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LEARNER'S LICENCE

Form 3
[See Rules 3(a),13]

Licence No. OD02K/0002044/2019


Issue Dt. 20-03-2019
Fee Details: Rs.200.0/- /ODS/13851 /18-03-2019
1. Name GULAM M M KHAN
Father's Name SAFIRULA KHAN
2.
3. Date of Birth 24-04-1997

4. Blood Group A+
5. Present Address KUSUMIPATNA Sanrautapada Tangi,Khordha,OD,752021

6. Permanent Address KUSUMIPATNA Sanrautapada Tangi,Khordha,OD,752021

7. Marks of Identification (1)


(2)
Specimen Signature/Thumb impression of
8. Qualifications Diploma in any Discipline the holder of the
is licenced to drive throughout India as a learner subject to the provisions of rule 3 of the Central Motor Vehicles Rules 1989, a motor
vehicle of the following description
*The holder of the licence has exempted from the medical test under
MCWG,
.................................................................................................................................
*The holder of the licence has passed the Preliminary test under rule11(1)of the Central Motor Vehicle Rules,1989

*Strike off which ever is inapplicable


This Licence is valid from 20/03/2019 To 19/09/2019

Licensing Authority
Warning: ASST.RTO,KHURDA
The attention of the holder of this licence is drawn to rule 3 of CMV Rules, 1989 which prohibits him from driving any motor vehicle unless
he has besides him a person duly licenced to drive the vehicle and in every case , the vehicle carries "L" plates both in front and in the rear
of the vehicle.

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