GCPP.-105/41-50,000 Cps.-15-11-2006. FORM LLD [ See rule 4 (1) ] INTIMATION OF LOSS OR DESTRUCTION OF DRIVING LICENCE AND APPLICATION FOR DUPLICATE To The Licensing Authority, I . ........................................................................... son / daughter / wife of ......................................................................... (Permanent address) ..................................................................................................................................... and (Present address) ................................................................................................................................................................. hereby report that the driving licence No ...................................................................issued by the Licensing Authority.................................................................. on or about ................................................................ the day of ......................................... and renewed in No............................. by the Licensing Authority ............................................................................................................................................ for the period up to ............................................. * has been lost / destroyed in the following circumstances : 2. I furnish below further details of the licence (a) Class of vehicles for which the licence is valid (The Licensing Authority which issued, each class may be mentioned) (b) The number and date of the authorisation and the Licensing Authority which issued the authorisation to drive as a paid employee (if so authorised) (c) Whether authorised to drive transport vehicles , if so, the date and authority ? (d) Serial number of badge, if any, and by whom issued (e) Endorsements of punishment 3. I hereby apply for a duplicate licence. 4. I attach two clear copies of a recent photograph of myself. 5. I hereby declare that the above particulars are true to the best of my knowledge and correct. Date : Signature or thumb-impression of applicant. Note : `Strike out alternative not required and items not applicable if the column is not sufficient particulars to be furnished on a separate sheet to be appended. Forwarded to the Licensing Authority ................................................................................................................................ for verificationand completion of Part-II. Date : Licensing Authority. Note : If no reply is received within six weeks from the date of receipt of this reference it will be presumed that this authority has no objection to the grant of duplicate licence.
