Fillable Printable Form of Application for License to Drive a Motor Vehicle

Form of Application for License to Drive a Motor Vehicle

FORM 4

[See Rule 1

FORM OF APPLICATION FOR LICENCE TO DRIVE A MOTOR VEHICLE

To,

T HE LICENSING AUTHORITY,

……………………………………..

I apply for a licence to enable me to enable me to drive vehicles

Of the following descrip tion:-

Passport

(a) Motor Cycle without gear. Size photograph

(b) Motor Cycle with gear. Of the

(d) Light Motor Vehicle

(e) Medium Goods Vehicle

(f) Me dium P assenger Motor Vehic l e

(g) Heavy Goods Vehicle

(h) Heavy Passenger Motor Vehicle

(i) Road Roller

Q ) Moto r Vehicle of the follo wing description

____________________________________________________________________________________________

Part iculars to be furnished by the a pplicant

1. Full name ………………………………………………………

2. Son/ wife/ daughter of ……………………………………………………….

3. Permanent address (Proo f to be enclosed) ……………………………………………………….

4. Temporary address/ Official addr ess (if any) ……………………………………………………….

5. Date of birth (Proof to be enclosed) ……………………………………………………….

6. Educational qualification ………………………………………………………..

7. Identification mark (1)……………………………………………………

(2)…………………………………………………….

8. Blood Group with Rh factor (optional ) ………………………………………………………..

9. Have you previously held d riving licence? ………………………………………………………..

if so, give details.

10. Particulars and date of every conviction ………………………………………………………..

which has been ordered to be endorsed on ………………………………………………………..

any licence held by the applicant.

11. Have you been disqualified for obtaining ………………………………………………………

a licence to drive? If so, for what reason?

12. Have you been subjected to a driving test as to your

fitness or ab ility to drive a vehicle in respect of

which a licence to drive is applied for? If so, give

the following details :-

Date of test Testing Authority Result of test

(1)

(2)

(3)

(4)

13. I enclose three copies of my recent passport size photographs ( where Laminated card is used, no photographs

are required ).

14. I enclose learner’s licence number ________________date __________________ issued by licesing

Authority_______________________________________________________________________________

15. I enclose the driving certificate number ____________________ dated _____________________________

issued by _______________________________________________________________________________

16. I have submitted along with my application for learner’s licence the wr itten consent of parent / gaurdian.

17. I have submitted along with my ap plication for learner’s licence. I enclose the me dical fitness certificate.

18. I am exempted from the medical test under rule 6 of the Central Motor Vehicle Rules , 1989.

19. I am exempted from preliminary test under rule 11 (2) of the central motor vehicle rules 1989.

20. I have paid the fee of Rs. ___________________________________________________________________

I hereby declare that to the

best of my knowledge and belief the particulars gi ven above are true.

*Strike out whichever is inapplicable.

Date : Signature / Thumb impression of applicant.

Certificate of test of competence to drive

The applicant has passed the test prescribed under rule 15 of the Central Motor vehicle Rules, 1989. T he

test was conducted on (here enter the registration mark and description of the vehicle)______________________

On (date)___________________________________________________________________________________

*The applicant has failed in the test.(The details of deficiency to be listed out.)

Date_________________ Signature of Testing Authority

Full na me a nd d esingna t ion____________________________________________________________________

T wo specimen signatures of applicant:

(1) (2)

_______________________

strike out whichever is inapplicable