FORM P. CO. P. A.

{See Rule 71 (1) (ii)}

APPLICATION FOR A PERMIT IN RESPECT OF A CONTRACT CARRIAGE TO BE

REGULARLY SO USED
(*CAB / AUTORICKSHAW / TOURIST CAB / CONTRACT CARRIAGE)
(*STRIKE OUT WHICH IS NOT APPLICABLE)
To,
The Assistant /Dy. Regional Transport Officer, PUNE
In accordance with the provisions of sections 69, 73 and 80 of the Motor Vehicles Act, 1988, I, the undersigned, hereby apply for
the permit under section 66 of the Act in respect of a Contract Carriage as here under set out : -
1. Application No.:MH230515T9993536
2. Full Name of applicant / Company PRAMOD KUMBHAR
(surname) (Name) (Father's / Husband's name).
3. Age ---------------------------------------
4. Full Address: H. No A/P-KUMBHAR GALLI NR, BHAIRAVNATH MANDIR, WAGHOLI PUNE, Pune, Maharashtra-412207
5. Telephone No.: 8087630039
6. Area or route for which permit is required: / Pune District Only.
7. Seating Capacity: 4 seats.
8. The type of vehicle ( Bus / Car / A-R / A-C- Bus / Imported Car): Three Wheeler (Passenger)
9. Arrangements made for customers to contact permit holder : -- Office and phone number
10. Particulars of any stage carriage or contract carriage permit valid in the State or any other permit held by the applicant in
respect of : -- (a) this vehicle
(b) any other vehicle
11. Particulars of any permit held by the applicant in respect of the use of any transport vehicle in any State during the last four
years which has been the subject of any order of suspension or cancellation : --
12. * I am in possession of the vehicle. the Certificate of Registration of which is enclosed.
13. * I have not yet obtained possession of the vehicle and I understand that the permit will not be issued until I have done so and
have produced the Certificate of Registration and further declare that I propose to purchase a vehicle manufactured in the
year : --
14. * I intend to drive the vehicle No.:---------------------

P. S. V. A. No.: A002561323
My MDL No.: MH12 20140047253
issued by ------------
15. I hereby declare that the above statements are true and agree that they shall be conditions of any permit issued to me.

Signature or thumb impression

Date: 15-MAY-2023
of the applicant.
Place: A/P-KUMBHAR GALLI NR, BHAIRAVNATH MANDIR,
WAGHOLI PUNE, Pune, Maharashtra-412207

(* Strike out which is not applicable)

(To be filled in the office of the Transport Authority)
1. Date of receipt :
2. Amount of rupees 500.00 received, vide receipt number ------- dated 15-MAY-2023
3. Circulation to members
Date of Consideration at meeting decision by the Chairman
4. Granted in modified from on the ------- day of -------
5. Number of permits issued -------

Secretary,
Transport Authority.

For further process, please submit the signed copy of the Application Form along with the following documents in
originals for verification at the concerned Permit issuing authority:
1. Address Proof
2. PAN Card
3. Udyog Aadhaar/Shop Act License, if applicable
4. Professional Tax Certificate
5. OG Sanction Order (Only for Contract Carriage Permits)
6. Vehicle Measurement report (only for TC office Permits)
7. Seating / Sleeper Chart (only for TC office Permits)
8. Emergency exit door certificate (only for TC office Permits)
9. Vehicle photographs signed by IMV and RTO / Dy RTO (only for TC office Permits)
10. Recommendation Letter and verification of Parking by RTO / Dy. RTO (only for TC office Permits)