| . | .. | FORM - 2
[See rule 10] Form of application for the grant or renewal of Learner’s
Licence To The Licensing Authority ……………………….. ………………………..
I hereby apply for a licence authorizing me to drive as alearner, the following motor vehicle(s): (a) Motor cycle without gear (b) Motor cycle with gear (c) Invalid carriage (d) Light motor vehicle (e) Medium goods vehicle (f) Medium passengers motor vehicle (g) Heavy goods vehicle (h) Heavy passenger motor vehicle (i) Road roller Motor vehicle of the following description………………………………………………………… -------------------------------------------------------- Particulars to be
furnished by Applicant 1. Full Name 2. Son/Wife/Daughter of 3. Permanent address Proof to be enclosed 4. Temporary address Official address (if any) 5. Date of birth (proof of age to be enclosed ) 6. Educational qualification 7. Identification mark(s) (1) (2) 8. Blood group ………………………………………………… RH factor ………………………………………………… 9. I hold an effective driving licence to drive (a) Motor cycle/light motor vehicle/medium passenger motor vehicle/medium goods vehicle with effect from……………… 10. Particulars of any driving licence previously held by applicant. Whether it was cancelled?…..………………… And if so, for what reason; 11. Particulars of any learners licence previously held by applicant in respect of the description of vehicle to which the applicant has applied ………………... 12. Have you been disqualified for holding or btaining driving licence or learner’s licence? ……………………….. If so, for what reasons 13. I enclose 3 copies of my recent photograph (Photograph to be of the size of five centi-meters by six centimeters) 14. I enclose medical fitness certificate dated……………..issued by (Doctor)……………………. 15. I have submitted along with my earlier application for Learner’s Licence/I enclose the written consent of parent/guardian (in case of applicant being a minor) 16. I enclose driving certificate dated………..…issued by…………………………………….( Name and address of the driving school) 17. I have paid the fee of Rs…………………………………. 18. I am exempted from the Medical Test under rule 6 of Central Motor Vehicles Rules, 1989. 19. I am exempted from the preliminary Test under Rule 11(2) of Central Motor Vehicles Rules, 1989. * Strike out whichever is inapplicable.
Date:
Signature of applicant
Duplicate signature of applicant Declaration under
sub-section (2) of Section 7 of the Motor Vehicle Act, 1988. Shri/kumari ………………………………Son/daughter of ……………………………………. Who is a minor is under my care and I accept responsibility for his/her driving. If at a later date I decide not to accept responsibility for his/her driving shall intimate the licensing authority in writing for the cancellation of the licence. I give my consent for his/her obtaining learner’s licence.
Signature …………………………..
Name and full address of the
Parent/guardian.
Relationship ……………………… (To be signed in the presence of the licencing Authority or person authorised in this behalf by the Licencing Authority ) For Office Use*The applicant is exempted from the medical test under rule 6 and the preliminary test under rule 11(2) of Central Motor Vehicle Rules,1989. Learner’s Licence may be issued : The applicant was tested with reference to rule 11(1) of the Central motor vehicles rules,1989. He has passed the test. Learner’s Licence may be issued. *He has failed in the test.(Reasons should be specified) Learner’s licence may be refused.
Signature of Licencing Authority
or Other person authorised in this behalf. *Strike out whichever is inapplicable. ~~*~~ |
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