signature of the INSPECTING AUTHORITY Date: 13/05/2019 Designation (Check List of the documents to be submitted along with this Form) Sale certificate in Form 23, Form 22 Invoice Insurance Address Proof Computer generated cash receipts (To be used by Transport Department officer) 1 Designation certified that all the tax and fee details mentioned in this form ‘are correct and all other mandatory information provides by the autharsea dealer in is capactty of being registering authority are correct. Signature and seal oF RTO: BHOPAL RTO htps:dpes.mpranspert orgIDPESIDealer/Form20 aspx?dala=6919182 22.