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GATIDHARASCHEME

Application Form (Annexure -I) for Subsidy under the

Schcmc (2 sets)

Family Income Certificate (Annexure -II) (Xerox Copy - 2 sets)

Self-declaration (Annexure IiI) (Xerox Copy - 2 se ts)

Application Form for permit (Goods carriage, Stage Carriage,

Contract Carriage) - (1 set)

5. Proof of enrolment in Employment Bank (Xerox Copy - 2 sets)

1.

2.

aJ.

4.

'7

B.

6. Photocopy ofproof of age" (X.ro* Copy - 2 sets)

Photocopy of proof of address. (Xerox Copy -'2 sets)

Identityproof (Xerox Copy - 2 sets)

Photocopy ofproof of Bank A/C (Xerox Copy'- 2 sets)

Coloured passport size photograph (6 copies)

11. Quotatiol fo. vehicle issued by Gatidhara Facilitator

9.

10.

\I

('t

rrtffiulmri:;w zmtmtdi m

Annexure - I(Reference Transport Department Resolution No 400r-wT /3M-15/2015

Dated: Kolkata, the 2nd November,2Ol5)

1.

2.

3.

4.

5.

6.

7.

8.

q

10.

11.

12.

Government of 'West Bengal

Transport Department

Application Form for GATIDHARA

(To be submitted in duplicate)

Yes/No.

Photo to be

pasted and

Self Attested

Yes/No.

P.T.O.

Telephone No.

e-mail (if any)

Date of Birth and Age (Proof to be attached)

Educational Qualifi cation

Enrolment No. in Employment Bank

with Date (Proof of enrolment to be attached)

Community/Sub-caste/Sub-tribe/OBC/PH

(Certificate ro be attached)

Family Income (Certificate to be attached)

") (i) Whether received any Self-Employment

loan under the Central/State/Quasi Govt.

(il) Ifyes the loan has been fully repaid

t

(2)

b) Whether received assistance from

YUVASREE scheme, if ves with effect frorn

13. Bank Account details

14. Type ofVehicle/Type of Pennit

15. Name & Address of the proposed

Dealer-cum-Gatidhara-Facilitator

16. Name & Address of the proposed Financer, if anv

17. Project Cost

18. Subsidy Amount (30% of Pro;ect Cost or

Rs. 1,00,000/-, u,hichever is n-rinimum)

19. Driving License Number and Validiw, if anv

I declare that the information given are true and correct to my knou.ledge and belief.

Date: (Full Signature of Applicant)

Annexure - II(Reference Transport Department Resolution No 400 I -If/T I 3M- | 5 / 20 I 5

Dated: Kolkata, the 2nd November, 2015)

(Income ofthe family to be su

(Name)

Date: (Signature rvith Seal)

Certified that the average monthly family income in respect of Shri/Shrimati

who will apply for financial assistance under the GATIDHARA Scheme in the financial year ending on

31st March, ...... (Year of application) is Rs. (Rupees

..)only.

Certified that Sri/Srimati is still unemployed.

2.

Annexure - III(Reference Transport Department Resolution No 4001-IfT l3M-1512015

Dated: Kolkata, the ZndNovember, 20 l5)

(Proforma of the self-declaration to be submitted by the applicant applying for

subsidy under GATIDHARA Scheme)

I, Shri/Shrimati.......'......,.'. """", Son/daughter/wife of

1.

for sanctioning or

5. I shall abide by the terms and conditions of the agreemenr ll,ith the financer, lr'ho agreed to sanction the loan

6.

from ........... (Bank/Financial instirute) and the last date of repayment of che

installment of the said loan was ... (date).

I am still unemployed.

The starements made in rhe foregoing paragraphs hereof are true to my best of knou,'ledge

4.

7.

8.

Date:

Place: Applicant

To

Form - I[See rule 123 of the'S7'est Bengal Motor Vehicles Rutes. I 989]

Application for a permit in respect of a Stage Carriage

The Regional/State Transport Authoriry

The rype ofvehicle

Approximate seating capacity: Not less than ............ and nor more rhan ... seats.

In accordance with the provisions of sections 69,70 and 80 of the Mocor Vehicles Act, 1988. I/we,the undersigned, hereby apply for a permit under section 66 of that Act in respect of a Srage Carriage as

hereinunder set out:

2. Name of father or husband (in rhe case of an individual)

^ r ll

3A. lMhether the applicant is a Co-operative Society, and if so, state registration particulars erc................

4. The route or routes or the area for which the

5.

6.

B.

9

A time-table................... is appended.

7. will be arranged wich other operators on the route.

No time-table is proposed but l/we undertake ro run the following minimum service:

t

The standard rate of fare which is proposed to charge is ............... paise per passenger per kilomerre.

Particulars of any Stage Carriage, Contract Carriage or Goods Carriage Permit, valid in -Vest Bengal,

or in any other States in India and held by rhe applicant in respect of -a) this vehicle

b) any other vehicles .................

10. Particulars of anypermit held by the applicant in respect of the use of any transporr vehicle in Indiaduring the last four years which has been the subject of an order of suspension or cancellation.

lOA.Particulars ofvehicle/vehicles owned by the applicant or in his control for which permit is sought.

l0B. Arrangement for garage made in respect of such vehicle/vehicles (Rule 193). p.T.o.

l2)

11. i) I/\7e desire ro use the vehicle for rhe carriage of goods as a Goods Carriage and I/We apply for

a Goods Carriage Permit in addition ro a Stage Carriage Permit in respect of the route, routes or

area above specified.

ii) I/We intend to carry goods of the following description

IZ. I/\(e desire to use the vehicle as a Contract Carriage within the area specified below

13. I am/We are in possession of rhe vehicle, the certificate of registration of which is enclosed.

I/We have nor ye r obtained possession of the vehicle and I/r,ve understand that the permit wili not be

issued uncil l/we have done so and have produced the certificate of registration.

14. I/-Ve intend to drive the vehicle.

15. I/\7e desire a permit valid for """"""""""" vears'

1 5A. I/\7e enclose cash/challan/' [.**] for Rs....'..."

16. I/\7e hereby declare that the above statements are true and agree that they shall be conditions of an-v

permit issued to me/us.

Date ........... .............20 Signature or thumb impression of applicant

To bef.lted in the ffice of tbe Transport Authoritv

1. Date of receipt:

1A. Amount of Rs......... received, uide receiptnumber "" dated ""/'[*-*]challandated....'......................./DCRNumber"""""""""' anddate

2. Date oFpublication :

3. Date or dates of hearing of objections :

4. Granted/Granted in modified form/Ref ected on the .............. day of '............'....'......20........

5. Number ofpermits issued:

t

Secretary

Transport Authority

* Strike out inapplicable entries or alternatives throughout'

Here srare *h.ih.. single or double deck, fixed roof or hood only, glass',vindor'v or side curtains.

N.B. Verification sheet as appended to these rules shall be dulv filled in and submitted along u'ith the application

for env kind of permir.

1. Certain r,vords omitted bv Notification No. 5305-WT l6M'Zl/2002, dated 12.12'2003.

To

Form - II[See rule lZ3 of the\7est Bengal MotorVehicies Rules. 1989]

Application for a permit in respect of a particular

Contract Carrage to be regularly so used

The Regional/State Transport Authoriry

In accordance with the provisions of secrions 69, 73 and 80 of the MotorVehicles Act, 1988. I/we,

the undersigned, hereby apply for a permit under section 66 of that Act in resPect of a Contract Carriage

as hereinunder set out:

L Full Name

2. Name of father or husband (in the case of an individual)

J.

34. \Thether the applicant is a Co-operative Society, and if so, state registration particulars etc.......'....""

6. Approximate seating capacity: Not less than ............ and noc more than "' seats'

7. Particulars of service to be performed by the Contract Carriage (not necessary in case of a motor

cab), and rhe manner in which it is claimed that che public convenience u'ill be served:

Particulars of any Stage Carriage or Contracc Carriage Permit, valid in this State or in any other

States and held by the applicant in respect of :

a) this vehicle:

b) any other vehicles: ................

particulars ofvehicle/vehicles orvned or under the control of the applicant for which permic is sought.

Arrangement for garage made in respect of such vehicle/vehicles (Rule 193).

P.'t.o.

84.

88.

t2l

9. Particulars of anypermit held by the applicant in respecr of the use of any rransport vehicle in Indiaduring the last four years, which has been the subject of an order of suspension or cancelladon.

10. I am/I7e are in possession of the vehicle, the certificate of regisrration of which is enclosed. I/\il7'e

have not yet obtained possession of the vehicle and I/we understand that the permit will not be

issued until I/we have done so and have produced the certificate of registration ................

11. I/We intend to drive the vehicle.

12. I/'V7'e desire a permit valid for ..................... years.

lZAJlWe enclose cash/challan/'[***] DCR No.... .. date ....... for Rs........................

being the prescribed fee.

13. I/'V7'e hereby declare that the above statements are true and agree that they shall be conditions of any

permit issued to me/us.

Date ........... .............20 Signature or thumb impression of applicant

" Note: Here state whether single or double deck, fr-xed roof or hood only, glass windows or ride curtains.

To beflled in the ffice of tbe Transport Authoritlt

1. Date of receipt :

1A. Amounr of Rs......... received, uide receiptnumber .... dated ..../t[.-*]challan dared .......... ..................1DCR Number ................... and dared

2. Date of Circulation to members/consideration ar meeting/decision by Chairman ..................

3. Granted/Granted in modified form/Rejected on the ............... day of .........................20........

4. Number ofpermit....

Secretary

Transport Authority

* Strike out inapplicable alternatives throughout.

-AL8. Verification sheet as appended to these rules shall be duly filled ln and submitted along with the applicationFor any kind ofpermir.

1. CertainwordsomittedbyNotificationNo. S305-WTl6M-2112002.dated12.12.2003.

To

Form - III[See rule 123 of the\flest Bengal Motor Vehicles Rules. 1 989]

Application in respect of Goods Carriage Permit

The Regional/State Transport Authority

In accordance with the provisions of sections 69,76 and 80 of the Motor Vehicles Act, 1988.

I/we, the undersigned, hereby apply for a Goods Carriage Permit under section 66 of that Act, as

hereinunder set our:

2. Name of father or husband (in the case of an individual)..............:;.........

S[hether the applicant is a Co-operative Society, and if so, state registration particulars etc................

3.

34.

4.

5.

The route or routes or the area for which the permit is desired

Type and capacity of vehicles including trailer and alternative trailers of articulated vehicle.

Irlotes: (1)If any of the vehicles are nor in the possession of the applicant it r.r,ill suffice if the figures in columns3 and

4 are correct within ren percenr, above or below, subject to any limitation ofrveight in force. The certificates

of registration musr be presented to the Transport Authority so that the registration marks may be entered

in the permit before the permit is issued.

(2) If the appiication is in respect of a large number of vehicles than can be specified above, an additional

schedule may be appended to the Form.

5,\. Parriculars ofvehicle/vehicles owned or under the control of the applicant for which permit is sought.

58. Arrangement for garage made in respect of such vehicle/vehicles (Rule 193).

6. Particulars of the service to be performed by the vehicle and the manner in which it is ciaimed that

the public convenience will be served..........

7. Particulars of any Goods Carriage Permit valid in che State and held by the applicant at present or

at any time during the last rwo years and of the maximum and minimum rates charged for the carriage

ofgoods thereunder -llVote : If the particulars are extensive, append further statement.l

P.T.O.

No. ofVehicles

Typ. Load capacity

Kg.

Laden weight

Kg.

Registration

marks

l2)

Particulars of any Goods Carriage Permir valid in India held by the applicant rvhich has been the

subject of any order of suspension or cancellation............'..

Particulars, other than particulars furnished under item 7, or any agreement or arrangement, affecting

in any marerial respecr the provision u,ithin the region of the Regional Transport Authority of

facilities for the rransport of goods for hire or rev,ard, entered into by the applicant with any other

person by whom such facilities are provided whether within or outside the region:

9A. Arrangements made or intended to be made for the housing of the vehicles

98. Arrangements made or incended to be rnade for the storage and safe custody of goods to be carried

10. i) I/We desire ro use the vehicle or vehicles as a Goods Carriage for the carriage of goods which are

my/our o\\rn property or the carriage of which is incidental to my/our business of '........'.............."

ii) The goods which I/we desire to carry in the Goods Carriage are:

1 1. I/\Me forward herewith rhe certificates of regiscration of the vehicles, or I/we will produce the

certificates of registration of rhe vehicles before the permit is issued.

12. I/We desire a permit valid fbr ..................... years.

12A.I/We enclose cash/1[***]/challan for Rs.......... being the prescribed fee:

13. i/\Me hereby declare that the above sratements are true and agree that thev shall be conditions of anv

permit issued to me/us.

Date ........... .............20 Signature or thumb impression of applicant(s)

* Strikeoutinapplicable entries/alternatives throughout.

1L-8. Verification sheet as appended to these rules shall be duly filled in and submitted along with the application

for any kind of permit.

8.

g