Download as pdf or txt
Download as pdf or txt
You are on page 1of 1

clear form print

FOOMKA DIIWANGELINTA GADIIDKA DATE:

SUMAD BEDAL
Tell:_______________________________________ Vehicle Color: _____________________________

Iibiye : ____________________________________ Registration No:___________________________

Iibsade____________________________________ Cylinders: _______________________________

Gender:____________________________________ Model: __________________________________

D.O.B:_____________________________________ Made in: ________________________________

Magaca Entryga :____________________________ Ld/Seat No: ______________________________

Entry No: __________________________________ HP: _____________________________________

Plate No : _____________________________ Road Tax No : _____________________________

EX Plate_________________________ Circulation Card:__________________________

Nooca B / Buurka ___________________________ GR:___________________________________

Nooca Buudhiga : ___________________________ EX book______________________

Engine No: ______________________________

Chasis No: ________________________________ Maximum Weight: ___________________

Ku Xigeen Ka Madaxa G. Dadweynaha Agaasimaha ku Xigeenka Waaxda liisamada iyo buugaagta

C/Rashiid Cali Maxamed :: ________________ Maxamed Salabeen Jamac (Abyan)____________________

Agaasimaha Waaxda Liisamada iyo Bugaagta

Ayaan Abdiaziz Mohamed ________________________

You might also like