Form Tr.P.A.
See Rule 73 (5) ( ii)
Application for transfer of a permit/countersignature
To,
The State Transport Authority Full name and address ..................................................................
Jharkhand, Ranchi. of the applicant/applicants .............................................................
I hereby apply for a transfer of the permit/countersignature as hereinunder set out set out :
1. particulars of permit/countersignature
a) Permit countersignature no. ..............................................................................................................
b) Issued by ............................................................................................................................................
c) Valid from ............................. to ..................................
d) Type of permit ...................................................................................................................................
e) Name of the permit holder ................................................................................................................
f) Registration mark of the vehicle covered by the permit/countersignature .......................................
2. Name of transferee ...........................................................................................................................
3. Reasons for transfer .........................................................................................................................
4. Whether any premium, payment of other consideration arising out of the transfer, is to pass or has
passed between the applicants .................................................................................. if yes, the nature and
amount of any such premium, payment of other consideration ......................................................................
5. Whether any agreement is made between the applicants for transfer of the permit .........................
...........................................................if yes, the details of such agreement ...................................................
6. In case the transfer is required upon death of the permit holder :-
a) Date on which the permit holder died ................................................................................................
b) Relation between the applicant and deceased permit holder .............................................................
7. In case the transfer of a countersignature is required, whether the primary permit is transferred in
the name of the applicant ................................................................................................. if yes, the date on
which such transfer is effected ............................................................................................................
8. Whether the vehicle covered by the permit is held under a hire purchased/lease/hypothecation
agreement ........................................................................................................................................ if yes, no
objection certificate from the financier must be attached.
9. I/We declare that the above statements are true, and that I/We have supplied all the informations
and documents necessary to support the statements made in this application.
10. I herewith tender the fee prescribed in rule 71.
Date : Signature of transferee
Place : Signature of transferor
Note : Where the space is not sufficient, the applicant should furnish the information, item wise, on separate sheets,
must sign each sheet, and must attach then with the application.