DETAILS FOR ISSUE OF STICKER FOR TWO-WHEELER OF EMPLOYEES OF

KHARAGPUR WORKSHOP/WAGON SHOP

NAME OF THE
EMPLOYEE
DESIGNATION

OFFICE &
DEPARTMENT

PF NO/ Employee ID

SHOP NO

TICKET NO
TWO-WHEELER
(VEHICLE NO.) with
Details.
Driving License No. &
Validity Date
NAME OF THE OWNER
(Consent letter to be
attached is using
vehicle of family
members.)
CONTACT NO/
MOBILE NO

BLOOD GROUP

I hereby declare that the above information is true. I further declare that I am holding a
valid driving (Two-Wheeler) license (if applicable). In case, any information is found to
be incorrect I am liable to be taken up under D&A Rules.

[Signature of the Applicant]

Name
Desig
T. No.
UNIT