P T A. Application in respect of a temporary permit (See Rule 170 ) To The Regional / State Transport Authority ................................................................ In accordance with the provisions of section 69 and 87 of the Motor Vehicles Act, 1988, I / We the undersigned hereby apply for a temporary permit under section 66 of that Act as hereunder set out : 1. a) Name b) Age (in words and figures) c) If the applicant is a minor, full name and address of the guardian 2. Name of father (in the case of an individual) 3. Address 4. Purpose for which permit is required 5. Nature of goods, if goods are to be carried 6. Route(s) / Area 7. Period of duration of permit 8. Type and registered laden weight / seating capacity of the vehicle for which the temporary permit is required 9. 1) The registered owner(s) of the vehicle(s) is / are and the registration marks is / are :. . . . . . . . . . . . . . . . . ..:. . . . . . . . . . . . . . . . . .. :. . . ... . . . . . . . . . . . . ... :. . . . .. . . . . . . . . . . . . . :. . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . ... :. . . . . . . . . . . . . . . . . .. :. . . . . . . . . . . . . . . . . .. :. . . . . . . . . . . . . . . . . .. :From. . . . . ... To. ... . . . . . :. . . . . . . . . . . . . . . . . .. :. . . . . . . . . . . . . . . . . .. :. . . . . . . . . . . . . . . . . .. 2) The vehicle has / vehicles have not yet been hired by me / us and I / We undertake to intimate the registration mark(s) if required within twenty-four hours of hiring the vehicle / vehicles. 10. I / We enclose cash challan / cheque / money order receipt for Rs. . . . . . . being the prescribed fee. 11. I / We hereby declare that the above statements are true and agree that they shall be conditions of any permit is used to me / us. Date: ............ Signature of Applicant(s). NOTE: Strike out inapplicable entries or alternatives throughout.
