APPLICATION FOR GRANT / RENEWAL OF COUNTERSIGNATURE

To
The State Transport Authority
5/9, Under Hill Road,
G.N.C.T. of Delhi
Delhi!!""5#
$/%e the undersi&ned apply for rene'al of
(er)it/Countersi&nature as hereunder set out*
!. Contra+t Carria&e (er)it
Nu),er of -ehi+le ........................

/. Re&n. No. of the -ehi+le .......................
0. Na)e and address of per)it holder ........................
........................
#. Date of e1piry of the per)it .......................
5. 2uel 3ode 4as per RC5 .......................
6. %hether the -ehi+le in 7uestion is
)anufa+tured after "!."#./""5 or
not 4if yes, atta+hed proof5 .......................
8. 9alidity of +ertifi+ate of fitness ........................
:. 9alidity of (UCC .......................
$/%e here ,y su,)it the selfattested photo+opies of the re&istration
+ertifi+ate and per)it, proof of the )anufa+turin& date of the -ehi+le, Certifi+ate
of fitness and (UCC. $/%e further de+lare that the infor)ation furnished a,o-e
are true to ,est of )y ;no'led&e and $/%e a)/are lia,le for any ina++ura+ies.
$/%e +ertify that $/%e ha-e 4i5 (ainted )y +ontra+t +arria&e -ehi+le as per
+olour +ode and lo&o for re+o&nition as pres+ri,ed in the a&ree)ent and the
-ehi+le also +o)plies 'ith <harat Sta&e $$$ nor)s 4ii5 Co)plied 'ith re7uisite
pro-isions under the 3otor 9ehi+les A+t, Rules fra)ed thereunder and pro-isions
of the interstate a&ree)ent under referen+e and also 4iii5 =n+losed t'o re+ent
passport si>e photo&raphs in addition to )y photo pasted a,o-e.

Si&nature of (er)it Holder...................
(aste re+ent passport si>e
photo&raph of per)it holder
Date.............
Note:-
1. No additional ta1es 4passen&er/road ta15 shall ,e paya,le, ho'e-er,
+ountersi&nature fee of the +on+erned state shall ,e paya,le.
2. Countersi&nin& of the per)its for these -ehi+les 'ould ,e re7uired ,y
parti+ipatin& States ,efore -ehi+le is plied in National Capital Re&ion.