Owner: SUNIL KUMAR VISHWAKERMA Mobile: 8097911095 Chassis: MA3BNC62SRH869455

FORM 20
APPLICATION FOR REGISTRATION OR TEMPORARY REGISTRSTION OF A MOTOR VEHICLE
To,
The REGISTERING AUTHORITY
Siddharth Nagar(naugarh)
............................
1. Full Name of the Person to be registered as :
SUNIL KUMAR VISHWAKERMA
registered owner
Son/Wife/Daughter of : RAMANAND
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
GRAM BHATNGWA POST GAURA BAZAR
Government or a local body/Any other
DUMARIA GANJ, Siddharthnagar
document or documents as may be prescribed
Uttar Pradesh
by the State Government/Affidavit sworn
272189
before an Executive Magistrate or a First Class
Judicial Magistrate or a Notary Public to be
enclosed)
4. : GRAM BHATNGWA POST GAURA BAZAR DUMARIA GANJ,
Temporary address/Official address, if any
Siddharthnagar Uttar Pradesh 272189
4A. Ownership Type : INDIVIDUAL
5. Duration of stay at the present address :
6. PAN Number (Optional) :
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 KULDEEP MOTORS LUCKNOW PVT. LIMITED PLOT NO - B 991
purchased (sale certificate and certificate of SECTOR A MAHANAGAR MANDIR MARG NEAR CHANNILAL
road worthiness issued by the manufacturer to CHAURAHA
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 or :
Motor Car
without gear)
13. The Motor vehicle is (a) a new vehicle (b) Ex-Army :
vehicle (c) Imported vehicle (d) in-use E-rickshaw or NEW
E-cart
14. Type of Body : RIGID (PASSENGER CAR)
15. Type of vehicle : LMV
16. Makers Name : MARUTI SUZUKI INDIA LTD
17. Month and year of Manufacturer : Aug-2024
18. Number of Cylinder : 4
19. Horse power : 99.16
20. Cubic Capacity : 1462.00
21. Maker’s classification or if not known, wheel base : ERTIGA VXI (O) CNG 2740
22. Chassis No(Affix Pencil print) : MA3BNC62SRH869455
23. Engine Number or Motor Number in case of Battery :
K15CN9592752
Operated Vehicles
24. Seating Cap(Including Driver) : 7
Owner: SUNIL KUMAR VISHWAKERMA Mobile No: 8097911095 Chassis: MA3BNC62SRH869455
25. Fuel used in the engine : PETROL/CNG
26. Unladen weight(kgs) : 1250
27. Particulars of Previous Registration and :
Registered Number(if any)
28. Colour or colours of body wings and front end : PEARL ARCTIC WHITE
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) : 1820
40. The vehicle is covered by a valid certificate of : The New India Assurance Company Limited. Covernote
Insurance under Chapter XI of the Act No.-98000031240915271467, Valid From 31-Aug-2024 To 30-Aug-2027
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.
Owner: SUNIL KUMAR VISHWAKERMA Mobile No: 8097911095 Chassis: MA3BNC62SRH869455
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: (1) Hypothecation Type :HT, Financier's Name :ICICI BANK LIMITED
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 UP55AS9516 . 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)………………………………………………………