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High Security Registration Plates (HSRP)

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					 HSRP Application Form


                                                                                                                       Celex Technologies Pvt. Ltd.
    Date :                                                                                                Email : info@celex.co.in, website: www.celex.co.in




    Regd. No.: ...............................................................Make & Model..................................................................

    Engine Number:...................................................................Chassis Number..................................................




    Owner’s Name: ...............................................................................................................................................

    Contact Person (In case owner is a company): ..............................................................................................

    Address:...........................................................................................................................................................

    PIN:........................................ City:.....................................................State: ..............................................

    Tel (R) .......................................... Tel (O) ......................................... Mobile ..................................................

    Email ID: .........................................................................................................................................................




    Size of HSRP: (Please Tick)

    Front              285X45 mm                             200X100 mm                           500X120 mm                         340X200 mm

               Shapes



    Rear               285X45 mm                             200X100 mm                           500X120 mm                         340X200 mm

                                                                                                          This above informations are true and correct to the
                                                                                                                        best of my knowledge.




Dealer/Agent’s Name:                                                                                     Signature of Owner/Owner’s Authorised person

For office use only,
Not to be filled by the Applicant
                                                                                                        Estimated date of Fitment:................................




                    ___________________                                       _________________                              _______________
                    Customer Reference No                                     Operator Signature                             Cashier Signature

				
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posted:10/9/2012
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