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Name

Email

Phone no

Number of Plates/प्लेटों की संख्या * 1 Plate 2 Plates

State* Select Registration State Andhra Pradesh Arunachal Pradesh Assam Bihar Chhattisgarh Goa Gujarat Haryana Himachal Pradesh Jharkhand Karnataka Kerala Madhya Pradesh Maharashtra Manipur Meghalaya Mizoram Nagaland Odisha Punjab Rajasthan Sikkim Tamil Nadu Telangana Tripura Uttar Pradesh Uttarakhand West Bengal Andaman and Nicobar Islands Chandigarh Dadra and Nagar Haveli and Daman and Diu Lakshadweep Delhi Puducherry Ladakh Jammu and Kashmir

Vehicle Reg No*

Chassis No.* (XXXXX12345)

Engine No.* (XXXXX12345)