I.VEHICLE IDENTITY No.

Reg : ……………

R/64699/X/2005/DITLLJBR

1. Police identification number : D 65533 EG

2. Make : YAMAHA

3. Series name : 5TL MIO

4. Vehicle description : MOTORCYCLE

5. Model : SINGLE MOTORCYCLE

6. Year of production : 2005

7. Year of manufacture : 2005

8. Engine size : 113 CC

9. Color : YELLOW

10.Vehicle Identification Number : MH35TL0035K163384

11.Engine Number : 5TL-163787

12.Total Fuse :

13.Total Wheel : 2 TWO

14.Fuel type : GASOLINE

15.Examination type certificate number:

16.Periodically examination number :

 Registering authority at which

Signature of First Owner registered : BANDUNG

31 OCTOBER 2005

[sealed and signed]

Drs. BENJAMIN SELAWA, SH.

POLICE COMMISIONER NRP. 55080595

MODEL I CERTIFICATE OF VEHICLE OWNERSHIP

II. OWNER IDENTITY

F.No. 6331199 H

NAME : PUTRI ASTRI WULANDARI

ADDRESS : JL. MARS I NO.7 RT 001 RW 024

SEKEJATI – MARGACINTA - BDG

OCCUPATION :

Passenger Vehicle Bus

1. Sedan 1. Bus

2. ST. WAGON 2. Micro Bus

3. Mini Bus 3. Double decker Bus

4. Jeep 4. Other

5. Other
 Pickup Vehicle Motorcycle

1. Pick up 1. Single Motorcycle

2. Deliver Van (checked)

3. Truck 2. Motorcycle with sidecar

4. Double Cabin 3. Scooter

5. Other 4. Trail

5. Other

Special Vehicle

1. Fire Truck

2. Ambulance

3. Hearses

4. Fork Lift

5. Other

III. CUSTOM NOTES/ORIGIN

1. Number :

2. Date :

3. Port :

4. Import method :

5. Receipt number : 02114/TL/DA0008-0105 15.10.2005

6. C.K.D number :
7. Other note : Receipt PT. YAMAHA INDO MTR MFG JKT

A/N. PUTRI ASTRI WULANDARI

JL. MARS I NO. 7 RT 001 RW 024

SEKEJATI – MARGACINTA - BDG

Import method:

C.K.D = Complete Knock Down

S.K.D = Semi Knock Down

B.U. = Built Up

= Form, A/B/C, Invoerpas, PIB, Recipt and others.