FORM 3

[See Rule 3(a) and 13]

LEARNER'S LICENCE

4298228122
Application No...................................

Learner's Licence KL30 /0005901/2022 10-11-2022

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

1. Name : VIJIN K JOHN

2. Father's Name JOHN MATHEW

3. Date of Birth : 24-12-2000

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

the holder of the of the
KEERICKAL THONDETHU PRAYAR PANDANAD NORTH P O
5. Present Address/ Chengannur,Alappuzha,KL,689124
Permanent Address :

KEERICKAL THONDETHU PRAYAR PANDANAD NORTH P O

6. Temporary/Official(if Chengannur,Alappuzha,KL,689124

Marks of Identification : 1. A BLACK MOLE ON THE RIGHT FOOT

7.
2. A BLACK MOLE NEAR THE LEFT KNEE

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
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 : 10/11/2022 To 09/05/2023

* 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