FORM - 2 Sr. No. (See Rule 10) Form of Application for the Grant or Renewal of Learner's Licence To, Space for The Licencing Authority photograph of ................................................................................ the size five ................................................................................ centimetres by I hereby apply for a Licence authorising me to drive as a six centimetres Learner, the following motor vehicle(s): a) Motor cycle without gear b) Motor cycle with gear c) Invalid carriage d) Light motor vehicle e) Medium goods vehicle f) Medium passenger motor vehicle g) Heavy goods vehicle h) Heavy passenger motor vehicle i) Road roller Motor vehicle of the following description: .............................................................................. Particulars to be furnished by Applicant 1. Full name : ......................................................................................... 2. Son/wife/daughter of : ......................................................................................... 3. Permanent address : ......................................................................................... ......................................................................................... (Proof to be enclosed) : ......................................................................................... 4. Temporary address : ......................................................................................... Official address : ......................................................................................... (if any) ......................................................................................... 5. Date of Birth : ......................................................................................... (Proof of age to be enclosed) ...................................................................................... 6. Educational qualification : ......................................................................................... 7. Identification Mark(s) 1) ...................................................................................... 2) .................................................................................... 8. Blood group : .......................................................................................... RH Factor : ......................................................................................... 9. I hold an effective driving licence to drive: (a) Motor Cycle/Light Motor Vehicle/Medium Passenger Motor Vehicle/Medium Goods Vehicle with effect from ........................................................... 10. Particulars of any driving licence previously held by applicant. Whether it was cancelled and if so, for what reason .................................................................. 11. Particulars of any learner's licence previously held up by applicant in respect of the description of vehicle to which the applicant has applied ............................................................................. 12. Have you been disqualified for holding or obtaining a driving licence or learner's licence? If so, for what reasons? .......................................................................... 13. I enclose 3 copies of my recent photograph (Photograph to be of the size of five centimetres by six centimetres) ......................................................................... 14. I enclose medical fitness certificate dated ................. issued by (Doctor) ......................................................................... 15. I have submitted alongwith my earlier application for learner's licence/I enclose the written concent of parent/guardian in the case of (applicant being a minor) ...................................................................... 16. I enclose driving certificate dated ............................................................................. issued by ....................................................................................................................... (name and address of the driving school) 17. I have paid the fee of Rs............................................................................................... 18. I am exempted from the medical test under Rule 6 of Central Motor Vehicles Rules, 1989. 19. I am exempted from the preliminary test under Rule 11(2) of Central Motor Vehicles Rules, 1989. *Strike out whichever is inapplicable. Date .................... Signature of applicant Duplicate signature of applicant Declaration under subsection (2) of Section 7 of the Motor Vehicles Act, 1988 Shri/Kumari .............................................................................................. son/daughter of ................................................................... who is a minor is under my care and I accept responsibility for his/her driving. If at a later date I decide not to accept responsibility for his/her driving I shall intimate the Licencing Authority in writing for the cancellation of the licence. I give my concent for his/her obtaining learner's licence. Signature ........................................... Name and full address of the parent/ guardian .......................................... .......................................................... Relationship ..................................... (To be signed in the presence of the Licencing Authority or person authorised in this behalf by the Licensing Authority) For office use The applicant is exempted from the medical test under Rule 6 and the preliminary test under Rule 11(2) of the Central Motor Vehicles Rules, 1989. Learner's Licence may be issued. The applicant was tested with reference to Rule 11(1) of the Central Motor Vehicles Rules, 1989. He has passed the test. Learner's Licence may be issued. He has failed in the test. (Reasons should be specified). Learner's Licence may be refused. Signature of Licensing Authority or other person authorised in this behalf Strike out whichever is inapplicable.
