appointment schedule

form 2
[see rule 10] date :05/05/2017
form of application for learner's license time :11:00 am
place :GUNA RTO
reference id :MP081782138082
Your test reference number : 8213808

to
the licensing authority
please affix a
GUNA RTO
photo
i here by apply for a license authorizing me to drive as a learner. of the size
the following motor vehicle(s) : 5 cm. x 6 cm.

a) Motor Cycle With Gear

b) Light Motor Vehicle-Non Transport

1. full name of the applicant KAPARAPU GOUTHAM

2. son/wife/daughter of SATYANARAYANA

3. permanent address
B 438 NFL TOWNSHIP VIJAIPUR ,GUNA
(proof to be enclose)

4. temporary address/official B 438 NFL TOWNSHIP VIJAIPUR ,GUNA

address if any

5. date of birth 16-Feb-1990

(proof to be enclose)

6. educational qualification POST GRADUATE

7. identification mark(s) SCAR ON RIGHT CHEEK

8. blood group A

rh factor -ve

9. i hold an effective driving license to drive:

a) motor cycle/light motor vehicle/medium passenger
motor/medium goods vehicle with effect from

10.particulars of any driving license previously held

by applicant,whether it was cancelled and
if so ,for what reason

11.particulars of any learner's license previously

held by applicant in respect of
the description of vehicle to which the
applicant has applied.

12.have you been disqualified for holding

or obtaining driving license or learner's
license if so for what reason

13.i enclose 3 copies of my recent photograph to be size of 5 cm. x 6 cm.

14.i enclose medical fitness certificate date
issued by doctor

( For non transport vehicle license bring Self attested medical certificate and for transport vehicle bring medical
certificate form prescribed medical officer.)

15.i have submitted along with my earlier application for learner's license /
i enclose the written consent of parent /guardian (in case applicant being minor).

16.i enclose driving certificate date issued by

name and address of the driving school.

17.i have paid the fee of rs. 350 receipt number 9317306690634

18.i am exempted from the medical test under rule 6 of central motor vehicle rule 1989.
Rule 6 and 11(2) of Central Motor Vehicle act are given on
http://122.168.193.74/APPOINTMENTSYSTEM/CentralMotorRule.aspx
19.i am exempted from the prelimiary test under rule 11(2) of central motor vehicle rule 1989.

strike out whichever is inapplicable

date signature of applicant

specimen signatures or thumb-impression of applicant

declaration under sub section (2) of section 7 of the motor vehicle act 1988 shri / kumari
son /daughter of

who is minor is under my care and i accept responsibility for his/her driving. if at a later date i decide not to accept
responsibility or is/her driving i shall intimate the licensing the authority in writing for the cancellation of the license
i give my consent for his / her obtaining learner's licenses.

signature

name and full address of the

parent / guardian

relationship

(to be signed in the presence of the licensing authority or person authorized in theis behalf by the licensing authority.)

for office use

the applicant exempted from the medical test under rule 6 and prelimiary test under rule 11(2) of the
central motor vehicle rule 1989.

learner's license 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 license may be issued.
* he has failed in the test.reason should be specified.
* learner's license may be refused.

signature of licensing authority or

strike out whichever is inapplicable other person authorized in this behalf
remarks :
rto address :- Smart Card Centre, A B Road, RTO Office Guna (MP) - 473001

* The applicant should reach at RTO 15 minutes before the appointment time
* Bring following documents along with the [ Form -2 ]
a) Address & Age proof -
1) Life Insurance Policy 2) Passport
3) Pay slip issued by any office of the Central Government or State Government or a local body
4) School certificate
b) Medical certificate (For non transport vehicle license bring medical certificate and for transport vehicle
bring medical certificate form prescribed medical officer.)
* Please bring either attested photocopies or original document along with application form