The land of the Dancing Deer

 


BACK

FORM –4
(Rule No. 14)
FORM OF APPLICATION FOR LICENCE TO DRIVE MOTOR VEHICLES

To,

The Licensing Authority

 

             I apply for License to enable me to drive Vehicles of the following description:-

1. Motor Cycle without gear and with gear
2. Light Motor Vehicles
3. Auto Rickshaw
4. Medium goods Vehicles
5. Tractor
6. Heavy Transport Vehicles
    Motor Vehicle of the following description :-


PARTICULARS

1.Name :- ……………………………………………………………….

2. Father/Mother/Daughter/Wife of :- …………………………………..

3. Address :- …………………………………………………………….

4. Official/Temporary address :- ………………………………………..

5. Date of Birth (Proof certificate) :……………………………………..

6. Education qualification :- ……………………………………………

7. Identification Marks :- ……………………………………………….

8. Blood group and RH factor :- …………………………………..

9. Have you previously held driving license? If so give details :-

10. Particulars and date of every connection which has been ordered to be endorsement on any License held by the
     applicant.

11. Have you been disqualified for obtaining a License to drive? If so for what reason ........................................................ 

12. Have you been subjected to a driving test as to your fitness or ability to drive a vehicles in respect of which a license to 
     drive applied for? If so give the following details :-

DATE OF TEST                       TESTING AUTHORITY                                     RESULT OF TEST

1.

2.

13.  I enclose three of my recent photograph of the size five centimeters into six centimeters.

14.  I enclosed the learner’s License No. ………………….. date ………………
       issued by Licensing Authority.

15. I have enclosed the driving certificate No. ……………………. date ……………… Issued by     ………………………………………….

16. I have submitted along with my application for learner’s license the written consent of parents/guardians.

17. I have submitted along with the application for learner’s license. I enclosed the Medical fitness Certificate.

18. I have paid the fee of Rupees ………………………………………..

  I declared hereby that the best of my knowledge and belief that the particulars given above are true.

  Notes :- Strike out whichever is inapplicable.



Date :- …………………
                                                                                       Signature/Thump impression of the applicant.





                                                 Certificate of test of circumstances to drive

The applicant has passed, the Test prescribed under Rule 15 of the Central Motor Vehicles Act/Rules, 1989. The test was conducted on (here the registration Mark and description of the Vehicle) ………………….

The applicant has passed in the test.

(The details of the deficiency to be listed out)


Date :- ………………………                                  Signature of Testing Authority

                                                                                  Full name and Designation.

                                                                                  Two specimen signature of applicant


Strike out whichever is inapplicable.