APPLICATION FORM FOR CARS/TWO WHEELERS

1. IRLA/F.No. _______________________________________
Rank & Name _______________________________________
Unit/formation _______________________________________
Identity Card No. _______________________________________
Basic Pay Rs. _______________________________________
PAN/GIR No. _______________________________________

2. Present Address of the _______________________________________

Applicant _______________________________________

3. Permanent Address of the _______________________________________

Applicant _______________________________________
_______________________________________

4. Name & Full address of _______________________________________

Demand generating Canteen _______________________________________
_______________________________________

5. Model No. _______________________________________

Colour _______________________________________

6. Name of Dealer with Full Address):- ______________________________________

______________________________________
_______________________________________

7. Mode of payment with BD No.& _______________________________________

Date.
8. I affirm that the above details, as submitted, are correct .

Place __________________________
Date __________________________ Signature of the Applicant

It is certified that the information/particulars/details given by the applicant are

verified/scrutinized and found correct.

Countersigned by Commandant/
DIG/IG(with stamp)
Rank
Name

Counter signature of I/C Master Canteen

With TIN No. and round rubber stamp

Note: If PAN No. is not available, declaration in Form-16 should be furnished as per IT Rules.
 UNDERTAKING CERTIFICATE
(To be submitted by the customer)

I, Regt. Number/IRLA No.___________________ Rank____________

Name_____________________________________________ undertake that I have

not purchased any four wheeler vehicle through CPC either in the name of myself or

any member of my family during last 4 years/or have purchased the vehicle through

Central Police Canteen in the year……………..vide Vehicle invoice no………dated

…………..which have now completed more than 04 years. I shall not sell this vehicle

to any person/firm before 2 years from the date of purchase. Beside I also give

undertaking that I will submit copy of registration of vehicle to Master Canteen and

Central Office CPC New Delhi within two months of purchase of vehicle.

Signature of the individual

Force No./IRLA No.____________
Place :_________ Rank_________Name__________
Dated :__________ Unit/Office____________________

Countersigned by Head of Office/officer(Duly stamped)