FORM 4

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(See rule 14 )

Form of Application for Licence to drive a Motor Vehicle

To                                                                                                         Space for photograph of

                                                                                                            The size five centimeter

                                                                                                            by six centimeters

            The Licensing Authority

            ………………………….

            I apply for a licence to enable me to drive vehicles of the following descriptions ;

(a)                             Motor cycle without gear

(b)                            Motor cycle with gear

(c)                             Invalid carriage

(d)                            Light motor vehicle

(e)                             Medium goods vehicle

(f)                              Medium passenger motor vehicle

(g)                             Heavy goods vehicle

(h)                             Heavy passenger motor vehicle

(i)                               Road roller

(j)                              Motor vehicle of the following description

Particulars to be furnished by the 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 to be enclosed)

6.          Educational qualification

7.         Identification mark(s)                                   (1)

                                                                              (2)

8.          Blood group and RH factor

9.                   Have you previously held driving

            Licence ? If so, give details.

 

10.                 Particulars & date of every conviction

            Which have been order 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 ability 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 enclosed three copies of my recent photograph of the size five centimeters into six centimeters   (where laminated card is used no photograph are required).

14.                               I enclose the Learner’s licence No………………dated……………….

Issued by Licencing Authority.

15.                               I enclose the Driving Certificate No……………dated………………..

Issued by …………………………………………………….

16.                               I have submitted along with my application for Learner’s Licence the written consent of parent/guardian.

17.                           I have submitted alongwith the application for Learner’s Licence/ I enclose the medical fitness certificate.

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

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

20.                           I have paid the fee of rupees.

I have declare that to the best of my knowledge and belief the particulars given above are true.

Note :- Strike out whichever is inapplicable.

Date :

                                                                                    Signature/Thump impression of

                                                                                    Applicant.

Certificate of test of competence to drive

            The applicant has passed the test prescribed under rule 15 of the Central Motor Vehicles Rules, 1989. The 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 the deficiency to be listed out)

Date :                                                                            Signature of Testing Authority

                                                                                    Full name and designation.

Two specimen signatures of applicant :

·                     Strike out whichever is inapplicable.

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