Form of application for the Grant for renewal of learner s license

Transcription

1 Form of application for the Grant for renewal of learner s license To The Licensing Authority I hereby apply for a license authorising me to drives as a learner the following motor vehicles. a) Motor cycle without gear b) Motor cycle with gear c) Valid carriage d) Light motor vehicle e) Medium goods vehicle f) Medium passer motor vehicle g) Heavy passengers motor vehicle h) Auto Rickshaw i) Road Roller Motor vehicle of the following description Particulars to be furnished by applicant 1. Name in Full :- 2. Son / wife / daughter of :- 3. Permanent address :- 4. Temporary address :- (Official address if any) 5. Date of Birth :- 6. Educational Qualification :- 7. Identification marks 1) 2) 8. Blood group R.H. Factor :- 9. I hold an effective driving license to drive a) Motor cycle / light motor vehicle med passenger motor vehicle / medium goods vehicle with effect from :- 10) Particulars of any driving license previously held by application in whether it was cancelled and if / do for what reason.

2 11. Particulars of any learner s licence previously held up applicant in respect of the description of vehicle to when the applicant has applied :- 12. Have you been disqualified for holding or obtaining driving licence of learner licence, if so, for what reason? 13. I enclose 5 copies of my recent photograph (photographs to be of size of five centimeters by six centimeters. 14. I enclose medical illness certificate dated issued by doctor :- 15. I have submitted a-long with my earlier application for Learner s Licence :- 16. I enclose the written consent of parent / guardian ( in case of applicant being a minor ) :- 17. I enclose driving certificate dated issued by a) Name and address of the driving School :- b) I have paid the fee of Rs :- 18. I am exempted from the Medical test under rule 6 of the Central Motor Vehicle rule 1989 :- 19. I am exempted from the preliminary test under rule 11(12) of Central Motor Vehicle rules : Strike out which ever is inapplicable : Date : (Sign of the Applicant) (Sign of the Applicant)

3 FORM 3 Licence No Dated Signature & Seal of the Licencing Authority 1. Name in Full :- : 2. Son / wife / daughter of :- : 3. Date of Birth : 4. Blood group R.H. Factor : 5. Present / Permanent address : 6. Identification marks : 1) 2) In Licence to drive throughout India as a Learner subject to the provision/s of Rules of the Central Motor Vehicles Rules, 1989, a Motor Vehicle of the following description. The holder of the Licence has passed the medic test under the rule and the preliminary test referred to in Rule 11(1) of the Central Motor Vehicles Rules, The holder of the Licence is exempted from the medic treat under Rule 6 and from preliminary test under 11(2) of the Central Motor Vehicles Rules, The Licence is valid from to * Strike out whichever is inapplicable Warning :- Signature & Designation of the Licensing Authority The attemtion of the holder of this Licence is draw to Rule 3 of the Central Motor Vehicles Rules, 1989 which prohibits from driving andy motr vehicles unless he has besides him a person duly Licenced to drive the vehicle and in every case, the vehicles carried (L) Plates both in the front and in the rear of the vehicle.

4 FORM 4 Form of application for the Grant for renewal of learner s license To The Licensing Authority Apply for a license to enable me to drive vehicle of the following description :- a) Motor cycle without gear b) Motor cycle with gear c) Valid carriage d) Light motor vehicle e) Medium goods vehicle f) Medium passer motor vehicle g) Heavy goods vehicle h) Road Roller i) Heavy Passenger motor vehicle j) Vehicle of the following description (Particulars to be furnished by the applicant) 1. Name in Full :- 2. Son / wife / daughter of :- 3. Permanent address :- 4. Temporary address :- (Official address if any) 5. Date of Birth :- 6. Educational Qualification :- 7. Identification marks 1) 2) 8. Blood group R.H. Factor :- 9. Particulars you held driven licence? If so, give details 10. Particulars and date of every conviction which has been ordered to be enclosed on any licence held by the applicant. 11. Have you been disqualified your obtaining licence to drive? If so for what reason 12. Have you been subjected to driving test into your fitness or ability to drive a vehicle in respect of which a licence to drive give is applied for? If so give the following details :- Date of Test Testing Authority Result of Test

5 13. I enclose three copies of my recent photographs of the size five cent. into six cent (where laminated card is used on phographs as enclosed). 14. I enclose the learner s licence to... Dt... issued by the Licencing Authority I enclose the driving certificate No... Dt... issued by I have submitted along with my application for learners licence along with my application for learners licence written consent of parent / guardian. 17. I have submitted along with the application for learner s licence enclose the medical certificate fitness certificate. 18. I am examined from the medical test under Rule 6 of the Central Vehicles Rules, I am exempted from preliminary test under rule 11(2) of the Central Vehicles Rules, I have paid the fee of Rupees... I declare to the best of my knowledge and the belief the particulars are given above are true. * strike out which ever is inapplicable. Certificate of test of competence drive Signature of the applicant Applicant has passed the test prescribed under the rule 15 of the Central Vehicles Rules, The test was conducted on (hereunder the registration and description on the vehicle). Date... Signature of the Testing Authority Full name & Designation Specimen signature of the applicant, strike out whichever is inapplicable 1)... 2)...

6 (To be filled in Block Letters or Typed) Name : S/D/W : Address : D/L Licence No Pl. & NPL. Dt. of Birth Paste the colour P/P size photograph in the space given below :- Signature... Signature... / For official use only / Licence No. W. B... T/ NT Date of issue... valid upto... Strike of which is not applicable Class of Vehicle a) M. cycle, b) M/ cycle without gear, c) LMV, d) MGV, e) MPMV, f) HGV, g) HPMV, h) Auto rickshaw, i) Cab, j) Road Roller Others Rs... for new DL / Renew Vide DCR No... Dated... Lic. No. WB... Rs... received for issue of laminated driving licence Receipt No... Dated...