Form P.T.

A
(Rule 171 (iv) of the Telangana Motor Vehicles Rules, 1989)

To

The Regional / State Transport Authority.

In accordance with the provisions of Sections 69 and 87 of the Motor Vehicles Act 1988. I/We the
undersigned hereby apply for a temporary permit under section 66 of the Motor Vehicles Act. 1988
as hereunder set out :

1. Full Name : Nachigari Charankanth

2. Name of the Father
(in case of an individual) : N Shankar
3. Address :
4. Class of permit and the purpose for which it is
required :
5. If the vehicle is to be used as contract carriage,
the particulars of contract and copy of contract in
duplicate should be furnished.
6. Route(s), area :
7. Period of duration of permit from :
8. Type and Gross vehicle weight, seating
capacity of the vehicle or the vehicles for
which the permit is required. :
9.
i. The registered owner(s) of the
vehicle(s) is/are and the Registration
mark(s) is/are.:
ii. No. and validity of permit, if any already
held in respect of the vehicle.
iii. Validity of F.C.
iv. Validity of I.C.
v. Tax paid upto.
10. I/We enclose cash/challan/cheque/money
order receipt for Rs being the
prescribed fee.
11. I/We hereby declare that the above statements are
true and agree that they shall be conditions of any
permit issued to me/us.

Signature or thumb impression of

the applicant(s)