FORM - L.L.D.

[See rule 13(1)]

Application for a duplicate driving licence
To,
The Licencing Authority,

Full Name
Address of the .
applicant ..

1.

I hereby report that the driving licence held by me is lost/destroyed/torn/defaced/mutilated in

the following circumstance

2.

I hereby apply for a duplicate driving licence and tender the fee prescribed in rule 6.

3.

The particulars of such driving licence held by me is as follows :Driving licence no.. issued for (here enter the class of motor
vehicles) in the name of by the licencing authority .. on
.. and expiring on ...

4.

I hereby declare that my driving licence is not impounded by any authority and that
there have been no/following endorsement by the court since the date of
grant/renewal.
Signature of the applicant.

Date :
Place :
Specimen signature of the applicant
1.
2.
*Strike out whichever is either required or not applicable.