FORM G.L.D. [See rule 37 (1) ] Intimation of loss of destruction or Conductor's licence and application for duplicate To, The Licensing Authority ------------------------------------------------------------------------------- I , ------------------------------------------------------------------of ----------------------------------(Permanent address )---------------------------------------------------------------------------------------and (Present address) -------------------------------------------------------------------------------------(Father's name)---------------------------------------------------------------------------------------------hereby report that Conductor's Licence No.----------------------------------issued by the Licensing Authority ---------------------------------on or about the -------------------------------------------day of -----------------20 --------------has been * lost /destroyed in the following circumstances: ( To be filled in ) 2. I hold conductor's badge No. -------------------------------------------------------------is sued by the Licensing Authority ------------------------------------------------------------------------------------------ 3. I hereby apply for a duplicate conductor's licence and tender rupees ten by cash/ money/order/ Cheque/ challan. *4.I attach two clear copies of a recent photograph of myself. 5. I further declare that my conductor's licence is not impounded by any authority, the licence has not been suspended or revoked by any authority and that the license has not ceased to be valid by Efflux of time. 6. I hereby declare that there has been *following /* no endorsement by the Court since the date of last renewal/grant. Date of Court Officer Punishment endorsement (1) (2) -------------------------------------------- ------------------------------------------------- ------------------------------------------------------------------- Dated --------------20 Signature of applicant For use in the office of the Licensing Authority. PART I *Duplicate of conductor's licence No.----------------------------------------------------------------------first granted on -----------------------------------------has been issued by me this ----------------------day of ---------------------------20 ---------------------Application refused in letter No.-----------------dated the ---------------------------------------to the applicant giving reasons. Dated: ----------------------20--------------------- Licensing Authority *Strike out what is not required.
