FORM - ACC Application for Surrender of Permit and Clearance Certificate (See Rule 204) PART I The Secretary, Regional / State Transport Authority .......................................................... Sir, I / We propose to surrender the Stage carriage / Goods carriage / Contract carriage permit in respect of my / our vehicle and request that a clearance certificate be granted to me / us. I / We give below the necessary particulars: 1. Full name & address of the permit holder (in block letter) 2. Registration mark of the vehicle covered by the permit 3. Authority by which the permit was issued 4. Number of the permit and the date of issued 5. Route of Area for which the permit is valid 6. Goods which the vehicle is permitted to carry (in the case of a Goods vehicle) 7. (a) Passenger Capacity in the luxury Coach (in the case of Contract Carriage) (b) Big, Medium Baby, Tourist or luxury Coach (in the case or Contract Carriages) 8. Date of expiry of the permit 9. (a) Place(s) at which the business is / was carried on (b) Place where the vehicle may be bound for inspection 10. Reasons for surrender of the permit 11. Whether evidence obtained from a competent Central Excise authority regarding the payment of difference of excise duty as applicable to private cars is enclosed, in case the permit is surrendered within three years from the date of registration (in the case of a motor cab or maxi cab allotted under Taxi Trade Quota): : ................................................................. ................................................................. ................................................................. : ................................................................. : ................................................................. : ................................................................. : ................................................................. : ................................................................. : ................................................................. : ................................................................. : ................................................................. : ................................................................. : ................................................................. : ................................................................. : ................................................................. I / We enclose cash / challan / cheque / money order receipt of Rs............................................ .................................................... being the................................................................... .............................. prescribed fee .............................................................................................................................................. I / We enclose the Permit of the Vehicle. I / We will produce the certificate of registration of the vehicle on receipt of further intimation. I / We declare that to the best of my / our knowledge, belief, the information furnished in the application is correct, complete and is truly stated. Place : Date : ................................................ Signature of the applicant (s). Note: - (a) Strike out inapplicable entries or alternatives throughout. (b) Where the space provided under or against a column is founded inadequate, particulars should be appended quoting number of the column concerned. PART II The application for surrender or permit for cancellation in respect of vehicle belongs to ........................................................................................................................................................... ......................................................................................................................................................... (here enter full name and address of the permit holders) is accepted with effect from The permit of the said vehicle are hereby cancelled. The application for surrender of permit for cancellation in respect of vehicle ...................... ........................................................................................................................................................... ........................................................................................................................................................... (here enter full name and address of the permit holder) is rejected for the following reasons: 1. Arrears of fee or tax due under the following in respect of the above vehicles have not been paid: (a) Motor Vehicles Act, 1988 and the rules made thereunder. (b) TamilNadu Motor Vehicles Taxation Act, 1974. 2. Disciplinary proceedings are pending against the permit holder in respect of the following cases: Current Number. Particulars of Offences. 1. 2. 3. 3. The permit has been cancelled / suspended with effect from ..................................... The certificate of registration of the vehicle and (other records, if any) is/are returned herewith. Place: Date: Regional/Secretary,.................... State Transport Authority. Copy communicated to 1. 2. 3. NOTE: Strike out inapplicable paragraphs entries or alternatives throughout.
