Form 4
(See Rule 14)
Form
of application for licence to drive a Motor Vehicle
To
Space for
Passport Size Photograph
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The Licensing Authority
.....................................................................
I apply
for a licence to enable me to drive
vehicles of the following
description:
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. 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
Marks. : (1)
.............................................................................
(2)
.............................................................................
8. Optional: Blood
Group/RH Factor :
....................................................................................
9.
Have you previously held driving
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
subject 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 enclose three copies of my recent Passport size photograph
(where laminated card is used no
photographs 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 along with my 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 form 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 given above are true
........................................
NOTE: Strike out whichever is inapplicable Signature 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.
The test was
conducted on ………………………………………………………….....................……………..
(here enter the registration mark and description of the
vehicle)…………….…………....……….on (date)
The applicant has failed in test (The details of the
deficiency to be listed out)
.................................................................................................................................................................................
.................................................................................................................................................................................
.......................................................
Date: Signature
of Testing Authority
Two Specimen Signature of Applicant: Full Name and Designation.
1.
2.
