ANNEXURE X
MORMUGAO MUNICIPAL COUNCIL
Application form for Requisition of
Hearse Van cum Ambulance Vehicle.
From : .......................................... .......................................... .......................................... To, Date : .......................................... The Chief Officer,
Mormugao Municipal Council,
Vasco-da-Gama.Sub : Request for the use of
Hearse Van cum Ambulance Vehicle.
Sir, You are requested to provide your Hearse Van cum Ambulance Vehicle for transportation of
dead body/patient from .................................. to ........................................ Necessary charges will
be paid by the undersigned as per existing Rules of the Council. The particulars are given below :1. Name & Address of
the person to be transported: .......................................................................................... 2. Date & Time : .......................................................................................... 3. Place of transportation : .......................................................................................... 4. Destinatio : .......................................................................................... 5. Purpose for which required : .......................................................................................... Thanking you, Yours faithfully ( )