MVLIC (2012/03) APPLICATION FOR LICENSING OF A MOTOR VEHICLE

REPUBLIC OF ZIMBABWE

Note: If any detail provided does not coincide with detail as per the registration book, application form CVR04 Application/Notification Vehicle Registration should be completed as required by the Vehicle Registration and Licensing Act. PART A - VEHICLE PARTICULARS Licence type Renew X
X

New

Duplicate licence disc Vintage Vehicle Twelve (12) month validity

Special licence type None Licence frequency

Exempt from licensing

Four (4) month validity

X 1 6

Six (6) month validity

Registration number A Tax class (in net mass)

3
Heavy vehicle (4601 to 9000kg) Heavy vehicle (> 9001kg) Trailer small (1 to 500 kg)

Heavy vehicle (2301 to 4600kg)

Light vehicle (1 to 2300kg) X Motor bikes, Tractors

Trailer big (> 501 kg)

Registration book number Vehicle make Vehicle model Net mass (kg) Chassis no./VIN Vehicle usage
M E E 3

2
R 2

5
C 0

3
E

1
D

6
E

4
S B E N Z

1
A

4
D

5
B

0
2 1 0 0 3 7 6 A 2 9 3 7 1 4

Business

Diplomatic

Private X

Public service vehicle Year

Current licence expiry date Day

1 Month

Y
X

PART B - OWNER PARTICULARS Type of identification: National identification (natural person) Identification/Business registration number Surname/Name of organisation S First name Person initials Contact number
Permanent address

Business registration certificate (organisation)

0
A

8
R

T I M

U A

F
0

S
7 1 2 6 0 5 2 1 9

1 C

1 I
O
A

4 R
R
R

7 C
R
A

L
O
R

E
W
E

L
D A

A
L

N
E

Suburb City

B
H

Tick if postal address is the same as permanent address Postal address

Suburb City PART C- DECLARATION BY THE OWNER I, the owner declare that all the particulars furnished by me in this form are true and correct and realise that a false declaration is a criminal offence. Signed at:

Signature

Date:

PART D- DOCUMENTS REQUIRED The following documents are required for the application of a new vehicle licence disc or the renewal of a vehicle licence 1. Fully completed Application for Licensing of a Motor Vehicle form (MVLIC) X 2. Original Registration book 3. Original Insurance Cover note 4. Copy of the Registration book (front and back) 5. Copy of the Insurance Cover note

X
X X X

In addition to the above, the following document is required for the re-issue of a duplicate licence disc 6. Licence receipt