FORM P.S.A. [Rule 53 of Delhi Motor Vehicles Rules, 1992] APPLICATION FOR A PRIVATE SERVICE VEHICLE PERMIT In accordance with the provisions of Sec.69 and 76 of the Motor Vehicles Act, 1988, I/We the undersigned hereby apply for permit under Sec.69 of the Act in respect of a private service vehicle as hereunder set out: 1. Name of applicant ................ 2. Name of father (in case of an individual) ................ 3. Address ................ 4. Area/route for which permit is required ................ 5. Type of vehicle ................ 6. Registered seating capacity of vehicle ................ 7. Particulars of service to be performed By the private service vehicle and the Manner in which it will benefit the owner ................. 8. Particulars of any stage carriage or contract carriage permit already held by the applicant: Regn. Mark of Vehicle Type of Permit Permit No. (whether contract/stage carriage) 9 (i) Particulars of any permit or motor Vehicle licence held by the applicant In respect of the use of any transport Vehicle in India during the last 4 years Which has been subject of an order of Suspension or cancellation. ................ (ii)Prosecutions/challans or convictions, if any................ 10 Income Tax Number and circle where ................ Assessed (attach details of assessment ................ For the last three years) 11. Manner in which it is claimed that the Purpose of carrying passengers otherwise For hire or reward or in connection with Trade or business carried on by the Applicant will be served by the vehicle ................. 12. I/We hereby undertake that the vehicle shall not be used for hire or reward. 13. I/We have not yet obtained possession of the vehicle and I/We understand that the permit will not be issued until I/We have done so and have produced the certificate of registration. 14. I/We have arrangements for parking of the vehicle (Enclose location plan of the parking area and the premises). 15. I/We hereby declare that the above statements are true and agree that they shall be the conditions of permit. I also agree that in the event of any of the statements made above or information furnished being found false, the permit granted shall be liable for cancellation. Dated: Signature or thumb impression of the applicant(s)
