RTA,PATIALA

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

Licence No. PB11 /0027547/2022 Appl No. 4624634922

Issue Date: 29-11-2022
Fee Details: Rs.520.0/- /PBV/1493378 /29-11-2022
1. Applicant Name PANKAJ PREM MEHTA

2. Father's Name PREM KUMAR MEHTA

3. Date of Birth 02-03-1996

Optional/Blood Group
4. B+
-RH Factor
Spicemen signature/ thumb
5. Present Address H NO 175 ST NO 6 OLD BISHAN NAGAR impression of the holder Licence
PATIALA PATIALA,PB,147001

6. Permanent Address H NO 175 ST NO 6 OLD BISHAN NAGAR

PATIALA PATIALA,PB,147001

7. Marks of Identification (1)

(2)

10th Standard or Equivalent

8. Qualifications

is licenced to drive throughout India as a learner subject to the provisions of rule 3 of the CMV
Rules 1989, a motor vehicle of the following description

Motor Cycle with Gear(Non Transport), LIGHT MOTOR VEHICLE,

.......................................................................................................................................

*The holder of the licence is exempted from medical test under rule 6.
*The holder of the licence has passed the preliminary test referred to in rule 11(1) of the CMV
Rules ,1989.
This Licence is valid from 29/11/2022 To 28/05/2023

Licensing Authority
Warning: RTA,PATIALA
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.