Form 54

[See Rule 150 (a) and (2)]

Application for intimation and transfer of ownership of a motor vehicle

1.   Name of the police station :
2.   CR No./Traffic Accident report :
3.   Date, time and place of the accident :
4.   Name and full address of the injured/deceased :
5.   Name of the hospital to which he/she was removed:
6.   Registration Number of vehicle and the type of the
                 vehicel :
7.   Driving Licence particulars :
      (a)   Name and address of the driver:
      (b)   Driving licence number and date of expiry :
      (c)   Address of the issuing authority:
      (d)   Badge No. in case of public service vehicle:
8.   Name and address of the owner of the vehicle at the
                 time of the accident :
9.   Name and address of the Insurance Company with
                 whom the vehicle was insured and the particulars
                 of the Divisional Officer of the said insurance company:
10. Number of Insurance Policy/Insurance Certificate
                 and the date of validity of the Insurance Policy/
                 Insurance Certificate:
11. Registration particulars of the vehicle (class of vehicles)
      (a)   Registration No :
      (b)   Engine No :
      (c)   Chasis No :
12. Route Permit Particulars :
13.  Action taken, if any, and the result thereof :