FORM 25

FORM OF APPLICATION FOR RENEWAL OF CERTIFICATE OF REGISTRATION OF A

MOTOR VEHICLE, OTHER THAN A TRANSPORT VEHICLE. Application No:
[See Rule 52(1)] AS20061978284168
Receipt No:
AS6R200600001828

To
THE REGISTERING AUTHORITY,
DIBRUGARH
ASSAM

I MRS ANJALI BARUA having mobile number 9435874810 hereby apply for the renewal of the certificate of registration which is attached, the particulars of which are as follows:­
(a) Registered number : AS06E2829
(b) Date of issue : 09-Aug-2005
(c) Date of expiry : 18-Jun-2025
(d) Registering authority by which the certificate was issued/last renewed : DIBRUGARH
My present address is NEAR OUT DOOR STADIUM,BAIRAGIMATH,,Dibrugarh,Assam-786003 If this address is not entered in the certificate of registration, I do/do not wish that it
should be so entered. The renewal of the certificate has not been refused by any registering authority. I hereby declare that the certificate of registration has not been cancelled or
suspended by any registering authority.

1. Class of vehicle :Motor Car

2. The motor vehicle was registered as : NEW
(a) A new vehicle :
(b) Ex-Army vehicle :
(c) Imported vehicle :No
3. Type of body : HATCH BACK
4. Maker’s name : TATA MOTORS LTD
5. Month & Year of manufacture : 6/2005
6. Number of Cylinders :4
7. Cubic capacity/Horse power : 1405.00
8. Maker’s classification : TATA INDICA
9. Chassis number-Affix pencil print : 600121DUZP56609
10. Engine number : 475IDI05DUZP56593
11. Seating capacity (including driver) :5
12. Unladen weight : 980
13. Fuel used : DIESEL
I enclose the certificate of insurance for perusal and return.
I have paid the fee of rupees : 600
Dated: ____________________ Signature or Thumb impression of the applicant.

Note :- The motor vehicle above described is not subject to an agreement of hire purchase, lease or hypothecation.
The vehicle is:
(i) Subject to hire purchase agreement/lease agreement with ...................
(ii) Subject to hypothecation in favour of ...................
Signature or Thumb impression of registered owner
Specimen signature or thumb impression of registered owner:
1.
2.
3.

CERTIFICATE
Inspected the vehicle-verified the chassis number and engine number. Certificate that the particulars contained in the application and the corresponding particulars declared in the
certificate of registration of the vehicle are true and that the ve hicle complies with the requirement of the Motor vehicle Act, 1988 and rules made thereunder.
Signature of the Inspecting Authority.
Name .................
Designation .................

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 Payment Details
Transport Department, Government of Assam

Registration Authority DIBRUGARH

Application No./RECEIPT No: AS20061978284168 / AS6R200600001828 Receipt Date: 20-Jun-2020

Vehicle Class: Motor Car Owner Name: MRS ANJALI BARUA

Vehicle No: AS06E2829 Chasis No: 600121DUZP56609

Vehicle Registration Date: 09-08-2005 Payment Transaction No:

GRN No: Bank Reference Number:

Servicing Authority: DIBRUGARH

Particular Period Amount Penalty Total

Issue of Duplicate RC 300 0 300

Renewal of Registration 600 0 600

GRAND TOTAL (in Rs): 900/- (NINE HUNDRED ONLY)

Note:Application for this service is applied via .In case of any data discrepancy, please contact respective State/RTO department.

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