Form - 2 (See rule 10) FORM OF APPLICATION FOR THE GRANT OR RENEWAL OF LEARNER'S LICENSE Space for Passportsize Photograph To The licensing authority . . . . . . . . ... . . . . . . . . . . I hereby apply for a license authorising me to drive as a 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. j) Motor vehicles to the following description: ........................................................................................................................................................... ........................................................................................................................................................... .................................. Particulars to be furnished by the 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. Optional: Blood Group / RH factor .................................... 9. I hold an effective driving license to drive a) Motor cycle / Light motor vehicle / Medium Passenger motor ..................................... vehicle/Medium goods vehicle with effect from 10. Particulars of any driving license previously held by applicant. ..................................... Whether it was cancelled and if so, for what reason? 11. Particulars of any learner's license previously held 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 license ..................................... or learner's license ? If so, for what reasons ? 13. I enclose 3 copies of my recent photographs (passport size) 14. I enclose medical fitness certificate dated ...........................issued by (doctor ) 15. I have submitted along with my earlier application for learner's license /I enclose the written consent of parent / guardian( In the case of applicant being a minor ) 16. I enclose driving certificate dated .......................... issued by . . . . . . . . . . . . . . . 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. ( Name & address of the driving school ) Date: 1 Signature or thumb impression of the applicant 2 Specimen Signature or thumb impression of the applicant 1. ....................................................................................................................... 2. ........................................................................................................................ Declaration under sub-section (2) of section 7 of the Motor Vehicles Act, 1988. Shri / Kumari ......................................................................................................... Son / Daughter of.................................... who is a minor under my care and accept responsibility for his / her driving. If I at a later date decide not to accept responsibility for his / her driving , I shall intimate the licensing authority in writing for the cancellation of the licence. I give my consent for his / her obtaining learner's license. Signature: Name and full address of the parent / guardian ................................................................. Relationship.............................................. (To be signed in the presence of the Licensing Authority or person authorised in thisbehalf 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 License 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 License may be issued. *He has failed in the test, (Reason should be specified) . . . . . . . . . . . . . . . . . . . . ... Learner's License may be refused. Signature of Licensing Authority or other person authorised in this behalf *Strike out whichever is inapplicable.
