FORM L.L.D. (Rule 2.3 of Delhi Motor Vehicle Rule, 1989) INTIMATION OF LOSS OR DESTRUCTION OF LICENCE AND APPLICATION FOR DUPLICATE To The Licensing Authority, ............. ............. I........................................... Son/Daughter/Wife of.................................... with my Permanent Address as.............................. Hereby report that my driving licence, the particulars of which are given below has been lost/ destroyed. 1. Licence No. ......................... 2. Name of Licensing Authority ......................... 3. Date of issue ......................... 4. Vehicle for which licenced ......................... 5. Valid upto ......................... 6. Endorsement, if any ......................... I solemnly declare that the licence has not been impounded by any authority and I will return the same to the Licensing Authority if at any stage licence is found. The duplicate licence fee has been vide receipt No.......... Signature or thumb impression of the applicant Date...... ............................................. (FOR OFFICE USE OF LICENSING AUTHORITY) 1. The particular as given above have been checked. 2. The adverse entries as per records are as under. ............................................. ............................................. ............................................. 3. Duplicate licence may be issued/refused on account of reasons given below. ............................................. ............................................. (Dealing clerk) (Licensing Authority)
