LEARNER'S LICENCE

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

Licence No. OD22 /0000420/2020

Issue Dt. 02-01-2020
Fee Details: Rs.222.0/- /OD22/54469 etc /02-01-2020
1. Name JUMMA KHAN
Father's Name MANNAN KHAN
2.
3. Date of Birth 01-01-1969

4. Blood Group A+
5. Present Address SANA SANKARPUR BHADRAK Bhadrak
Rural,Bhadrak,OD,756100
6. Permanent Address SANA SANKARPUR BHADRAK Bhadrak
Rural,Bhadrak,OD,756100
7. Marks of Identification (1)
(2)
Specimen Signature/Thumb impression of
8. Qualifications Not Specified / NA 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 02/01/2020 To 01/07/2020

Licensing Authority
Warning: RTO,BHADRAK
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.