FORM 2 (See Rule 10) . FORM OF APPLICATION FOR THE GRANT OF LEARNER’S LICENCE To, The Licensing Authority @ as a learner | hereby apply for a licence authorising me to dt the following motor vehicle(s) :- a) Motor cycle without gear b). Motor cycle with gear ©) Invalid Cartage 4) Light motor vehicle e) Transport Vehicle 1) Road-roller 9) Motor vehicle of a specified ‘Space for photograph of the size of 5 x 6 cms description, namely PARTICULARS TO BE FURNISHED BY THE APPLICANT 1. Full Name 2. Son/Wite/ Daughter of 3. Permanent Address. (Electoral Rolfe Insurance Policy/Passpor/Pay slip issued by and offce of the Canal Governmen/State Government or a local + Dbody/Any other document of documents 8s may be prescribed by the Stale Governmenv/Alfidavit sworn before an Executive Magistrate ora First Class Judicial Magistrate or a Notary Pubbe to be enclosed) 4, ‘Temporary address / Official address (if any) 5. Duration of stay at the present address & Date of Binh Birth Cerlficate/Schoot Executive Magistrate or @ Notary Pubic to be enclosed icato/atidavit sworn detore an rst Class Judicial Magistrate or a 7. Place of Birth 8. I place of birth outisde India, when migrated of India 9, Educational Qualification 10. Identification Mark (s) ) 2) 11. Declaration of citizenship status () doomed Ctizen or Gizen by Bit (Binh Conificate and schoo! certificate In support of Citizenship as inian to be enclosed) (®) Hf Citizenship is acquired by Descent Rogitraton . (in case Citizenship acquired by Descent, Birth Corticate, Land property ‘ocument of parenvn case of citizenship acquired by registration, corticte 12 be enclosed, (iH Cizenship by Naturalization (Conicate ot Naturalization and Certicate of Registration tS be oncosed) (@) Trondecian Citizen (Valid passport or otner travel documents and such other document or authority as may be proscribed by law lo enclosed) 12, Blood Group Rh (Rhesus) factor73. [ hold an effective driving licence to drive: Motor cycle/Light motor vehicleltrasnport vehicle —} with effect gegoen 14, Particulars of any driving licence previously held by applicant whether it was cancelled and i so, for what reason 16. Particulars of any learner's licence previously held by applicant in respect of the description of vehicle to which the applicant has applied 46. Have you been disqualified for holding or obtaining driving licence or learners licence, if $0, for what reasons 17. | enclose three copies of my recent photograph {passport size photograph) 18. | enclose medical fitness certificate dated... Issued bY... nnrnnetne termes (DOCION) 19. | have submitted along with my earlier application for learner's licence /I enclose the written consent of parent / guardian (in case of applicant being a minor) 20. | enclose driving certificate dated... Issued by... ..(Name and address of the driving schoo!) 21. | have paid the fee of Rs. 22. | am exempted from the mecical test under Rule 6 of the Central Motor Vehicle Rules, 1969 23. | am exempted from the preliminary test under Rule (11(2) of the Central Motor Vehicles Rules, 1989 © Strike out whichever is inapplicable. Date (Specimon Signature oF UMD impression of Applicant) 1 Signature or thumb impression of Applicant 2. DECLARATION UNDER SUB-SECTION (2) OF SECTION 7 OF THE MOTOR VEHICLE ACT, 1988 Shi/Kumar .-Son/Daughter o.. who isa Minor under my care and I accept responsibilty for his/her driving, if ata later date | decide not to accept responsibilty of hisher driving, | shail intimate the licence authority in writing forthe cancellation of the licence | give my consent for his/her obtaining learner's License. Signature. Name and full address of the Parent Guardian Relationship. (To be signed in the presence of the Licensing Authority or person authorised in this behalf by the Licensing Authority) FOR OFFICE USE ‘he apa xem om he medal es! ude lean he priate ander ne 1) feo cocen aeatee ee oe eee Mea henee ies te tateaierialt essen eee roca esranee set Sana of Leahy IGroptto ne Auton concerned onan appa cae ong mth he Soatrans fr keer Venleaton, suomi of apyicalon to and eamnaton crite appecant "Authorised in this behalf oo00 G6