FORM LCA

Form of application for intimation of Temporary / Permanent / Change of Address in respect of a

License holder authorized to drive Motor Vehicle.
(Rule 30 of APMV Rules 1989)
To
The Licensing Authority
____________________
I, the under signed hereby apply for Intimation of change of Temporary / Permanent
Address under Rule 30 of APMV Rules, 1989 in respect of my Driving License authorized to
drive Motor Vehicle.

1.

Name of the Applicant

: _____________________________________

2.

Fathers Name

: _____________________________________

3.

Address

: ____________________________________

(Evidence to be produced)

: ____________________________________

4.

Address as mentioned
In the Driving License

: ____________________________________

5.

Driving License Number

: _____________________________________

6.

Validity of the Driving License

: _____________________________________

7.

Licensing Authority by which. : ____________________________________

License was originally issued /
Last Renewed

8.

Fee Paid

: _____________________________________

I hereby state that the particulars mentioned above are true to the best of my knowledge
and undertake to hold the responsibility in the event the address being found false in future.

Signature of the applicant