FORM D. C. B. [See rule 40(1)] Application for duplicate of Conductor's badge To, The Licensing Authority _________________________________________________________ I, (Name in full) ________________________________________________________ of (permanent address) _________________________________________________________ and (present address) _________________________________________________________ hereby report that conductor's badge No. _______________ issue by you is lost/destroyed * in the following circumstances. ___________________________ (to be filled in) _____________________________________ 2. I hold conductor's licence No. _______________________________ issued by you which is valid upto ____________________________________________________ 3. I hereby apply for a duplicate conductor's badge and tender (Rupees ten) by cash/money order/cheque/challan.* 4. I further declare that my conductor's licence has not been suspended or revoked and has not ceased to be valid by efflux of time. Date: ________________ 20 __________ *Strike out alternative which is not applicable. Price : Rs. 5.00 Note:Please pay the cost of this form to the concerned RTO Printed from www.gatransport.com
