Form R C L A. Form of application for renewal of conductor's Licence (See rule 40) To The Licensing Authority , ..................................... I hereby apply for the renewal of my licence which is attached herewith and the particulars of which are as follows 1. Name :....................... 2. Fathers Name :....................... 3. Present Address :....................... 4. Number and date of issue of the licence :....................... 5. Authority by whom the licence was issued :....................... 6. If the licence is not renewed within 30 days from the date of expiry of the licence, full reasons for delay :...................... 7. I hereby declare that I am not disqualified for holding or obtaining a conductor's licence and that I am not subject to any disease or disability likely to render me unfit to perform the duties of a conductor. Place : Date : . . . . . . . . . . . .. Signature of the applicant.
