Scribd
Upload
2K views1 page

FASTag Exemption Form

This document contains an application form for an exempted category FASTag. The form requests information such as the applicant's name, address, contact details, vehicle details, and bank account/e-wallet details. For MPs/MLAs/MLCs, additional details are required like identity card number, constituency name and state, present tenure end date, and vehicle registration details for vehicles in New Delhi/state capital and respective constituency. The form needs to be signed by the applicant or authorized representative and includes spaces for remarks from NHAI and IHMCL officials.

Uploaded by

Amit Singh Chauhan
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
2K views1 page

FASTag Exemption Form

This document contains an application form for an exempted category FASTag. The form requests information such as the applicant's name, address, contact details, vehicle details, and bank account/e-wallet details. For MPs/MLAs/MLCs, additional details are required like identity card number, constituency name and state, present tenure end date, and vehicle registration details for vehicles in New Delhi/state capital and respective constituency. The form needs to be signed by the applicant or authorized representative and includes spaces for remarks from NHAI and IHMCL officials.

Uploaded by

Amit Singh Chauhan
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 1

Standard

Application Format for Exempted Category FASTag


Passport
Size
Photograph
APPLICATION FORM

1. Name of the Person :


(in Block Letters)
2. Applicant (For Self – Identity Proof, :
For Authorized Representative- Authorization
Letter, as applicable)
3. Category Code of Exemption :
(as per Annexure – A*)
4. Present Address with Telephone No :

5. Permanent Address with Telephone No :

6. Mobile number :
7. Email ID :
8. Details of Bank Account/ e-Wallet :
9. Details of vehicle for the Exempted Category as :
mentioned in Annexure A*: -
a) Ownership – Govt./Personal/Third Party

b) Usage of vehicle - Official/Personal
c) Vehicle Registration – Copy of
Registration Certificate to be enclosed
10. Validity period sought (maximum 5 years) :
11. In case of M.P/MLA/MLC, the following :

additional information to be provided
a. Identity Card Number :
b. Constituency Name
c. State of the Constituency :
d. Present tenure end date :
e. Vehicle No. at New Delhi/State Capital (only :
(Vehicle RC Copy to be enclosed)
Car/Jeep/Van)
Vehicle No. at respective Constituency (only :
(Vehicle RC Copy to be enclosed)
Car/Jeep/Van)


Date Signature and seal of Applicant/Authorized Representative for categories as per Annexure A*)
(For official purpose)


Remark of RO – NHAI:
Remark of IHMCL:

FASTag validity: Pan India/Within State -


*Note : For Annexure A – Please refer to the Standard Operating Procedure for exempted FASTag issued by MoRTH

You might also like