FORM - 2
(See Rule 10)
Form for Application for grant or renewal of learners licence
To,
The Licensing Authority
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I hereby apply for a Licence authorising me to drive as a
Learner, the following motor vehicles (s):
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.
Motor vehicle of the following description :
--------------------------------------------------------
Particulars to be furnished by 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 of age to be enclosed) ---------------------------------------------------
6. Educational qualification : -------------------------------------------------
7. Identification Mark (s) : 1) -----------------------------------------------
2) ------------------------------------------------
8. Blood group : ------------------------------------------------
RH Factor :------------------------------------------------
9. I hold an effective driving licence to drive :
(a)Motor Cycle/Light Motor Vehicle/Medium
Passenger Motor Vehicle / Medium
Goods Vehicle with effect from -------------------------------------
10. Particulars of any driving licence
previously held by applicant. Whether it
was cancelled and if so, for what reason -----------------------------------------
11. Particulars of any learner’s licence
previously held up by applicant in
respect of the description of vehicle
to which the applicant has applied --------------------------------------------
12. Have you been disqualified for holding
or obtaining a driving licence or learner’s
licence? If so, for what reason ? ---------------------------------------------
13. I enclose 3 copies of my recent photograph
(Photograph to be of the size of
five centimeters by six centimeters ) -----------------------------------------------
Space for
photograph of
the size five
centimeters by
six centimeters.
14. I enclose medical fitness certificate
dated --------- issued by (Doctor) ---------------------------------------------
15. I have submitted alongwith my earlier
application for learner’s licence / I enclose
the written consent of parent / guardian
in the case of (applicant being a minor ) ------------------------------------------
16. I enclose driving certificate dated ------------------------------------------------
issued by ---------------------------------------------------------------------------------------
(name and address of the driving school )
17. I have paid the fee of Rs----------------------------------------------------------------
18. I am exempted from the medical test under Rule 6 of Central Motor Vehicles Rules, 1989.
19. I am exempted from the preliminary test under Rule 11 (2) of Central Motor Vehicles Rules, 1989.
*Strike out whichever is inapplicable.
Date ------------- Signature of applicant Duplicate signature of applicant
Declaration under sub-section (2)of Section 7 of the Motor Vehicles Act ,1988
Shri / 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 authorized 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 Vehicle Rules,1989. He has passed the test.
Learner’s Licence may be issued.
* He has failed in the test.(Reasons should be specified).Learner’s Licence may be refused.
Signature of Licensing Authority or
other person authorized in this behalf
* Strike out whichever is inapplicable.
Please pay the cost of this form at the concerned RTO Rs.5-00 Printed from www.goatransport.Com