FORM 3

[See Rule 3(a) and 13]

LEARNER'S LICENCE

4174906221
Application No...................................

Learner's Licence KL55 /0028208/2021 28-12-2021

Issue Date......................

1. Name : HASEENA THASNEEM C P

2. Father's Name ALIKUTTY C P

3. Date of Birth : 25-03-1998

4. Blood Group(Optional) : B+ Spicemen signature/ thumb impression of

the holder of the of the
CHERUPARAMBIL HOUSE VAVOORKUNNU CODACAL PO THIRUNAVAYA
5. Present Address/ TIRUR,MALAPPURAM,KL,676108
Permanent Address :

CHERUPARAMBIL HOUSE VAVOORKUNNU CODACAL PO THIRUNAVAYA

6. Temporary/Official(if TIRUR,MALAPPURAM,KL,676108

Marks of Identification : 1.
7.
2.

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
LMV, MCWG,

*The holder of the licence has passed the medical test under rule 5 and the preliminary

*The holder of the licence is exempted from medical test under rule 6 and from the
preliminary test under rule 11(2) of the Central Motor Vehicles Rules, 1989.
This Licence is valid from : 28/12/2021 To 27/06/2022

* Strike off whichever is inapplicable

Signature of the Licencing authority

Warning: The attention of the holder of this licence is drawn to rule 3 of Central Motor vehicle 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.
DL Test Schedule
Sl.No Class of Vehicle Date and Time Venue