TRANSPORT DEPARTMENT

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

Fee Details Rs.350.0/- /UPU/4129583 /05-11-2021 ApplNo: 3833590121 Issue Dt. 19-01-2022

1. Licence No. UP83 /0001518/2022

SHIV KUMAR
2. Name

3. Father's Name RADHE SHYAM KUSHWAHA

4. Date of Birth 07-08-2002

5. Optional/Blood Group- O+
RH Factor

6. Present Address Asva Shikohabad,Firozabad,UP,283141

Holder's Signature

7. Permanent Address Asva Shikohabad,Firozabad,UP,283141

(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:
LIGHT MOTOR VEHICLE, 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 19/01/2022 To 18/07/2022

Signature and Designation of

the Licensing Authority
Warning: ASST.RTO, FIROZABAD
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.