FORM 4 (See Rule 14) Form of Application for Licence to Drive a Motor Vehicle To The Licensing Authority 1 Apply for a Licence to enable me to driver Vehicle of the following description (a) Motor cycle without gear (b) Motor cycle with gear (c) Invalid carriage (d) Light Motor vehicle (e) Medium goods vehicle (f) Medium passengers 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 to be enclosed) .............. ................................ 6. Educational qualification .............. ................................ 7. Identification mark(s) ...... ........ ................................ 8. Optional-Blood Group RH FACTOR .............. ......................... 9. Have you previously held driving .............. ................................ Licence if so give details 10. Particulars and date of ever .............. ................................ conviction which has been ordered to be endorse on any Licence held by applicant 11. Have you been disqualified for .............. ................................ obtaining a Licence to drive if so, for what reason. 12. Have you been subjected to a .............. ................................ driving test as to your fitness or ability to drive a vehicle in respect of which a Licence to drive is applied for ? If so give the following details. .............. ................................ Date of test Testing Authority Result of test 13. I enclose 3 copies of my recent photograph of the five centimeters into six centimeters (Where laminated card is used on photograph are required) 14. I enclose the learner Licence No .................. Issued by Licensing Authority. 15. I enclose the Driving Certificate No. ............. Dated ................ Issued by ........................ 16. I have submitted along with application for Learners Licence the written consent of parents / guardian. 17. I have submitted along with application for Licence/enclose the medical certificate 18. I enclose form the Medical test under rule 6 of Central Motor Vehicle Rule 1989. 19. I am examined from the preliminary test under rule (2) of Central Motor Vehicle Rules. 1989. 20. I have paid the fee of rupees. I have by declare the best of my knowledge and behalf the particulars give above and Note - Strike out whichever in applicable. Date ................... Signature or thumb impression of applicant Certificate of test of competent to driver The applicant has passed the test prescribed under the rule 15 of the Central Motor vehicle Rules 1989. The test conducted on (enter the registration trade and description of the vehicle .......................................... on date The applicant has failed in the test (The details of deficiency to be listed out) Date .................. Signature of testing Authority Full name & designation Two specimen signature of applicant
