Owner: ANJALI B A Mobile: 9496173716 Chassis: MAT626371RKN79486

FORM 20
APPLICATION FOR REGISTRATION OR TEMPORARY REGISTRSTION OF A MOTOR VEHICLE
To,
The REGISTERING AUTHORITY
KOILANDY SRTO
............................
1. Full Name of the Person to be registered as :
ANJALI B A
registered owner
Son/Wife/Daughter of : C/O: BABU A K
2. Age of the Person to be registered as :
registered owner
3. Permanent address (Electoral Roll / Life :
Insurance Policy / Passport / Pay Slip issued
by
any office of the Central Government/State
KUTTIPPARAMBIL HOUSE
Government or a local body/Any other
ARANGADATH,CHENGOTTUKAVU MELUR,
document or documents as may be
CHENGOTTUKAVU, Kozhikode
prescribed
Kerala
by the State Government/Affidavit sworn
673306
before an Executive Magistrate or a First
Class
Judicial Magistrate or a Notary Public to be
enclosed)
4. : KUTTIPPARAMBIL HOUSE ARANGADATH ,
Temporary address/Official address, if any CHENGOTTUKAVU MELUR, CHENGOTTUKAVU , MELUR
PO, Kozhikode Kerala 673306
4A. Ownership Type : INDIVIDUAL
5. Duration of stay at the present address :
6. PAN Number (Optional) : DCYPB5025D
7. Place of birth :
8. If place of birth is outside India, when :
migrated to India
9A. Nominee Name :
9B. Relationship with the nominee :
10. Name and address of Dealer or :
Manufacturer from whom the vehicle was
purchased (sale certificate and certificate of KL11-ROTANAMOTOR-NRPARAGON-TATA KANNUR ROAD
road worthiness issued by the manufacturer NEAR PARAGAN RESTAURANT, KOZHIKODE
to
be enclosed)
11. If ex-army vehicle or imported vehicle, :
enclose
proof. If locally manufactured Trailer/Semi-
Trailer, enclose the approval of design by the
State Transport Authority and note the
proceedings number and date of approval
12. Class of Vehicle (If motor cycle, whether with :
Motor Car
or without gear)
13. The Motor vehicle is (a) a new vehicle (b) Ex- :
Army vehicle (c) Imported vehicle (d) in-use NEW
E-rickshaw or E-cart
14. Type of Body : HATCHBACK
15. Type of vehicle : LMV
16. Makers Name : TATA MOTORS PASSENGER VEHICLES LTD
17. Month and year of Manufacturer : Nov-2024
18. Number of Cylinder : 3
19. Horse power : 84.42
20. Cubic Capacity : 1199.00
21. Maker’s classification or if not known, wheel :
TATA TIAGO XTA 1.2RTN BS6PH2 2400
base
22. Chassis No(Affix Pencil print) : MAT626371RKN79486
23. Engine Number or Motor Number in case of :
REVTRN19NVXKD0601
Battery Operated Vehicles
24. Seating Cap(Including Driver) : 5

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Owner: ANJALI B A Mobile No: 9496173716 Chassis: MAT626371RKN79486
25. Fuel used in the engine : PETROL
26. Unladen weight(kgs) : 983
27. Particulars of Previous Registration and :
Registered Number(if any)
28. Colour or colours of body wings and front end : DAYTONA GREY
29. Model Manufactured Location : Manufactured in India
I hereby declare that the Motor vehicle has not been registered in any state in India. Additional particulars to be completed
only in the case of transport vehicles other than motor
30. Number Description size and ply rating of tyres, as declared by the manufacturer
a) Front axle :
b) Rear axle :
c) Any Other axle :
d) Tandem axle :
31. Gross vehicle
a )As certified by :
manufacturer
b) To be registered :
32. Maximum axle weight in (Kg.)
a) Front axle :
b) Rear axle :
c) Any Other axle :
d) Tandem axle :
33. a) Overall length :
b) Overall width: :
c) Overall height: :
d) Over hang: :
The above particulars are to be filled in for a rigid frame motor vehicle of two or more axles for an articulated vehicle of three
or more axles, or to the extend applicable for trailer, where a second semi-trailer or additional semi-trailer are to be
registered with an articulated motor vehicle

The following particulars are to be furnished for each semi-trailer

34. Type of body :
35. Unladen weight :
36. Number, description and size of tyres on each axle
a) Front axle :
b) Rear axle :
c) Any Other axle :
d) Tandem axle :
37. Maximum axle weight in (Kg.)
a) Front axle :
b) Rear axle :
c) Any Other axle :
d) Tandem axle :
38. AC Fitted : YES
39. Gross Vehicle Weight(kgs) : 1383
40. : THE NEW INDIA ASSURANCE CO. LTD.. Covernote
The vehicle is covered by a valid certificate of
No.-80000031240950163795, Valid From 07-Jan-2025 To 06-
Insurance under Chapter XI of the Act
Jan-2028
41. The vehicle is exempted from Insurance. :
The relevant order is enclosed. :
42. I have paid the prescribed fee of :
rupees.............................

Signature or thumb impression of the dealer

Date: ....... ....... .......

Signature or thumb impression of the owner.

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Owner: ANJALI B A Mobile No: 9496173716 Chassis: MAT626371RKN79486
Note: The Motor Vehicle above described is :
i. Subject to Hire-Purchase agreement/Lease agreement with
ii. Subject to Hypothecation in favour of
iii. Not held under Hire-Purchase agreement or Lease agreement or subject to Hypothecation

Hypothecation Details:
Strike out whatever is inapplicable. If the vehicle is subject to any such agreement the signature of the Financier with whom such agreement has been entered into is
to be obtained.

..................... .....................
Signature of the financier with whom an Agreement of Hire-purchase, Lease or Signature or thumb impression of the
Hypothecation has been entered into registered owner

CERTIFICATE OF INSPECTION OF MOTOR VEHICLE WHOSE BODY HAS BEEN FABRICATED SEPARATELY TO THE
PURCHASED CHASSIS
Certified that the particulars contained in the application are true and that the vehicle complies with the requirement of the Motor Vehicle Act, 1988 and the Rules
made there under.

Signature of the INSPECTING AUTHORITY

Name: ....... ....... ....... .......
Date: ....... ....... ....... Designation:....... ....... ....... .......
Ref.No ....... ....... .......
(FOR OFFICE ENDORSEMENT)

Office of the ...... ....... ....... ....... .......

The above said motor vehicle has been assigned the Registration number NEW . and registered in the name of the applicant and the vehicle is subject to an
agreement of Hire-purchase/ Lease/ Hypothecation with the Financier referred above.

Date: ....... ....... ....... Signature of the Registering Authority

To,
The Financier ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... .......
....... .......

(TO BE SENT BY REGISTERED POST ACKNOWLEDGMENT DUE)

Specimen signature or thumb-impression of the person to be registered as Registered Owner and Financier are to be obtained in original application for affixing and
attestation by the Registering Authority with office seal in Forms 23 and 24 in such a manner that the part of impression of seal or a stamp and attestation shall fall
upon each signature.

Specimen signature of the Financier Specimen signature of the Registered Owner

(1)……………………………………………………… (1)………………………………………………………
(2)……………………………………………………… (2)………………………………………………………

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