GOVERNMENT OF KERALAMOTOR VEHICLES DEPARTMENTForm TR5(c) (See Rule 90(a) of KTC)

Table ID: 2Transaction No: A/15702/2013Date : 22/05/2013

Office : SRTO, KAZHAKUTTOMPayee Name : SIDDHARTH DASAddress : QTE.NO:E-40

: V.S.S.C HOUSING COLONY: PALLITHURA P.O TRIVANDRUM

License No : 22/4506/2006Purpose : Issue of duplicate DL - form 7Fee : 200Service Charge : 50Total Amount : 250.00Amount in words : Two Hundred and Fifty Rupees OnlyBank Reference No: IK28397784 Bank : STATE BANK OF INDIA* This is a computer generated document and does not require any signature

* Any modification or misuse of this receipt is an offence which shall attract legal action and punishment

(Office Copy. Please attach with the application)......................................................................................................................................................................................................

GOVERNMENT OF KERALA

MOTOR VEHICLES DEPARTMENTForm TR5(c) (See Rule 90(a) of KTC) Table ID: 2

Transaction No: A/15702/2013Date :22/05/2013

Office : SRTO, KAZHAKUTTOMPayee Name : SIDDHARTH DASAddress : QTE.NO:E-40

: V.S.S.C HOUSING COLONY: PALLITHURA P.O TRIVANDRUM

License No : 22/4506/2006Purpose : Issue of duplicate DL - form 7Fee : 200Service Charge : 50Total Amount : 250.00Amount in words : Two Hundred and Fifty Rupees OnlyBank Reference No: IK28397784 Bank : STATE BANK OF INDIA* You are instructed to submit the Online application with required documents at the counter of RT office/Sub RT Office within 3 days, belated applications shall not be entertained.

* Department is not responsible for the delay in service due to short remittance of fee,tax,service charge,cess,inaccurancy in application and documents submitted.

* This is a computer generated document and does not require any signature

* Any modification or misuse of this receipt is an offence which shall attract legal action and punishment (Acknowledgement and applicants copy) IT Services NIC Kerala

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