Declaration by owner of a Motor Vehicle under Section 13

*See instructions at the end of this form before completing it)

PART I

(To be completed by the owner of the motor vehicle)

I, ................................................ residing at ........................ hereby apply for the issue of a token under Section 13 of the Uttar Pradesh Motor Vehicles Taxation Act in respect of the motor vehicle described below and for the registration of the said motor vehicle under the Motor 

Vehicles Act.

1. Full name of owner ........................
2. Full address................................................
3. Trade name of vehicle (i.e., Ford, Chevrolet, etc.) ........................
4. Year of manufacture ...................................
5. Horsepower...............................................
6. Number of cylinders.....................................
7. Engine Number ..........................................
8. Chassis Number ......................................
9. Type and colour body (e.g., touring or saloon).........................................
10. Width and class of each tyre*........................
11. Unladen weight*.....................................
12. In the case of all vehicles other than motor cycles and motor cars*-Load capacity........................
13. In the case of a heavy motor vehicle only:
(i) Axle weight........................
(ii) Diameter of each wheel........................
14. The vehicles to be used (a) as a private vehicle or (b) as transport vehicle plying for hire* ........................
15. Type of vehicle*-(A) In the case of a private vehicle-
(i) bicycle   with/without   side car/trailer
(ii) tricycle   with/without   side car/trailer
(iii) vehicle used solely by invalids;
(iv) vehicle used solely for the conveyance of not more than seven passengers inclusive of the driver (i.e., ordinary private motor car);
(v) motor hearse;
(vi) other private vehicle (i.e., motor lorry, steam or motor tractor, motor bus or motor car with more than seven seats in all);
(B) In the case of a transport vehicle plying for hire:-
(i) vehicle for the conveyance of passengers only;
(ii) vehicle constructed partly for the conveyance of passengers and partly for the transport of goods;
(iii) vehicle for the transport of goods only;
(iv) vehicle for the conveyance of passengers or of goods alternatively.
16. In the case of a transport vehicle plying for hire only:-
(a) maximum number of passenger seats exclusive of the driver’s seat and of the attendant’s or conductor’s seat, if any;
(b) maximum authorised load in hundred weights........... Plus/or ........
(c) Class of route for which a permit has been issued (i.e., A Class or B Class) area within which the vehicle will ply, in the case of a taxi cab.
17. I claim exemption from payment of the tax under rule ........................ and attach hereto proof of my claim.
18. I hereby declare that the above is a true statement of my name and address and of the particulars of the motor vehicle described herein.
19. (In the case of private motor vehicle only)-I claim to pay the tax at the reduced rate in respect of the above vehicle on the following grounds:
20. (In the case of transport vehicles plying for hire only)-I attach to this declaration the permit issued to me under the Uttar Pradesh Motor Vehicles Rules in respect of the transport vehicle plying for hire described herein.
Date........................
Signature of Applicant
PART II
(To be completed by the Regional Transport Officer or  Assistant Regional Transport Officer)
Certified that the motor vehicle described above is exempt from tax under Rule ........................ and that Token No......................... Book No......................... dated ........................ has been issued.
OR
Certified that according to the above declaration the annual tax payable on the motor vehicle described therein is Rs.........................
Certified also that a sum of Rs......................... has been paid as tax in respect of the said vehicle for the period ending........................ 20..... and that, subject to the correctness of the above declaration, this licence is valid until .......... 19....... A Token No. ........................ dated ........................ has been issued to the applicant.
Signature of Regional Transport Officer
Date........................
Region........................
PART III
(To be completed by the Registering Authority)
Certified also that motor vehicle herein described has been registered under the Uttar Pradesh Motor Vehicles Rules, and that a registration certificate valid until ........................ 20........... has been issued and that the registration number of the vehicle has been entered in the token.
Particulars of vehicle...........................................
Name of registered owner.........................................
Address...........................................................
Registered Number of Vehicle.....................................
Signature of Regional Transport Officer
Date........................
Region
*Instructions
Item 9.-The ordinary open type of private car body is known at “touring” and the covered-in-body as “saloon”. If the colour of the body is at any time changed, the fact of such change shall be reported when the licence is next renewed.
Item 10.-Here insert whether “pneumatic”, “resilient” or “non-resilient”. “Pneumatic” means containing air beyond the rim of the axle, i.e., generally solid nabber tyres.
“Non-resilient” means neither pneumatic nor resilient, e.g., generally iron or steel tyres.
“Width”........................ e.g., “20x5”.
Item 11.-Unladen weight may be entered according to the maker’s specification or where a weighbridge is available, the ascertained weight. Should the applicant be unaware of the unladen weight the item may be left blank to be completed by the Taxation Officer.
“Unladen weight” should be in tens weights, except in the case of bicycles not exceeding 4 hundred weights in weight unladen, when it should be in kilograms.
Item 12.-Load capacity means the load which according to the manufacturer’s specification the vehicle is constructed to carry.
Motor car means a motor vehicle which is designed and used for the conveyance of persons and which has seating accommodation for not more than seven persons, inclusive of the driver.
Item 13.-A heavy motor vehicle means a vehicle of which the unladen weight exceeds two tons, but does not include a private motor car constructed for the conveyance of not more than seven persons.
Items 14, 15 and 16.-Strike out so much of the descriptions given as is not applicable to be motor vehicle to be described.
Item 16.-Will be completed by reference to the permit issued in respect of the motor vehicle. Where a transport vehicle plying for hire is authorised to carry partly goods and partly passengers, strike out the word “or” before sub-item (b). Where it is authorised to carry a full load either of passengers or of goods strike out the word “Plus” only.
Items 17 and 19.-Strike out if no claim is made.
WARNING
The delivery of a declaration which is not true is an offence punishable under Section 13 of the Uttar Pradesh Motor Vehicles Taxation Act.