Application Form

Dealer Registration Form

(To be filled in Block Letters)

Form No.

1. RTO Name ...................................................................................................................

2. Name of Firm ........................................................................ PAN No. ..................................

3. Name of Proprietor .................................................................................................................

4. Fathers / Husbands Name.......................................................................................................

5. Email Address ........................................................................ Mobile ........................................

6. Postal Address...........................................................................................................................

....................................................................................................... .. ..........................................

7. Contact No. ................................... (Code)...............................................................................

8. Manufacturer Type of Vehicle Trade Certificate

a. ........................................................................

b. ........................................................................

c. ........................................................................

9. Account No. (SBI, Net banking Only) And Branch Name

....................................................................................................... .. ..........................................

....................................................................................................... .. ..........................................

10. Choice of User Name(s)

(a) ........................................................................

(b) ........................................................................

(c) ........................................................................

Date: Name of Applicant

Place:

(Seal & Signature)

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 Application Form

RTO Use Only

This is to certify that all the documents & information provided by

..........................................................................................................................................................................
(Name of applicant) are found to be correct.

I hereby recommend .................................................................................................................. to be

registered for Vehicle Enrolment Agency at..........................................................................................

Signature of RTO
Name: ..........................

Distt: ..........................

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Transport Department Govt of MP

(For Office Use Only)

The applicant is hereby authorized for Dealer Point Enrolment System & the permission is

Granted.

Denied for generation of username.

(Name & Signature)

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Transport Department Govt of MP

(For Office Use Only)

The applicant has been issued the User Name.

User Name ..........................................

(Name & Signature)

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