Fillable Printable Form of Application for the Grant of Learner's License

Form of Application for the Grant of Learner's License

FORM 2

[See Rule 10]

FORM OF APPLICANT FOR THE GRANT OF LEARNER’S LICENSE

The Licensing Authority,

........................................

I hereby apply for a license authorizing me to drive as a learner, the following

motor vehicle(s) :-

Space for Photograph

of the Size

Five Centimeters

by Six Centimeters

(a) Motor cycle without gear

(b) Motor cycle with gear

(d) Light Motor vehicle

(e) Transport vehicle

(f) Road roller

(g) Motor vehicle of a specified description, namely .....................................................................................................

PARTICULARS TO BE FURNISHED BY APPLICANT

1. Full Name ......................................................................................

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

3. Permanent address ......................................................................................

(Electoral Roll / Life Insurance Policy /

Passport / Pay slip issued by any office of

the Central Government / State Government

or a local body / Any other document or

documents as may be prescribed by the State

Government / Affidavit sworn before an

Executive Magistrate or a First Class Judicial

Magistrate or a Notary Public to be enclosed) ......................................................................................

4. Temporary address / Official address, if any ......................................................................................

5. Duration of stay at the present address ......................................................................................

6. Date of birth

(Birth certificate / school certificate / affidavit

sworn before an Executive Magistrate or a

First Class Judicial Magistrate or a Notary

Public to be enclosed) ......................................................................................

7. Place of birth ......................................................................................

8. If place of birth out side India, when migrated

to India ......................................................................................

9. Education Qualification ......................................................................................

10. Identification mark(s) 1. .................................................................................

2. .................................................................................

12. Blood group

RH (Rhesus) factor ......................................................................................

13. I hold an effective driving licence to drive :

Motor cycle / light motor vehicle / transport

vehicle with effect from ......................................................................................

14. Particulars of any driving licence previously

held by applicant. ......................................................................................

Whether it was cancelled and if so, for what

reason ......................................................................................

15. Particulars of any learner's licence previously

held by applicant in respect of the description

of vehicle to which the applicant has applied ......................................................................................

16. Have you been disqualified for holding or

obtaining driving licence or learner's licence.

If so, for what reasons ......................................................................................

17. I enclose three copies of my recent photograph

(passport size photograph) ......................................................................................

18. I enclose medical fitness certificate dated .............................. issued by ..........................................(doctor).

19. I have submitted along with my earlier application for learner's licence / I enclose the written consent of

parent / guardian (in the case of applicant being a minor)

20. I enclose driving certificate dated ................................. issued by ..............................................................................

(Name and address of the driving school).

21. I have paid the fee of Rs. ..............................................

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

23. I am exempted from the preliminary test under rule 11(2) of the Central Motor Vehicles Rules, 1989.

*Strike out whichever is inapplicable.

Date ................................... ......................................................................................

Signature of thumb impression of Applicant

Specimen signature or thumb impression of Applicant

1. ...............................................................................

...............................................................................

Declaration under sub-section(2) of section 7 of the Motor Vehicles Act, 1988

Shri /Smt. / 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 I 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 licensing authority or person authorised in this behalf by the licensing authority).

For office use

The applicant is exempted from the medical test under rule 6 and the preliminary test under rule 11(2) of the

Central Motor Vehicles 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.

Learner's licence may be refused.

.......................................................................

Signature of licensing authority or

other person authorised in this behalf.

*Strike out whichever is inapplicable.

Note - The application along with the scanned copies of the required documents may also be sent to the

concerned Licensing Authority through Electronic Mail, if allowed by the concerned State Government / Union

Territory Administration.

In case the application is accepted, the applicant shall be intimated through Electronic Mail to report to the

Authority concerned on an appointed date along with the documents for further verification, submission of

application fee and examination of the applicant.