Owner: JAYMAA Mobile: 9938043621 Chassis: MAT569002S3D12265

TRANSPORTMINING&SUPPLIES
PVT
FORM 20
APPLICATION FOR REGISTRATION OR TEMPORARY REGISTRSTION OF A MOTOR VEHICLE
To,
The REGISTERING AUTHORITY
BHADRAK RTO
............................
1. Full Name of the Person to be registered :
JAYMAA TRANSPORTMINING&SUPPLIES PVT
as registered owner
Son/Wife/Daughter of : NA
2. Age of the Person to be registered as :
registered owner
3. Permanent address (Electoral Roll / Life :
Insurance Policy / Passport / Pay Slip
issued by
any office of the Central Government/
State
Government or a local body/Any other MANAGING DIRECTOR-BHRAMARBAR NAYAK
document or documents as may be PLOT NO- P-72/2007, MAHUMUHAN, SORO, Baleshwar
prescribed Odisha
by the State Government/Affidavit sworn 756045
before an Executive Magistrate or a First
Class
Judicial Magistrate or a Notary Public to
be
enclosed)
4. : MANAGING DIRECTOR-BHRAMARBAR NAYAK PLOT NO-
Temporary address/Official address, if any P-72/2007, MAHUMUHAN, SORO, Baleshwar Odisha
756045
4A. Ownership Type : FIRM
5. Duration of stay at the present address :
6. PAN Number (Optional) :
7. Place of birth :
8. If place of birth is outside India, when :
migrated to India
9A. Nominee Name :
9B. Relationship with the nominee :
10. Name and address of Dealer or :
Manufacturer from whom the vehicle was
purchased (sale certificate and certificate
SAMAL AUTO PVT LTD REMUNA HGV BALASORE
of
REMUNA BALASORE
road worthiness issued by the
manufacturer to
be enclosed)
11. If ex-army vehicle or imported vehicle, :
enclose
proof. If locally manufactured Trailer/Semi-
Trailer, enclose the approval of design by
the
State Transport Authority and note the
proceedings number and date of approval
12. Class of Vehicle (If motor cycle, whether :
Goods Carrier
with or without gear)
13. The Motor vehicle is (a) a new vehicle (b) :
Ex-Army vehicle (c) Imported vehicle (d) NEW
in-use E-rickshaw or E-cart
14. Type of Body : TIPPER
15. Type of vehicle : HGV
16. Makers Name : TATA MOTORS LTD
17. Month and year of Manufacturer : Apr-2025
18. Number of Cylinder : 6
19. Horse power : 300.16
20. Cubic Capacity : 6702.00
21. Maker’s classification or if not known, :
SIGNA 3530.TK 8X4 BSVI HD 23BX 5580
wheel base
22. Chassis No(Affix Pencil print) : MAT569002S3D12265
23. Engine Number or Motor Number in case :
B6.7B62300D03152D64471134
of Battery Operated Vehicles
24. Seating Cap(Including Driver) : 2
Owner: JAYMAA Mobile No: 9938043621 Chassis: MAT569002S3D12265
TRANSPORTMINING&SUPPLIES
PVT
25. Fuel used in the engine : DIESEL
26. Unladen weight(kgs) : 13517
27. Particulars of Previous Registration and :
Registered Number(if any)
28. Colour or colours of body wings and front end : TITANIUM_WHITE
29. Model Manufactured Location : Manufactured in India
I hereby declare that the Motor vehicle has not been registered in any state in India. Additional particulars to be
completed only in the case of transport vehicles other than motor
30. Number Description size and ply rating of tyres, as declared by the manufacturer
a) Front axle : 11.00R20 RIB 16PR
b) Rear axle : 11.00R20 RIB 16PR
c) Any Other axle :
d) Tandem axle : 11.00R20 RIB 16PR
31. Gross vehicle
a )As certified by :
manufacturer
b) To be registered :
32. Maximum axle weight in (Kg.)
a) Front axle : 14000
b) Rear axle : 21000
c) Any Other axle :0
d) Tandem axle :0
33. a) Overall length :
b) Overall width: :
c) Overall height: :
d) Over hang: :
The above particulars are to be filled in for a rigid frame motor vehicle of two or more axles for an articulated vehicle
of three or more axles, or to the extend applicable for trailer, where a second semi-trailer or additional semi-trailer are
to be registered with an articulated motor vehicle

The following particulars are to be furnished for each semi-trailer

34. Type of body :
35. Unladen weight :
36. Number, description and size of tyres on each axle
a) Front axle :
b) Rear axle :
c) Any Other axle :
d) Tandem axle :
37. Maximum axle weight in (Kg.)
a) Front axle :
b) Rear axle :
c) Any Other axle :
d) Tandem axle :
38. AC Fitted : NO
39. Gross Vehicle Weight(kgs) : 35000
40. : SBI GENERAL INS CO LTD. Covernote No.-
The vehicle is covered by a valid certificate of
POCMVGC0100358532, Valid From 02-Jun-2025 To
Insurance under Chapter XI of the Act
01-Jun-2026
41. The vehicle is exempted from Insurance. :
The relevant order is enclosed. :
42. I have paid the prescribed fee of :
rupees.............................

Signature or thumb impression of the dealer

Date: ....... ....... .......

Signature or thumb impression of the owner.
Owner: JAYMAA Mobile No: 9938043621 Chassis: MAT569002S3D12265
TRANSPORTMINING&SUPPLIES
PVT
Note: The Motor Vehicle above described is :
i. Subject to Hire-Purchase agreement/Lease agreement with
ii. Subject to Hypothecation in favour of
iii. Not held under Hire-Purchase agreement or Lease agreement or subject to Hypothecation

Hypothecation Details: (1) Hypothecation Type :HT, Financier's Name :TATA CAPITAL LTD
Strike out whatever is inapplicable. If the vehicle is subject to any such agreement the signature of the Financier with whom such agreement has been
entered into is to be obtained.

..................... .....................
Signature of the financier with whom an Agreement of Hire-purchase, Lease Signature or thumb impression of the
or Hypothecation has been entered into registered owner

CERTIFICATE OF INSPECTION OF MOTOR VEHICLE WHOSE BODY HAS BEEN FABRICATED SEPARATELY
TO THE PURCHASED CHASSIS
Certified that the particulars contained in the application are true and that the vehicle complies with the requirement of the Motor Vehicle Act, 1988 and the
Rules made there under.

Signature of the INSPECTING AUTHORITY

Name: ....... ....... ....... .......
Date: ....... ....... ....... Designation:....... ....... ....... .......
Ref.No ....... ....... .......

(FOR OFFICE ENDORSEMENT)

Office of the ...... ....... ....... ....... .......

The above said motor vehicle has been assigned the Registration number NEW . and registered in the name of the applicant and the vehicle is subject to an
agreement of Hire-purchase/ Lease/ Hypothecation with the Financier referred above.

Date: ....... ....... ....... Signature of the Registering Authority

To,
The Financier ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... .......
....... ....... .......

(TO BE SENT BY REGISTERED POST ACKNOWLEDGMENT DUE)

Specimen signature or thumb-impression of the person to be registered as Registered Owner and Financier are to be obtained in original application for
affixing and attestation by the Registering Authority with office seal in Forms 23 and 24 in such a manner that the part of impression of seal or a stamp and
attestation shall fall upon each signature.

Specimen signature of the Financier Specimen signature of the Registered Owner

(1)……………………………………………………… (1)………………………………………………………
(2)……………………………………………………… (2)………………………………………………………