teregistration, alterations to registers particulars PMINN Viv 7001 Please answer in CAPITAL letters where applicable and sign the declaration. For reference, see Instruction notes on the Toll Free Number Section A : Applicant/ Transferee 1) Are you registering the motor vehicle/trailer/engineering plant in the NO (Fill part 3 and continue with Yes (Fill part 2 and continue from part 2) Name of Applicant(Individual): (In case of a minor, only details of the a) Tite(Optional) b) Sumame/Maiden’ ©) First Name d) Middle Name @) Acquired Name (if Different from 1) Family/Father's Sumame(If Different a) Male Female h) Date of Birth Day/Month/Year 3)Name of Applicant(Non | ERM! INVESTMENTS-SMO-LTD 4) Do you have a (J No(Fill part (¥)_Yes(if yes, provide 1017923720 5) Address in (This must be ‘a permenent physical address. Complete boxes(a) a) Plot Number 1 b) Street Name o)Building Name ‘@) Trading Center KAMPALA, e)District/City fy KAMPALA KAMPALA CENTRAL DIVI 9) Sub-County/Town Couneil/Division KAMPALA CENTRAL DIVISION hy Village/Local Section B : Purpose of the Indicate the purpose of the application by ticking appropriate box below. Note, the application should be for one vehicle and for one purpose Alternation to 4 Engineering First Time i Transfer of Registratio Re registrered | Duplicate De T, Motor J 2. Motor Cycle C CL CO CJ O O 3, Trailer O O Section Cc: Duplicates 7. Duplicate for: Registration number [ Duplicate registration 2. Indicate the reason for the duplicate by ticking the appropriate box below: CU Stole CU Lost C) Destroye O Others, 3. In case the log book or number plate was stolen, lost or destroyed, was the matter reported to Police ? No Yes {if yes, give details) a) Date of reported to Police Day/Month/Year4. Provide details of the vehicle below: a) Registration number plates b) Registration Book Number c) Name of present registered owner d) TIN of present Registered Owner Section D : Particulars of the Vehicle if the purpose of the application is transfer or duplicate, fill in details from no. 3 to 27 otherwise for registration and re registration, fill in fields 1 to 27 1) Are you applying to register(or reregister) a NoYes ityes, filin the following {@) Previous Registration Day/MonthiVear (b) Date of Previous Registration 21/02/2009 (©) Country of registration TAPAN 2 (a) Indicate the category of number plates you are 30 {(b) In case of personalized Number Plates, specify your - 3. Make of vehicle 4, Manufacturer's model 5. Country of orginin ‘SUBARU FORESTER DBA-SHS JAPAN 6 Fees classification 7. Description of the body 8. Color 1 ‘STATION WAGON BLACK 9, Year of manufacture 70. Attachment * Nil7 Side Car Ti Fuel 2008 NIL PETROL 72. Power (cubic 73. Engine Number 14. Chassis Number 1990 200728232 sH5028033 15. Net Weight (in Kgs) 16. Gross Weight (Laden) (in 17. Weight system used if not 1500 1775 78. Size of tyres 79. Number of wheels 20. Number of axles 215/65R15 4 2 21, Seating Capacity 22. Purpose / Function 23, Category of 5 PRIVATE COMPANY 2a. Tax Category 25. Classification of Vehicle 26. Insurance Company 4 bor Cars Salons Estates Station Wagons and Sedan | null 27. Insurance * policy / Cover Note nll Section E: Declaration and T7we declare that the information given on this application is true and correct and that failure to provide correct information may result in if this form is signed by a person other than the applicant, formal powers off attonery will be required. in the case|of a transfer, the 1. First Name 2. Last Name Office Signiture Date. _ Day/Month/Year 3 " Name 2. First Name Last Name - Signitur Signiture Date: Day/Month/Year Day/Month/Year Date