GCPP.-105/38-30 , 000 Cps.-12-7-2007. FORM-2 [ See rule (10) ] Application for the Grant or Renewal of Learner's Licence To The Licensing Authority Puducherry I hereby apply for a licence authorising me to drive as a learner of the following motor vehicle(s) Space for passport size (a) Motor cycle without gear photograph (b) Motor cycle with gear (c) Invalid carriage (d) Light motor vehicle (e) Medium goods vehicle (t) Heavy goods vehicle (g) Medium passenger motor vehicle (h) Heavy passenger motor vehicle (i) Road roller G) Motor vehicle of the following description : Particulars to be furnished by the Applicant 1. Full name 2. Son/Wife/Daughter of 3. Permanent address (proof to be enclosed) 4. Temporary address/Official address (if any) 5. Date of Birth (proof of age to be enclosed) 6. Educational qualification 7. Identification marks 2. 8. Optional-Blood Group RH factor 9. I hold an effective 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 learner's licence previously held up by the applicant in respect of the description of vehicle to which the applicant has applied 12. Have you ever been disqualified for holding or obtaining any driving licence or learner's licence? If so, for what reason? 13. 1 enclose 3 copies of my recent photograph (photograph to be of the size of 5 cm. x 6 cm.) 2 14. 1 enclosed medical fitness certificate dated ..........................................................................................issued by (Doctor) .......................................................................................................................................................... 15. I have submitted along with my earlier application for learner's licence/I enclosed the written consent of parent/guardian (in the case of applicant being a minor).. 16. 1 enclose driving certificate dated ....................................................... issued by ......................................... .................................... ............................................................. (name and address of the driving school) 17. I have paid fee of Rs ..................................................................................................................................... 18. 1 am exempted from the medical test under rule 6 of the Central Motor Vehicles Rules, 1989. 19. 1 am exempted from the preliminary test under rule 11(2) of the Central Motor Vehicles Rules, 1989. Date : Specimen Signature or thumb-impression of Applicant. (1) ............................................................................. (2) ............................................................................. Signature or thumb-impression of Applicant. 3 Declaration under sub -section ( 2) of section 7 of the Motor Vehicles 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 concent for his/her obtaining learner's licence. (To be signed in the presence of the Licensing Authority or person authorised in this behalf by the Licensing Authority) Signature Name and full address of the Parent/Guardian Relationship ................: .................................. FOR OFFICE USE ONLY * The applicant is exempted from the medical test under rule 6 and preliminary test under rule 11 (2)of the Central Motor Vehicles Rules, 1989. Learner's licence may be issued. * The applicant was tested with reference to rule 11(1) of the Central Motor Vehicles Rules, 1989. He has passed the test. Learner's licence may be issued. He has failed in the test (Reasons should be specified) Learner's licence may be refused. Signature of the Licensing Authority or other person authorised in this behalf: * Strike out whichever is inapplicable.
