(See Rule - 14 of MV Act-1983) FORM OF APPLICATION FOR LICENSE TO DRIVE A MOTOR VEHICLE FORM - 4 To The Licensing Authority , Arunachal Pradesh I apply for a license to enable me to drive Vehicle of the following description as paid employee/PRIVATE/Public Service vehicle/ Goods vehicle . a). Motor cycle/Scooter (Without Gear) b). Motor cycle/Scooter (With Gear) c). Invalid Carriage d). Light Motor Vehicle e). Medium Goods Vehicle f). Medium Passenger Motor Vehicle g). Heavy Goods Vehicle h). Heavy Passenger Motor Vehicle i). Road Roller. PARTICULARS TO BE FURNISHED BY THE APPLICANT Name in full (In block letter) Permanent Address Present Address 1. 2. 3. 4. 5. Father's / Mother's/ Guardian's/ Husband name ( If any)Temporary address/ Official address 6. Date of birth Published on National Portal of India (india.gov.in) Educational Qualification7. 8. Identification marks 9. Blood Group and (RH Factor) Have you previously held driving license, if so, give details :10. Yes No Particulars and date of every eviction which has been ordered to be endorsed on any license held by the applicant.11. 12. Have you been subjected to a driving test to your fitness or ability to drive a vehicle in respect of which a license to drive is applied for if so give the following details date of test 13. Have you been disqualified for obtaining a license drive ? if so for what reason : testing authority result of to Yes No14. I enclose three copies of my recent photograph of the size five centimeters into six centimeters ( where laminated card is used to photograph are required.) I enclose the driving license No. issued by the dated 15. 16. I enclose the driving certificate No. dated Published on National Portal of India (india.gov.in) 18. 17. 19. 20. I have submitted along with my application for learner's I enclose the medical fitness certificate. I have submitted along with my application for learner's I enclose the medical fitness certificate. I am exempted from the medical test under rule 4 of the Central motor vehicle Rule - 1989. I am exempted from the medical test under rule 11(2) of the Central motor vehicle Rule-1989. Yes No Yes No Yes No Yes No I have paid the fee Rupees21. I hereby declare the best of my knowledge and belief the the particulars given above are true. NOTE :- Strike out whichever is inapplicable. Signature/Thumb impression of Applicant /- Date :- Place :- CERTIFIED OF TEST COMPETENCE TO DRIVE 1. The applicant has passed the test prescribed under rule 15 of the central motor vehicle Rules,1989 the test was conducted on for Scooter/Motor Cycle/LMV/HMV/MMV/PSV . 2. The applicant has failed in the test. Two specimen Signature of Applicant :- Date :- 1) 2) Published on National Portal of India (india.gov.in)
