To I hereby apply for license authorizing me to drive as a learner the following Vehicles. 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 good Vehicle h. Heavy Passenger Motor Vehicle i. Road Roller j. Motor Vehicle of the following description. PARTICULARS TO BE FURNISHED BY APPLICANTFull Name of the Applicant 1. Son/ Wife/ Daughter of 2. Permanent Address 3. Proof to be Enclosed 4. Temporary Address 5. Official Address 6. Date of Birth proof of age to be enclosed 7. Educational Qualification with percentage of marks Affix a passport size photocopies of yours. (Space for Photograph of the Size Five Centimeter by Six Centimeter)The Licensing AuthorityFORM OF APPLICATION FOR THE GRANT OF LEARNER'S LICENSEFORM -2Government of OrissaCommerce & Transport DepartmentParticulars to be Furnished by Applicant Published on National Portal of India (india.gov.in) previously held of applicant in-respect of the description of vehicle to which the learner license, if so for what reason 14. I enclosed 3 copies of my recent photograph (Photograph to be of the size of five centimeter by six centimeter) 17. I enclosed the written consent of parents guardian in the case of applicant being minor 20. I am exempted from the medical test under rule 6 of the central motor vehicle Rule 1989. 21. I am exempted from preliminary test under rule 11(2) of case control motor vehicle Rule 1989. Date: Signature of Applicant Duplicate Signature of Applicant 12. Particulars of any learner's License 8. Identification Marks 9. Blood Group and R.H factor 10. I hold on effective driving license to drive a11. Particular of any driving license previously, hereby applicant whether It was cancelled and if so, for what reason applicant has applied18. I enclose driving certificate date issued by19. I have paid the required fees for the license YesNo Yes NMotor Cycle/Light Motor Vehicle/Medium Good Vehiclewith effect fromPassengerMotor Vehicle/ Yes13. Have you been disqualified for holding or obtaining driving license of 16. I have submitted along with my earlier application for learner's License15. I enclosed medical Fitness Certificate Datedissue by DoctorPublished on National Portal of India (india.gov.in) He has passed the learner's license may be issued. He has passed the test (Reason should be specific) .Learner's License may be referred. Strike out whichever is Applicable Signature of Licensing Authority of Person authorised in the behalf Who is minor is under my carry and accept responsibility for/ her driving if at a letter date I decide not to accept responsibility License . I drive my consent for her obtaining learner's license. Declaration under sub section (2) of section 7 of the motor vehicle act 1989. Signature (To be signed in the presence of the Licensing Authority or person authorised in this behalf by the Licensing Authority. ) The applicant is exempted from the Medical test under Rule (6) and Preliminary test under Rule (2) of the central Motor Vehicle Rules 1989 learner's may be issued. The applicant was tested with reference to rule 11(1) of the Central Motor Vehicle Rule 1989. Sri /Kumari NameFull Address of the parent guardian relationship : Daughter ofSon /FOR OFFICE USE Published on National Portal of India (india.gov.in)
