(in whose jurisdiction the Transferee resides)
I/We
Resident of
have on the day of the year
Sold & delivered my/our Vehicle No.
make Chassis No.
Engine No to
Shri/Smt. (Name)
Son/Wife/daughter ofresiding at
(House No./Street/Village/Town/Dist./State) under an Agreement of
Purchase/Lease/Hypothecation WithThe Registration Certificate and Insurance
Certificate have been handed over to him / her / them. To the best of my/our Knowledge and belief the
vehicle is not superdasi and free from all encumbrances and information furnished is true.I/We
undertake to hold my/ourself responsible for any inaccuracy or suppression of information.

Date
Signature
of the Registered Owner
Vehicle No.
I/We
(Transferee)
Copy to the Registering Authority in whose jurisdiction the transferer
reside
Note : To be sent to the Registering
Authority by Registered Post Acknowledgment due.
Office Endorsement
No.
Date
Office of the
The ownership of the vehicle has been transferred to the name Of
With effect from
(date)
Registering
Authority
(office Seal)
To,
(The Transferer)
By Registered Post or delivered under proper acknowledgement
* Strike out whichever is inapplicable