FORM FT [See rule 55 (3)] I __________________________________________________ residing (temporarily) at ____________________________(permanently) at __________________ hereby declare that I have brought the under mentioned Motor Vehicle into the State of Goa and that I intend to keep it in the State upto for use solely "within the limits of the local authority viz ________________ (here mention the name of local authority) _________________________ which has levied a tax on the motor vehicle" both within the limits of the local authority, viz. __________ (here mention the name of the local authority) ____________________ and outside these limits : (1) Class of motor vehicle ______________________________________________ (2) Registration mark ___________________________________________________ (3) Maker's name ______________________________________________________ (4) Type of the body ___________________________________________________ (5) Number of chassis __________________________________________________ (6) Number of engine __________________________________________________ (7) Unladen weight ____________________________________________________ (8) Whether used for carriage of persons or goods ___________________________ (10) If used for carriage of goods (a) Whether a private goods vehicle or a public goods vehicle. (b) Registered laden weight. (c) Carrying capacity i.e. the difference between the registered laden weight and the unladen weight. (11) (a) Date on which the motor vehicle __________________ was last brought into (9) If used for carriage of persons (a) Whether plying for hire (b) Carrying capacity (i) Seated (including driver) (ii) Standees Total ____________ ____________ The State of Goa. AND (b) Date on which it was last removed from the State of Goa. (12) The fuel used in the vehicle ___________________________________________ (13) Name of insurer ____________________________________________________ (14) Insurance Certificate No. _____________________________________________ (15) Date of validity of Insurance Certificate (From _______________________ to __________________________________ I tender herewith Rs. ______________________ by *Cash/*Cheque/*Demand Draft/*Money Order/*Treasury Chalan being the tax due in respect of the vehicle described above. The said vehicle is exempted from payment of tax by Government Notification No. ______________ for the period ending _________________ by virtue of having paid the tax for the said period in the State of ________________ Date the _______________ Signature of the Declarant Price : Rs. 10.00 Note:Please pay the cost of this form to the concerned RTO Printed from www.gatransport.com
