Form2 {See Rule -2} Form of Application for the grant of renewal of Learner's License To The Licensing Authority I hereby apply for a license authoriating 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 vehicles 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 (if any)________________________________________ 5. Date of birth _________________________________________ 6. Educational Qualification 7. Identification Mark (s) 1) 2) 8. 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 learners license previously held up applicant in respect of the description Of vehicle to which the applicant has applied___________________________ 12. Have you been disqualified for holding of obtaining driving license or learner's license if so, for what reason 13. I enclose 3 copies of my recent photograph (Photograph to be of the size of five centimeters by six centimeters)_______ 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 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 Vehicle Rule, 1989. 19. I am exempted from the Preliminary test under Rule 11 (2) of Central Motor Vehicle Rule, 1989. * Strike out whichever is inapplicable. Dated:__________ 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 minor is under my care and I accept responsibility for his/her driving. If at a later date I decide not accept responsibility for his/her driving shall intimate the licensing authority in writing for the cancellation of the license I gave 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 License Authority or person authorized in this behalf by licensing authority.) FOR OFFICE USE * The Applicant is exempted from the medical test under rule 6 and the preliminary test under 11 (2) of the Central Motor Vehicle Rules, 1989. Learner's License may be issued. * The applicant was tested with reference to rule 11(1) of central Motor Vehicle Rules, 1989. He has passed the test. Learner's License may be issued. * He has failed in test (Reason should be specified) Learner's License may be refused. Signature of Licensing Authority or Other person authorized in this behalf * Strike out whichever is inapplicable
