FORM 2 FORM OF APPLICATION FOR THE GRANT OR RENEWAL OF LEANER'S LICENCE [See rule 10] To The Licensing Authority, ............................................ ............................................ I hereby apply for a licence authorising me to drive as a learner, the following motor vehicles (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 (h) Heavy goods vehicle (i) Road roller (j) Motor vehicle of the following description : ___________________ PARTICULARS TO BE FURNISHED BY APPLICANT 1. Full Name (in Capital 2. Son/Wife/Daughter of 3. Permanent of address (Proof to be enclosed) 4. Temporary/Official address Official address (if any) 5. Date of Birth (Proof of age to be enclosed 6. Education qualification 7. Identification mark (s) 8. Optional ........................................................................ ........................................................................ ........................................................................ ........................................................................ ........................................................................ ........................................................................ Day.................Month.............Year................ ........................................................................ 1...................................................................... 2...................................................................... 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 learners licence previously held up applicant 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 reasons. 13. I enclose 3 copies of my recent photograph [passport size photograph]52 ............... 14. I enclose medical fitness certificate dated issued by (doctor).................................... 15. I have submitted along with my earlier application for Learner's Licence/I enclose the written consent 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 fee of Rs. ................................................................................................. 18. I am exempted from the Medical Test rule 6 of Centre Motor Vehicle Rules, 1989. 19. I am exempted from the preliminary test under Rule 11 (2) of Central Motor Vehicle Rules, 1989 Date : _____________ Place : _____________ Specimen signatures or thumb impression of the applicant Specimen signatures or thumb impression of the applicant 1 ........................................ 2. ....................................... DECLARATION UNDER SUB-SECTION (2) OF SECTION 7 OF THE MV 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 licensing authority in writing for the cancellation of the licence. I give my consent 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 Licensing 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 text 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 has passed the test. Learner's Licence may be issued. * He has failed in the test (Reason should be specified). Learner's Licence may be refused. * Strike out whichever is inapplicable. or other person authorised in this behalf
