FORM L. L. D. [See Rule 12 (1)] Intimation of loss or destroyed of driving licence and application for duplicate To, The Licensing Authority ........................... I .................................... of (permanent address) ............................. and present address ................................. (father's/husband's name) ............................. hereby report that driving licence No. ......................... issued by the Licensing Authority ......................... or about the ........... day of ........... 200 ..... destroyed lost * Has been in the following circumstances :- destroyed 2. I hereby apply for a duplicate driving licence and tender prescribed fee by cash/money order/cheque/challan. 3. I attach two clear copies of a recent photograph of myself* 4. I further declare that my driving licence is not impounded by any authority. 5. I hereby declare that there have been following* endorsement by the Court since no the date of last renewal* grant Date ....... 200 ...... Signature or thumb impression of applicant (Duplicate signature or thumb impression) (Duplicate signature or thumb impression) For use in office of the Licensing Authority PART I *Duplicate of driving licence No. .......... first granted on ....... has been issued be me this ............ day of .........200 ..... *Application refused in letter No. ........ Dated the ....... to the applicant giving reasons. *Dated ......... 200 ... Licensing Authority ........... Price : Rs. 5.00 Note:Please pay the cost of this form to the concerned RTO Printed from www.gatransport.com
