Form P.T.A
(Rule 171 (iv) of the Andhra Pradesh Motor Vehicles Rules, 1989)

To

The Regional / State Transport Authority.

In accordance with the provisions of Sections 69 and 87 of the Motor Vehicles Act 1988. I/We the undersigned hereby apply for a temporary permit under section 66 of the Motor Vehicles Act. 1988 as hereunder set out :
  1. Full Name :
  2. Name of the Father
    (in case of an individual) :
  3. Address :
  4. Class of permit and the purpose for which it is required :
  5. If the vehicle is to be used as contract carriage, the particulars of contract and copy of contract in duplicate should be furnished.
  6. Route(s), area :
  7. Period of duration of permit from :
  8. Type and Gross vehicle weight, seating capacity of the vehicle or the vehicles for which the permit is required. :
    1. The registered owner(s) of the vehicle(s) is/are and the Registration mark(s) is/are.:
    2. No. and validity of permit, if any already held in respect of the vehicle.
    3. Validity of F.C.
    4. Validity of I.C.
    5. Tax paid upto.
  10. I/We enclose cash/challan/cheque/money order reciept for Rs. ................being the prescribed fee.
  11. I/We hereby declare that the above statements are true and agree that they shall be conditions of any permit issued to me/us.
.




Signature or thumb impression of
the applicant(s)

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