Owner: VIJAYAKUMAR Mobile: 8971441575 Chassis:

MBP92PDDBST018243
FORM 20
APPLICATION FOR REGISTRATION OR TEMPORARY REGISTRSTION OF A MOTOR VEHICLE
To,
The REGISTERING AUTHORITY
YADGIRI RTO
............................
1. Full Name of the Person to be registered :
VIJAYAKUMAR
as registered owner
Son/Wife/Daughter of : TIPANNA RATHOD
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
Government or a local body/Any other R/O HOTHPET
document or documents as may be TQ-SHAHPUR, DIST-YADGIRI, Yadgir
prescribed Karnataka
by the State Government/Affidavit sworn 585287
before an Executive Magistrate or a First
Class
Judicial Magistrate or a Notary Public to
be
enclosed)
4. Temporary address/Official address, if : R/O HOTHPET TQ-SHAHPUR, DIST-
any YADGIRI, Yadgir Karnataka 585287
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
purchased (sale certificate and certificate RAMESH MOTORS PLOT NO 104 SY NO
of 9/1 DOMINANT DHAB DHABA YENKANCHI
road worthiness issued by the LAYOUT KUSNOOR PART
manufacturer 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 :
Three Wheeler (Passenger)
with or without gear)
13. The Motor vehicle is (a) a new vehicle (b) :
Ex-Army vehicle (c) Imported vehicle (d) NEW
in-use E-rickshaw or E-cart
14. Type of Body : FULLY BUILT
15. Type of vehicle : 3WT
16. Makers Name : MLR AUTO LTD
17. Month and year of Manufacturer : Feb-2025
18. Number of Cylinder : 1
19. Horse power : 7.64
20. Cubic Capacity : 435.60 1/5
21. Maker’s classification or if not known, :
D435 CITY 1930
wheel base
22. Chassis No(Affix Pencil print) : MBP92PDDBST018243
23. Engine Number or Motor Number in case :
A5A1827196
of Battery Operated Vehicles
24. Seating Cap(Including Driver) : 4

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Owner: VIJAYAKUMAR Mobile No: 8971441575 Chassis:
MBP92PDDBST018243
25. Fuel used in the engine : DIESEL
26. Unladen weight(kgs) : 460
27. Particulars of Previous Registration and :
Registered Number(if any)
28. Colour or colours of body wings and front :
BLACK AND YELLOW
end
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 : NO
39. Gross Vehicle Weight(kgs) : 786
40. : FUTURE GENERALI INDIA INSURANCE
The vehicle is covered by a valid certificate
CO. LTD.. Covernote No.-VD961264, Valid
of Insurance under Chapter XI of the Act
From 19-Apr-2025 To 18-Apr-2026
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: VIJAYAKUMAR Mobile No: 8971441575 Chassis:
MBP92PDDBST018243
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 :SHRIRAM FINANCE LTD
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- Signature or thumb impression of
purchase, Lease or Hypothecation has been entered into the 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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