FORM

K.M.V. 12

FORM OF APPLICATION FOR A CONDUCTORS LICENCE 1. 2. Name Name of father :: Date of birth (proof to be attached) Present Address Permanent Address Educational Qualification (proof to be attached) :: :: :: :: ::

3. 4. 5. 6.

7. 8.

I have *the following convictions /No convictions. I have *not previously held a conductors licence/ previously held a conductors licence issued by:: I am not disqualified for holding a conductors licence I hereby declare that I am not less than 18 years of age and that the above statements are true, I attach two copies of a recent photograph of myself. I further declare that I ordinarily reside / carry on business at .. In district..: I hereby tender rupees .. by cash.

9. 10.

11.

12.

Dated:

Signature of the applicant

Duplicate signature of the applicant *strike out whichever is not applicable. Proof of Date of Birth date to be out of the following documents: 1. 2. 3. 4. School leaving certificate Passport Secondary school certificate Domicile certificate.