F O R M – II

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(See Rule 5 (i)  (13)

APPLICATION FOR THE CONDUCTOR’S  LICENCE

To

            The licensing authority.--------------------------

I, Sri -----------------------------------------------Son of Sri --------------------------------

(Present address)-------------------------------------- and (Permanet address)--------------------

hereby apply for the grtant of conductor’s licence.

2.         I possess Audit First –Aid Ceertificate No.-------------------- issued by the St.John Ambulance Association  (India ------------------ branch valid till---------------- and attach the same herewith.

3.         I have the following convictions:

            ----------------------------------------

            ( No convictions)

---------------------------------------------    --------------------------------------

4.         I have -------------------- previously held a conductors licence issued

By ----------------which was revoked for the following reasons.

-----------------------------------

5.         I am not  disqualified for holding a conductors Licence.

6.         Particulars of orders of disqualifications and endorsement in respect of my previous licence,if any given below.

7.         I attach a medical certificate and two copies of recent photograph of myself.

8.         I hereby declare that  I am not less than 18 years of age.

9.         I further declare that I have passed Matriculation examination ----------- and enclose herewith a copy of the Matriculation Certificate.

10.       I further declare that the above statements are correct.

Date.-----------------                                                   Signature of applicant.

                                                            Duplicate signature of the applicant.

Schedule   IV--- Form No.-61

CONDUCTOR'S LICENCE

Conductor's Licence No.-------------------

Name ---------------------------------

Son of --------------------------------

Present Address----------------------

Permanet Address.--------------------------

             Space for Photograph                                               Space for pasting duplicate

                                                                                    Signature of applicant Form L.Con

Is licensed as a conductor and has been issued conductor's badge No.-------- the licence is valid from --------------- to --------

The------------------- 2000.                                                     Signature of the Licencing Authority.

The licence is hereby renewed up to the----------------- day of -----------2000.

                                                                                    Signature of the licencing Authority.

The licence is hereby renewed up to the-------------- day------------of  2000.

                                                                                    Signarture of the Licencing Authority.

FORM;      V 

( See Rule 6 (i) (160)

FORM OF APPLICATION FOR THE RENEWAL OF CONDUCTOR'S LICENCE

To

                        The Licencing Authority

                        -----------------------------

I ,Sri--------------------------- Son of --------------------------------

9Present  Address)___________________ and (Permanet address)__________________________

Hereby apply for a renewal of conductor licence No.______________________ which was issued to me on the ______________of ____________2000 by the Licencing Authority ____________________________

The licence is due to/has expired on________________________________

2.I attach herewith the conductor's licence issued to me _______________

3.I hereby declare that I am not subject to any disease disability that is likely to hamper me in performance of my duties as a conductor of stage carriage and that I am not disqualified for holding a conductor's licence.

Date___________                                            Signature.

FORM    III 

 (See Rule 5 (I)

MEDICAL   CERTIFICATE  FOR CONDUCTOR

(To be filled by a Registered Medical Practioner )

1.                   Name of the person examined.________________________

2.                   Father's name _____________________________________

3.                   Applicant's present age ________- Year __________-months ______________-days_______as on __________

4.                   Is the applicant to the best of you judgement subject to  epilepsy vertigo or any mental adment likely to effect his efficiency  ?

5.                   Does the applicant suffer from any heart or lang disorder which might interfere with the performance of his duties as a conductor  ?

6.                   Does the applicant suffer from any degree of deafnces ?If so would the deafnesd impede easy converse with passengers ?

7.                   Has the applicant any deformity of less of memory which would interfere with the efficient performance of his duties as a conductor ?

8.                   Does he show any evidence of being addicted to the excessive use of alcohol, tabacco or drugs ?

9.                   Is he in your opinion, generally fit as regards bodily health and eye sight.

10.               Marks of identification ________________

Signature of the person examined/.

            I certify that the person examined has affixed his signature hereto in my presence and that to the best of my knowledge and belief the above statements are true and the photograph attached is a reasonable/correct licence of the person desired.

Space for photograph                                                    Signature____________________

                                                                                      Name ______________________

                                                                                      Designation__________________

Dated.____________________

Place.____________________

(Registered Medical Practioner shall also sign on the photograph ,which shall be firmly affixed and not loosely pinned to the form in a manner that a part of his signature will be on the form)

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