6/16/2015

www.punjabtransport.nic.in/forms/formlld.htm

FORML.L.D.
INTIMATIONOFLOSSORDESTRUCTIONOFLICENCE&
APPLICATIONFORDUPLICATEDRIVINGLICENCE
(Rule15ofVEHICLESRULES,1989)
To
TheLicensingAuthority,
_______________________.
IamauthoriseddrivinglicenceholderwithLicenceNo.____________________________Isuuedby______________________

I,Shri/Smt./Kumari
herebyreportthatmydrivinglicencehasbeenlost/destroyedandapplyforduplicate.
Son/Daughter/Wife/Guardialof
1.ADDRESS

PERMANENT

TEMPORARY

DoorNo.
Village/town/city
Mandal
District
Pincode
2.Circumstancesofloss/Destructionofthelicence______________________________________
___________________________________________________________________________________________________________
3.PaidfeeofRs._______________________(Feeshouldbepaidatthecounter)
Signature/Thumbimpression
ofapplicant

http://www.punjabtransport.nic.in/forms/formlld.htm

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