FORM 2 [See Rule 10] Form of Application for Learner's License To The Licensing Authority ___________________ ___________________ I hereby apply for a license authorizing me to drive as a learner. The following motor vehicle(s) : (a) Motor Cycle without gear, (b) Motor Cycle with gear, (c) Invalid Carriages, (d) Light Motor, (e) Medium Goods Vehicle, (f) Medium Passenger motor Vehicle, (g) Heavy Goods Vehicle, (h) Heavy Passenger Motor Vehicle, (i) Road Roller, (j) Motor Vehicles of the following description _______________________________________________________________________________________ _______________________________________________________________________________________ 1. Full Name of the Applicant ________________________________________________ 2. Son/Wife/Daughter of ________________________________________________ 3. Permanent Address ________________________________________________ (Proof to be enclosed) ________________________________________________ 4. Temporary Address / Official ________________________________________________ Address if any ________________________________________________ 5. Date of Birth ________________________________________________ (Proof to be enclosed) Space for Photograph of the Size Five Centimeters by Six Centimeters 6. Educational Qualification ________________________________________________ 7. Identification Mark ________________________________________________ 8. Blood Group ________________________________________________ RH Factor ________________________________________________ 9. I hold an effective driving license to drive a) motor cycle/light motor vehicle/medium passenger motor/medium goods vehicle with effect from __________________________ 10. Particulars if any driving previously held by applicant, whether it was cancelled and if so, or what reason 11. Particulars of any learners license previously held up applicant in respect of the description of vehicle to which the applicant has applied. 12. Have you been disqualified for holding or obtaining driving license or learner's license if so what reasons 13. I enclosed 3 copies of my recent photograph to be size of five centimeters by six centimeters. 14. I enclosed medical fitness certificate date ______________________________________________ Issued by doctor __________________________________________________________________ 15. I have submitted along with my earlier application for learner's license / I enclosed the written consent of parent /guardian (in case of applicant being minor). 16. I enclosed driving certificate date ______________ issued by ______________________ name and address of the driving school. 17. I have paid the fees of Rs. _______________________________ 18. I am exempted fro the medical test under rule 6 of Central motor / Vehicle rule 1989. 19. I am exempted from the preliminary test under Rule 11(2) of Central Motor Vehicles Rules 1989. Strike out whichever is inapplicable Signature of applicant Date Duplicate Signature of applicant Declaration under sub section (2) of section 7 of the motor Vehicle Act 1989 Shri / Kumari ______ ______________________________ Son / Daughter of ______________________ who is minor is under my care and I accept responsibility for his/her driving. If at a later date decide not to accept responsibility or is/her driving shall intimate the license the authority in writing for the cancellation of the licence I give my consent for his / her obtaining learner's licenses. Signature _________________________________________ Name and Full address of the __________________________ Parent / Guardian ___________________________________ Relationship _______________________________________ (To be signed in the presence of the Licensing Authority or Person authorized in these behalf by the Licensing Authority.) For Office Use The applicant is exempted from the medical test under the rule 6 and preliminary test under rule 11 (2) of the Central Motor Vehicle Rule 1989. Learner's License may be issued. * The applicant was tested with reference to rule 11(1) of the Central motor Vehicle Rules 1989. He has passed the test Learner's License may be issued. * He has failed in the test. Reasons should be specified. * Learner's license may be refused. Signature of Licensing Authority or Other Person authorized in this behalf Strike out whichever is inapplicable
