Printed Name: _________________________________ Name: _________________________________ Signature: ________________________
Printed Name: _________________________________ ________________________ Date: __________
__________________ Issuing State/Country: _________ 2. SOURCE/VEHICLE OWNER INFORMATION Full Name / Company: ________________________________________ acknowledgement receipt for motor vehicle pdf
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Date: ____________________
__________________ Email: ___________________ 3. VEHICLE DETAILS | Field | Details | |-------|---------| | Make / Brand | _________________________ | | Model | _________________________ | | Year of Manufacture | _________________________ | | Color | _________________________ | | Vehicle Identification Number (VIN) / Chassis No. | _________________________ | | Engine No. | _________________________ | | License Plate No. | _________________________ | | Odometer Reading (km/miles) | _________________________ | | Fuel Level (approx.) | □ Full □ ¾ □ ½ □ ¼ □ Low | 4. PURPOSE OF RECEIPT (Check one) □ Sale / Transfer of ownership □ Loan / Borrowing □ Rental / Lease □ Repair / Servicing □ Return of vehicle after use □ Other (specify): _________________________ 5. ACKNOWLEDGEMENT I/We, the undersigned, hereby acknowledge receipt of the above-described motor vehicle from the Owner / Authorized Representative stated in Section 2 .
__________________________________________________ | _________________________ | | Engine No
ACK-MV-______________ 1. RECIPIENT INFORMATION (The party acknowledging receipt) Full Name: ________________________________________________
__________________ Email: ___________________ PURPOSE OF RECEIPT (Check one) □ Sale /