"Form 4-A [See Rule 14(2)] FORM OF APPLICATION FOR ISSUE OF INTERNATIONAL DRIVING PERMIT TO DRIVE A MOTOR VEHICLE IN OTHER COUNTRIES To Space for The Licensing Authority, Passport size .......... Photograph .......... I apply for an International Driving Permit to enable me to drive vehicles of the following categories. CATEGORIES OF VEHICLES FOR WHICH THE PERMIT IS APPLIED FOR (A) Motor Cycles Category L1 and Category L2 (B) Motor vehicles, other than those in category (A) above, having a permissible maximum mass/weight not exceeding 3.500 KG (7700 lb) and nor more than eight seats in addition to the driver's seat in Category M1: (C) Motor Vehicles used for the carriage of goods and whose permissible maximum mass/weight exceeds 3.500 KG (7700lb): (D) Motor vehicles used for the carriage of passengers and having more than eight seats in addition to the driver's seats; (E) Combination of vehicles of which the driving vehicle is in a category or categories for which the driver is licensed (B and/or C and/or D) but which are not themselves in that category or categories. PARTICULARS TO BE FURNISHED BY APPLICANT 1 Name (Surname)(Middle Name)(First Name) 2 Father's or Husband's name 3 Place of Birth and Country (Proof to be enclosed) 4 Address: (a) Present (b) Permanent 5 Date of birth (Proof to be enclosed) 6 Educational Qualification 7 Identificational Qualification (1) (2) 8 Blood group/RH factor 9 Have you previously held International Driving Permit? If so, give details. 10 Particulars and date of every conviction which has been ordered to been endorsed on any driving licence held by the applicant 11 Have you been disqualified for obtaining a driving 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 driving licence is applied for? If so, give the following details. Date of test Testing authority Result of test (1) (2) (3) (4) 13. I enclose three copies of my recent passport size photograph. 14. I enclose the copy of driving licence No... dated.... issued by...Valid upto.......... 15. I enclose a medical certificate in Form 1A. 16. I have paid the fee of Rs............... I hereby declare that the particulars given above are true to the best of my knowledge and belief. Date....... Signature/Thumb impression of Applicant * Strike out whichever is inapplicable. 14. In the said rules, after Form 6, the following form shall be inserted namely: "Form 6A [See rule 16(4)] Grey colour REPUBLIC OF INDIA INTERNATIONAL MOTOR TRAFFIC INTERNATIONAL DRIVING PERMIT No....... Valid until........(Maximuym for 1 year or upto the date of validity of driving licence whichever is earlier) Name and Designation of issuing Authority Place of issue Date of issue Driving licence No, and Valid upto Seal of the Authority Signature of Issuing Authority This permit is not valid for the territory of White colour (1)................. The categories of vehicles for the driving of which it is valid are mentioned in this from at paragraph B. (2) This permit shall in no way exempt the holder from the obligation to conform to the laws and regulations relating to residence and the exercise of a profession in each state through which he travels. In particular, itshall cease to be valid in a State if its holder establishes his normal residence there. A. PARTICULARS CONCERNING THE DRIVER (1) Surname/First name/Middle Name ............... (2) Father's or husband's Name ................. (3) Place of Birth and Country ................... (4) Date of Birth/approximate age ................. (5) Address (a) Current Address ................... (b) Permanent Address ................. (6) Blood Group/RH Factor ............. B.CATEGORIES OF VEHICLES FOR WHICH THE PERMIT IS VALID (A) Motor Cycles Category L1 and Category L2: (B) Motor Vehicles, other than those in category (A) above, having a permissible maximum mass/weight not exceeding 3.500 KG (7700 lb) and notmore than eight seats in addition to the driver's seat in Category M1: (C) Motor Vehicles used for the carriage of goods and whose permissible maximum mass/weight exceeds 3,500 KG (7700 lb). (D) Motor Vehicles used for the carriage of passengers and having more than eight seats in addition to the driver's seat. (E) Combination of vehicles of which the driving vehicle is in a category or categories for which the driver is licensed (B and/or C and/or D), but which are not themselves in that category or categories. Restrictive conditions of use such as: Must wear corrective lenses. Valid only for driving Vehicle No. Vehicle must be equipped tobe drivenbya one legged person. Seal or stamp of The Authority below In the appropriate Column. : Photograph 35 x 45 MM A B C D E Seal or Stamp of the Authority Signature or thumb print of holder Disqualifications: - The holder is deprivated of the right to Drive in the territory of (Name of country) at.............. The holder is deprivated of the right to Drive in the territory of (Name of country) at.............. Until .............. On .............. Signature and seal or stamp of Authority, which has invalidated the permit in its territory. Until .............. On .............. Signature and seal or stamp of Authority, which has invalidated the permit in its territory.
