Document Sample

To                             Passport size
IHQ MoD (Army)                 photograph of Pass           Application No.------------
MGO’s Branch (OS-4H)           applicant to be              MGO’s Br Regn No.---------
New Delhi -110 011             affixed and to be
                               attested by Secy             DGR Regn No. ---------------
                               RSB/ZSB/OC UNIT


Please release in my favour one ______________________________________________
(Indicate nomenclature of vehicle) Class VB from Ordnance/Vehicle Depot __________
__________________(Indicate name of Depot)
My service particulars are as under : Service No ________________________________
Rank _______________________________Name_______________________________
Father’s Name _______________________House No. ___________________________
Village _____________________________ Distt _______________________________
State ________________Pin code __________ Last Unit served____________________
Tele No. (Landline)____________ Mob No. _________________E-mail ID__________
Record Office ________________________ Date of Birth ________________Date of
enrolment _____________________Date of discharge ____________ ______Character
at the time of discharge ______________________________________
Ground of discharge _______________________________________________________
Name of Widow __________________________________________________________
Date of death of Husband ________________________ Age of applicant ____________
Disability percentage if any _________________________________________________
Identification marks _______________________________________________________
DGR/ZSB Employment registration No. _______________________________________
Employed at ______________________________________________Sources of Income
If any i.e. Business Rs _____________________Farming Rs. ___________________
Re-employed salary Rs ____________________Pension Rs ____________________
Total Rs. _______________________________
Purpose for which required _________________________________________________
How the cost of the vehicle will be financed _____________________________
Details of security deposit Viz : Name of Bank________ ______________ Bank Draft
No. and Date ________________________________ Amount Rs __________________
Declaration of affidavit on non judicial stamp paper is enclosed in triplicate, as desired

                                                            Yours faithfully,

Place : ___________

Date : ___________

    I, Service No. ____________ Rank ___________ Name ________________ son of
______________ resident of __________________________ do hereby solemnly affirm and declare
as under:-

1. That I am a bonafide ex-serviceman having served with the Army/Navy/Air Force from
_________ to __________which forms a part of the defence forces of the country. Now I have
physically retired from defence forces of the country w.e.f _________. A CTC of retirement
order/discharge certificate is attached.

2. That I am eligible for allotment of a surplus vehicle for my personal use and for the betterment of
my economic condition.

3. That I have neither applied nor already been allotted a vehicle from the Defence surplus stock
(An allotment order issued earlier but vehicle not collected on that release order is attached herewith
in original).

4. That I am not a member of any Ex-Servicemen Co-operative Society and that necessary financial
resources are available with me to purchase the vehicle on allotment.

5. That I am neither re-employed in Armed Forces/BSF/NCC, nor serving in a civilian capacity under
any State/Central Govt. or Public Sector Undertaking. I further depose that I have not availed of any
such scheme by any other State/Central Govt/Public Sector Undertaking.

6. That the vehicle will be registered in my name within six months of allotment and that vehicle will
NOT be mortgaged/resold within one year from the date of its purchase. In case it is decided to resell
the vehicle after one year, it will not be sold without verifying the antecedents of the person to whom it
is sold. In case the vehicle is sold without due diligence/verification of the buyer, I shall be held
personally responsible for any consequences which may happen, like misuse of the vehicle for anti-
national activities by terrorists or by anti social elements.

7. In the event of non-registration of the allotted vehicle with the local/concerned RTO within six
months from the date of issue, the amount of security deposit, deposited by me will be forfeited to the
Government of India.

8. That I will immediately get the vehicle re-painted with other than Defence services colour and
remove all military markings/tactical numbers before registration.

9. That in the event of any of above facts given in this affidavit being proved false, and for violation
of any of these provisions I hold myself responsible for all the consequences, besides being debarred
for allotment of a vehicle out of Army Surplus Quota. (ASQ). I also understand that I may also be
liable for action under Regulations 4 and 5 of the Pension Regulations for the Army, 1961 (Part I)
relating to withholding , suspension or discontinuation of the pension.

10. FOR WIDOWS ONLY (Death certificate & affidavit for her spouse be attached). That my late
husband (here indicate number, rank and name of unit of Armed Forces) has not been allotted any
vehicle from Defence surplus stock in the past.


Verified at ___________ this _____________ day of ____________year _________20___ that the
above affidavit given by me is true to the best of my knowledge and belief, and nothing has been
concealed therein.

Three Specimen signatures 1.______________ 2._______________ 3.________________


Certified that the above was declared on Oath before me, by the Deponent and who is personally
known to me/identified by Sh/Smt ____________s/d of ______________, resident of ____________

(FULL NAME & ADDRESS WITH SEAL)                                         COURT SEAL