TRANSPORT DEPARTMENT

FORM 3
[See Rule 3(a) and 13]
LEARNER'S LICENCE

Fee Details Rs.350.0/- /UPU/2190608 /23-06-2021 ApplNo: 1917694121 Issue Dt. 06-08-2021

1. Licence No. UP58 /0007467/2021

2. Name AJAY TRIPATHI

3. Father's Name SHRI PRAKASH

4. Date of Birth 17-07-1998

5. Optional/Blood Group- O+
RH Factor

6. Present Address VILL CHURIYA MEER PO BAKHIRA

KHALILABAD,SANT KABIR
NAGAR,UP,272199 Holder's Signature

7. Permanent VILL CHURIYA MEER PO BAKHIRA

KHALILABAD,SANT KABIR
NAGAR,UP,272199
(1)
8. Marks of Identification
(2)
is licenced to drive a Motor Vehicles of the following description through out India and in case of E-
rickshaw or E-cart, in specified areas or routes, as a learner,subject to the provisions of Rule 3 of
the Centeral Motor Vehicle Rules 1989:
Motor Cycle with Gear(Non Transport), LIGHT MOTOR VEHICLE,
.......................................................................................................................................

*The holder of the licence has passed the preliminary test referred to in rule 11(1) of the CMV
Rules ,1989.

*The holder of the licence is exempted from the medical test under rule 6 and from the
Preliminary test under rule11(2)of the Central Motor Vehicle Rules,1989

*Strike off which ever is inapplicable

This Licence is valid 06/08/2021 To 05/02/2022

Signature and Designation of

the Licensing Authority
Warning:

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.