TRANSPORT DEPARTMENT

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

Fee Details Rs.350.0/- /UPU/4753379 /18-12-2021 ApplNo: 4436189521 Issue Dt. 30-12-2021

1. Licence No. UP50 /0049715/2021

2. Name KARUTHEDATH ANIRUDH

3. Father's Name KARUTHEDATH MANIKANDAN

4. Date of Birth 21-10-2000

5. Optional/Blood Group- A1B+

RH Factor

6. Present Address 382, DENTAL COLLEGE Itaura Or Itraura

Azamgarh,UP,276128
Holder's Signature

7. Permanent 3/604 Panagallu (Rural)

Srikalahasti,Chittoor,AP,517644

(1) SCAR ON FOREHEAD

8. Marks of Identification
(2) BLACK MOLE ON TEMPLE
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 without Gear (Non Transport), Motor Cycle with Gear(Non Transport),
.......................................................................................................................................

*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 30/12/2021 To 29/06/2022

Signature and Designation of

the Licensing Authority
Warning: RTO, AZAMGARH

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.