FORM-1

REQU ISTION FORM FOR CONDEMNATION OF THE VEHICLE

Name of the Department BSNL

1. Reg Number of the vehicle TN 38AK 4057

2. Make AMBASSADOR 2000 DSL SEDAN
3. Model 2006
4. Fuel DIESEL
5. Registere owner of the vehicle ASSITANT GENERAL MANAGER (L&B), BSNL
6. Date of purchase 04.12.2006
7. Total KMs covered 190064
8. Engine Number 3HNJF019854
9. Chassis Number AKF907170
10. Details of the vehicle Date of overhauling KMs covered
a. Engine NOT DONE SO FOR
b. Gear box NOT DONE SO FOR
c. Clutch NOT DONE SO FOR
d. Suspension NOT DONE SO FOR
e. Steering NOT DONE SO FOR
f. Break 17/09/2022 186805
g. Differential NOT DONE SO FOR
h. Body repairs and painting NOT DONE SO FOR
11. Tyre size & Number and conditions

SI No Tyre size Make Tyre no Date of fitment/KM s KMs covered

1. 185/65 BRIDGESTONE 4WLXCKA0122 FEB 22 178625
2. 185/65 BRIDGESTONE 4WLXCKA5 221 FEB 22 178625
3. 185/65 BRIDGESTONE 4WLX KA0122 FEB 22 178625
4. 185/65 BRIDGESTONE 4WLXCKA0122 FEB 22 178625

12. Battery size & number and conditions

Size Make Number Daate of fitment/KMs KMs covered

80AH EXIDE A310A013215 3102 12.02.2021/165443 24621

165443

13. Copy of RC

ENCLOSED
 CERTIFICATE

1. Certified that the Coimbato re BSNL office vehicle bearing registrati on number TN38 AK
4057 has covered the required norms for normal condemn ation.

2. Certified that the Coimbato re BSNL office vehicle bearing registrati on number TN38 AK
4057 has not met any accident from the date of purchase .

Junior Te lec 1 fficer

;t~;m~ '3Tf"h:Ftt . • ~;:: /N WO-C M
"JfT ,f.~ -~i., ~ -~;1lffi<.P1
BSNL, METTUPALAYAM-64 1 301
 Chassis No. P .-g. Valid Till

AKF907170 !fl)6
J~

Engine No.
(Vi
3HNJF019854
Owner Name
✓
ASSISTANT GENERAL MANAGER L&B ~ ~
z
I I w
/' «
I Fi=_I Used Son/ Daughte r/Wife of
·t p1ESEL NA
I!
• Address
\
\
PGM BSNL METTUPALAYAM
ROAD COIMBATORE
Coimbatore TN M1CM3
 -
Vehicle Class
Motor Car
Reg. No. Maker's Name
TN38AK4057 HINDUSTAN MOTOR CORPORAl 1,:.;.-..
Month & Yr. of Mfg. Model Name
12/2006 AMBASSADOR 2000 DSL
Wheel Base (mm) Colour
CD
g 002464 CWHITE
g Cubic Capacity (cc) Body Type
[ 001995 SEDAN
Iib No. of Cylinders Seating/S tanding Capacity
<JI °' 005/ 00
Laden/ Tax Paid Upto
Unladen Weight (Kgs) LIFE TIME
001250 I 000122

Signatur e of Issuing Authorit y

TN38COIIIBATORENORTHRTO
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I Cl;v;~ nf \/Ptlt;:ln
I Ml/ Ml , I 01< !, Af(
2 Mnl,11(1, N ,lll lfl Appl1ca11on Mo I
ll !NI JU S TM,I M(d fJk ', LIIJ • I
26 '.I l ypo ol Uoily Permit Cranled rn Proceedings I
. 92S9 6 ~., f~ de, r1 Dt
•I Mo1111 , d. Ye,11 R Mo
LUU(>
6. No. of Cyllnclors
6. Chassis Nu1nlier : '•
AKF90 71 70 O. Len gth .4 Cm-; 0 . Wid t li .l e ms
7. Engine Number ( rr, ~.
3HNJ I· 0 19 8 1) 11 o. Hei gr,t Crri <:. O. Hdr1 g
8. Fuel Usod
9. B.H. P.
DIE SE L
FORM 23 55
(see rule 48) 1O. Cubic capa city
1 995 ENDORSEMENTS
M OF CERTIFICATE OF REGISTRATION 11. Make r's Class
FOR AM BASSADO R 200 0 DSL
12. Wheel-Base Change of Address/Transferred to
2 46 4
13. Sealing Capacity: R. No.
5
14. Unladen Weight : Name
Reg istration No. 1N3!:jA f\ 40 ~ I 1200 Kgs .
15. Colour Address
C. WHITE
Owner's Nam e 16. G.V.W (C )
A~~ I S IANI GlNERAL MANAGER GV.W. (R) : ~~S . Date
res Motor Vehicle Under with
S/W/0/o 17. Num ber Description and size ~r'ry
(L & Bl BSNL R.A. :
F.A. :
: -- . T.A. :
Per. Address O.A. qegislering Aulhority
0/0 . PGM BSNL Mt T TUP AI_AYAM ..,.::<~[,.-
f - --
18. RegisleredAxle Weight : 14'
rwAo , R.A.W. : ·: ~~
Pin 64 1 3 F.A.W. : Chan ge of Address/Transfer
COI MBA TORE O.A.W.: T.A.W. R. No. ". t• . ./.
. ......
Temp. Add ress
TAMlL NADU. 19. Type of Body Name I 1

20. Unladen Weight Address ~': ~

0/0 . PGM BSNL METT UPA LAYAM s
P1n 21 . Number, Description and size of Tyre
HO/\ D, Date
COI MBA TOHE Registered Axle Weig ht : Motor Vehi cle Under
64 1IJl\~2.
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. with
,·fo-·l,·-'~!~~~\ wr~,i;
"/Jl fl.:. ► • \
Specimen Sign atuM MI UJAOU 23. Motor Vehic le under / .. ~ _,,~ '',-6'1 ~.. '
Thumb Impression. . -,:;!Z ,•~ \1 1
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Oea 1Eir : CHEAM INVE STMENT ANO ING CO .al
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Date Registering Authority
r~
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r------- -- -·--', , •··~~,~~~ h : ,'• , ,
Date Change of Address/Transferred .
- ~ - r'
This Certificate is Valid R. .,. , ~
Tax Deta ils Name
o. i
N I fl
Life Time Tai .P,ili~ L / I. 0 0 6 twi; 12/ 20 06 •~'!(;f/'1-
Address
1
Date ' crffi~ ··
0/H/AfTax : t :3460 AA u ~ ~ ~-
FORM 38 !SEE RUL E 62(1)]
Motor Vehic le Under with
I I Certified as complying with the 'or- :1imb,~tOiC (N'1fJ~otor
Quarter Ending : l. IFE TI ME Nun1ue1 Oa. Le
0 4 / 12 /~.j)~<t~icles Act, 1988 and lhe Rl'.iles hereunder. It will expire on Registering Aut/J orily
Tar Card No. CEJ/;>3/.93:3
Issued/Nol lssue.d t OFF ICE DETAILS
Inspecting Aut/Jority MV I : MAN l P
~(\0 Date wed from R. No.
· Previous Registra tl ~YUlJ al) This cerllFicate of fitness is hereby rene TN038 / 1826 33/ 2 006 /R
;st t r,ist "'. rl ng Authority Fees Paid 20 0
P1evious Regn .No.: to
1
Challan No. : CES /2 329 33
: ;:;~ Offrce - ~ ~ ' - A- :i. , ,..; .; ('' •· r . •1 Inspecting Authority Dale l
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Registering Authority
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