Owner: DILIP KUMAR NAYEK Mobile: 9339408469 Chassis:
ME4HC155CTG183604
FORM 20
APPLICATION FOR REGISTRATION OR TEMPORARY REGISTRSTION OF A MOTOR
VEHICLE
To,
The REGISTERING AUTHORITY
JHARGRAM RTO
............................
1. Full Name of the Person to be :
DILIP KUMAR NAYEK
registered as registered owner
Son/Wife/Daughter of : S/O KALIPADA NAYEK
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 KENDUGARI
document or documents as may be KENDUGERYA, GOPIBALLAVPUR, Jhargram
prescribed West Bengal
by the State Government/Affidavit 721506
sworn
before an Executive Magistrate or a
First Class
Judicial Magistrate or a Notary Public
to be
enclosed)
4. : KENDUGARI KENDUGERYA,
Temporary address/Official address, if
GOPIBALLAVPUR, Jhargram West Bengal
any
721506
4A. Ownership Type : INDIVIDUAL
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 RAKESH AUTOMOBILES SALES PRIVATE
purchased (sale certificate and LIMITED GROUND FLOOR,HOLDING
certificate of 12/10/A,JAMDA JHARGRAM DAHIJURI ROAD,
road worthiness issued by the JHARGRAM
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, :
M-Cycle/Scooter
whether with or without gear)
13. The Motor vehicle is (a) a new vehicle :
(b) Ex-Army vehicle (c) Imported NEW
vehicle (d) in-use E-rickshaw or E-cart
14. Type of Body : SOLO WITH PILLION 1/5
15. Type of vehicle : 2WN
16. : HONDA MOTORCYCLE AND SCOOTER INDIA
Makers Name
(P) LTD
17. Month and year of Manufacturer : Mar-2026
18. Number of Cylinder : 1
19. Horse power : 7.28
20. Cubic Capacity : 98.98
21. Maker’s classification or if not known, :
SHINE 100 DX 1245
wheel base
22. Chassis No(Affix Pencil print) : ME4HC155CTG183604
23. Engine Number or Motor Number in :
HC15EG3183999
case of Battery Operated Vehicles
24. Seating Cap(Including Driver) : 2
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Owner: DILIP KUMAR NAYEK Mobile No: 9339408469 Chassis:
ME4HC155CTG183604
25. Fuel used in the engine : PETROL(E20)
26. Unladen weight(kgs) : 103
27. Particulars of Previous Registration and :
Registered Number(if any)
28. Colour or colours of body wings and front :
PEARL IGNEOUS BLACK
end
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 :
b) Rear axle :
c) Any Other axle :
d) Tandem axle :
31. Gross vehicle
a )As certified by :
manufacturer
b) To be registered :
32. Maximum axle weight in (Kg.)
a) Front axle :
b) Rear axle :
c) Any Other axle :
d) Tandem axle :
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) : 253
40. : Bajaj General Insurance Co. Ltd..
The vehicle is covered by a valid certificate
Covernote No.-OG-27-2410-1826-0000,
of Insurance under Chapter XI of the Act
Valid From 10-Aug-2026 To 09-Aug-2031
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.
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Owner: DILIP KUMAR NAYEK Mobile No: 9339408469 Chassis:
ME4HC155CTG183604
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 :HDB FINANCIAL SERVICES 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- Signature or thumb impression of
purchase, Lease or Hypothecation has been entered into the 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:....... ....... ....... .......
[Link] ....... ....... .......
(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)………………………………………………………
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