Before the Executive Magistrate of Panvel...

AFFIDAVIT-CUM-INDEMNITY
I, MR. MAHADEO MOTIRAM MORE, Age ____ Years,
Indian Inhabitant, Residing At:- Flat No. 601, 6th Floor, Tirupati, Plot
No. 21, Sector- 22, Kamothe, Tal. Panvel, Dist. Raigad, Navi
Mumbai - 410209; today at Panvel, state on solemn affirmation as
under:That I do not possess any proof of address as Electoral Roll, L.I.C.
Policy or passport as mentioned in the Rule 4 of CMV Rule 1989.
...2/-

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I am affirming this Affidavit Cum Indemnity Rule 4 of CMV Rule
1989, in order to prove of produce the same before Regional Transport
Officer R.T.O. PANVEL, DIST. RAIGAD.

1)

For Driving License of Motor Vehicle.

2)

For Registering of Motor Vehicle.

3)

For Transferring of motor Vehicle.

4)

For Re-registration of motor Vehicle.

5)

a) M.V. No. NEW

b) Model No. 2012
c) Ch. No. MA6BFBL2CCT047251
d) Engine No. B12D110AJVZ123110040

I undertake to inform Regional Transport Officer R.T.O.

PANVEL, if any change of address of residence or of business.
I say that I am submitting an attested copy of electric
bill/telephone bill/Rationing card/leave & license agreement /allotment
letter annexed here with as an additional proof of address.
I hereby indemnify the officials of Motor Vehicle Department and
also solemnly affirm that whatsoever stated in this affidavit is true and
correct. In case any information is repugnant to the above, I shall be
held responsible and shall accept whatever lawful action and legal
punishment in this regard for the consequences thereof.

Before the Executive Magistrate of Panvel...

AFFIDAVIT
I, MR. MANOJ BHASKAR TAPASE, Age ___ years, having
my original Address:- _______________________________________;
is shifted temporary / permanently for the business/service purpose at the
place having address as Flat No. B-12, Heramba C.H.S. Ltd., Plot No.
04, Sector- 15-A, New Panvel, Tal. Panvel, Dist. Raigad - 410206.
...2/-

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My work place is at following address namely Vandana Sanks
Pvt.Ltd., 33/37, Sector- 12, Kharghar, Tal. Panvel, Dist. Raigad, Navi
Mumbai.
My Mobile No. / Land Line No. / UID / E-Mail is as follows :9323078304.
I solemnly declare that contains stated above are true to my best
knowledge & belief. Anything is wrong or false in information if found
in future I know that my vehicle Registration/Driving License will be
canceled and prosecution under section __________ Indian Penal Code
will be launched against me for submitting false documents &
information before Government Servants.
I therefore pray that this Affidavit sworn in by me be accepted as
my temporary proof of address.
Solemnly affirmed at Panvel this 24th day of MAY, 2013.
DEPONENT
Before me.

Identified by me.
MR. MANOJ BHASKAR TAPASE
Name : ______________________
Address : ____________________
____________________________
Phone No. __________________