FORM ACLA. Form of application for an agent or canvasser licence in respect of Public Service Vehicles [See Rule 234 (3)] To The Secretary, Regional Transport Authority. ............................................... I hereby apply for the grant of a licence as an agent or canvasser in respect of Public Service vehicles. 1. Name in full (Block letters) : ................................................................................... 2. Name of father or husband : ................................................................................... 3. Address in full : ................................................................................... : ................................................................................... : ................................................................................... 4. Date of birth (to be supported : ................................................................................... by satisfactory proof) 5. Educational qualification (evidence to : ................................................................................... be enclosed) 6. (a) Particulars of an Agent's / Canvasser's Licence previously held : .................................................................................. (b) If you have already been granted a licence state whether it has been suspended or cancelled, and if so, by : .................................................................................. whom and when the suspension or cancellation has been ordered. I hereby declare that the above particulars are true to the best of my knowledge. I attach three copies of my recent photograph. I undertake to furnish a security of Rs. ........................................... only on demand and so abide by all the conditions that may be attached to the licence. ......................................... Specimen Signatures: Signature of applicant. 1. 2. Date :
