FORM 2 (See Rule 10) FORM OF APPLICATION FOR THE GRANT OR RENEWAL OF LEARNER'S LICENCE To The Licensing Authority, ____________________ Space for Passport Size I hereby apply for a Licence authorising me to drive as a Photograph 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 passengers motor vehicle (g) Heavy goods vehicle (h) Heavy passenger motor vehicle (I) Road Roller Motor vehicle of 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 age enclosed) 6. Educational qualification 7. Identification mark(s) 8. Optional-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 in respect of the description of vehicle to which the applicant has applied. 12. Have you been disqualified for holding or obtaining driving Licence or learner's Licence if so, for what reason. 13. I enclose 3 copies of my recent photograph (passport size photograph) 14. I enclose medical fitness certificate dated .............. issued by doctor. 15. I have submitted along with my earlier application of Learner's Licence/enclose the written concent of parents/guardian (in case of applicant being a minor) 16. I enclose driving certificate dated ................ issued by ....................... (Name & address of the driving school) 17. I have the fee of the Rs. ....................... 18. I am exempted the Medical test under rule of Central Motor Vehicle Rules 1989. 19. I am exempted from the preliminary test under rule 11 (12) of Central Motor Vehicle Rules. 1989. Strike out whichever is inapplicable. Date ................... Specimen signature or thumb impression of applicant .............. ............................ ......................... ............. ..... Specimen signature or thumb impression of applicant Declaration under sub-section (2) of section 7 of the Motor Vehicle Act. 1988. Shri/Kumari ................ son/daughter of ................ who is a minor under my care and I accept responsibility for his/her driving If at a late date I decide not to accept responsibility for his/her driving shall intimate the licensing authority in writing for a cancellation I give my consent for his/her obtaining learner's Licence. Signature ....... ................. Name & Full address of the Parent/guardian.................. Relationship..... ............... (To be signed in the presence of the Licensing Authority or person authorised in this behalf by the Licensing Authority) FOR OFFICE USE ONLY The applicant is exempted from the medical test under rule 6 and the preliminary test under rule 11 (2) of the Central Motor Vehicle Rules, 1989. Learner's Licence may be issued. The applicant was tested with reference to rule 11 (1) of the Central Motor Vehicle Rules, 1989 he/she has passe I the test. Learner's Licence may be issued. he/she 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.
