(Permanet address) hereby apply for the grtant of conductor's licence. ( No convictions) :- Published on National Portal of India (india.gov.in) Government of Orissa Department of Commerce & Transport APPLICATION FROM FOR THE CONDUCTOR'S LICENCE (See Rule 5 (i) (13)) F O R M - II To The Licensing Authority I, Sri Son of Sri (Present address) 2. I possess Audit First -Aid Certificate No. issued by the branch valid till St.John Ambulance Association (India and attach the same herewith. 3. I have the following convictions: Date. Duplicate signature of the applicant. Published on National Portal of India (india.gov.in) 4. I have By which was revoked for the following reasons; 5. I am not disqualified for holding a conductors Licence. 6. Particulars of orders of disqualifications and endorsement in respect of my previous licence,if any given below. 7. I attach a medical certificate and two copies of recent photograph of myself. 8. I hereby declare that I am not less than 18 years of age. 9. I further declare that I have passed Matriculation examination and enclose here with a copy of the Matriculation Certificate . 10. I further declare that the above statements are correct. Signature of applicant. previously held a conductors licence issued The licence is hereby renewed up to the Signature of the licencing Authority Published on National Portal of India (india.gov.in) Schedule IV--- Form No.-61 CONDUCTOR'S LICENCE Conductor's Licence No Name Son of Present Address Permanet Address. Space for Space for pasting Photograph duplicate Signature of applicant Form L.Con Is licensed as a conductor and has been issued conductor's badge No From To The 2000 Signature of the Licencing Authority. The licence is hereby renewed up to the Signature of the licencing Authority the licence is valid
