FORM 3

[See Rule 3(a) and 13]

LEARNER'S LICENCE

4427303121
Application No...................................

Learner's Licence KL18 /0020277/2021 23-12-2021

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

1. Name : ASMEERA

2. Father's Name MOOSA

3. Date of Birth : 18-02-1999

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

the holder of the of the
CHANDHAMKANDIYIL HO KATAMERI PO VILLIAPPALLY VIA,673542
5. Present Address/
Permanent Address :

CHANDHAMKANDIYIL HO KATAMERI PO VILLIAPPALLY VIA,673542

6. Temporary/Official(if

Marks of Identification : 1. MOLE BELOW THE ARM

7.
2. MOLE ON THE RIGHT CHEEK

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, MCWOG,

*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 : 23/12/2021 To 22/06/2022

* 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