FORM OF APPLICATION FOR THE REGISTRATION OF MOTOR VEHICLE

Reg. No : Date : Prev. Reg. No. (if any) :

Issue No : Date : Issue by :
Dairy No : Date : Received by :
Customer ID : District : Vehicle ID :
Veh. Description : Call on date :
Refusal : Refusal Code : Refusal by :
P.O./Bank : Index :
Remarks(if any) : Index No.
To be filled in by the office
Section- I
To be filled in by the Owner
Section-II
(Owner Information)
Name of Owner: MD. SHAIFUL ALAM H/P THE CITY 2. Date of Birth: 11/12/1985
BANK LTD.

3. Father /Husband: MD. SHAH ALAM 4. Nationality:

BANNGLADESHI
5. Sex: MALE 6. Guardian’s Name:

7. Owner’s Address: The City Bank Center, 136 Gulshan Avenue, Gulshan-2 Dhaka.
8. Phone No. (if any): 01755581911 9. P.O/Bank:
10: Joint Owner: 11. Owner Type:
12. Hire: 13. Hire Purchase: Yes To be filled in by
Owner
Section-III
(Vehicle Information)

14. Vehicle or Trailer: Vehicle 15. Prev. Reg. No. (if any):
14(a). Class of Vehicle: Private Pass 15(a). Maker’s Name: SAIC Motor Corporation Limited
16. Type of Body: Hard Jeep 17. Maker’s Country: China
18. Color (Cabin/Body): White 19. Year of Manufacture: 2021
20. Number of Cylinders: 03 21. Chassis Number: LSJW74C97NZ069647

22. Engine Number: LIY212814344 23. Fuel Used: Petrol

24. Horse Power: 155 25. R.P.M:

26. Cubic Capacity: 1349cc 27. Seat (Incl. Driver): 05
28. No. of Standee: 29. Wheelbase: 2585
30. Unladen Weight (Kg): 1318 31. Maximum Laden Weight (Kg): 1750

Section-IV
32. No. of Types: 04 33. Tyre Size: 215/55 R17
34. No. of Axle: 02 35. Maximum Axle Weight (Kg):
(Additional information for transport vehicle)
(a) Front axle (1) (2)
(b) Central axle (1) (2) (3)
(c) Real axle (1) (2) (3)
36. Dimensions (mm)
(a) Overall Length: 4323 (b) Overall Width: 1809 (c) Overall Height: 1653
37. Overhangs (%)
(a) Front (b) Rear (c) Other

38. A copy of the drawing the showing the specification of the body and of the seating arrangements
approved ..............on....................... is attached herewith.
 Section-V
39. Hire purchase/hypothecation information:
The vehicle is subject to hire purchase/hypothecation with:

a) Name: MD. SHAIFUL ALAM H/P THE CITY BANK LTD. b) Date:
Address: The City Bank Center, 136 Gulshan Avenue, Gulshan-2 Dhaka.

40. Insurance information :

a. Policy no: b) Type of policy: c) Insurer’s name & address:

b. Date of expiry:

41. Joint owner information:

a. Name: b) Name:
Father/Husband: Father/Husband:

Section VI
(Declaration, Certificates and documents)

42. Declaration by owner :

a. I the undersigned do hereby declare that to the best of my knowledge and belief, the information given and
the documents enclosed (as per list attached) are true. I also declare that in case the papers/documents and
information furnished are found to be incorrect at any later stage, I shall be liable for legal action.

Date: Signature of owner

Seal
Encl: List of documents

43. Registered dealer’s certificate :

I the undersigned do hereby certify that the vehicle in question has been sold by me/my firm and the ownership
documents attached with the application for registration are true. The information/specifications pertaining to the
vehicle are correct and the vehicle complies with all the requirements of the registration.

Date: Signature of owner

Seal
Encl: List of documents

44. certificate by the Inspector of Motor Vehicles :

Certificate that the particulars pertaining to the owner and the vehicle (Chassis No. LSJW74C97NZ069647
Engine No. LIY212814344) given in the application match with the ownership documents attached to this
application. It is further certified that the vehicle complies with the registration requirements specified in the MV Act
and the Rules and/or Regulations made thereunder and the vehicle is not mechanically defective. The necessary
documents/papers are available as per list enclosed.

Date: Signature of Inspector of Motor

Vehicles
Official Seal
Encl: List of documents

45. Registration Status:

Registration allowed/not allowed Signature of Registering Authority
Seal
46. Fees and Tax Accounts :

Necessary fees and taxes amounting to taka...........................................................................................has been

paid to
PO/Bank...................................................................vide vouchers and receipts enclosed.

Signature of owner Signature of dealing assistant

of his representative

Counter signature by the registering authority.

 OWNER'S PARTICULARS / SPECIMEN SIGNATURE
1.Owner’s Name: MD. SHAIFUL ALAM H/P THE CITY BANK LTD.

2. Father: MD. SHAH ALAM

3. Mother: AFROZA ALAM

4. Address: The City Bank Center, 136 Gulshan Avenue, Gulshan-2 Dhaka

5. Sex: MALE

6. Mobile No.: 01755581911 15. NID No: 7318981656

7. Nationality: BANGLADESHI 16. ETIN No: 266644389468

8. Date of Birth: 11/12/1985 17. Price: BDT 36,50,000/-

9. Guardian Name: 18. Double Vehicle TIN:

10. Chassis No: LSJW74C97NZ069647

11. Engine No: LIY212814344

12. Year of Manufacture: 2021

13. Preview Eng. No:

14. P.O. Box No:

14. SPECIMEN SIGNATURE:-