Page 874 - The Central Motor Vehicles Rules, 1989

846 MOTOR VEHICLES (REGISTRATION.....FACILITY) RULES, 2021 FORM-4

7. I, ........................................................ DESIGNATION ......................................................
hereby certify that the data submitted above is a true and accurate reflection of the
activities of the company for the financial year 2021-202........
Signature COMPANY
Place SEAL
DATE

FORM-4
[Refer rule 11(1)]
CERTIFICATE OF VEHICLE SCRAPPING
1. CERTIFICATE NUMBER:
2. DATE:

3. This is to certify that the Final Disposal of the Vehicle held on Deposit with us
vide our Certificate of Deposit No. ................................... Dated ........................ has
undergone Treatment according to the Annexure I of CMVR.

4. VEHICLES DETAILS
a Registration Number
b Make
c Model
d Month/Year of Manufacture MM YY
e Chassis Number Picture of cut out piece showing its number
f Engine Number Picture of Engine showing its number
5. OWNER DETAILS
a Name
b ID Proof Details
c Address
d Address Proof Details submitted
6. View foregoing it is requested that the records in respect of above-mentioned
vehicle may be updated.

Date: Authorized Signatory
Company Seal
Date