FORM L. CON. A. [Rule 18 of Delhi Motor Vehicles Rules, 1992] APPLICATION FOR ISSUE/RENEWAL OR DUPLICATE OF CONDUCTOR'S LICENCE/BADGE 1. Full name................................. 2. Name of Father............................. 3. Date of Birth............................... 4. Present Address............................. .................................... 5. Permanent Address........................... ...................................... 6. Conductor's Licence No..............Badge No......... 7. Date of Issue.......... Date of Expiry.............. 8. Issuing Authority.............................. 9. Valid upto................................ 10. Endorsement, if any........................... 11. (1) Certified that I am not disqualified from holding a Conductor's Licence. (2) Certified that there is no adverse entry on my Conductor's Licence. OR The adverse entry or punishment given to me since the date of last issue is as under:.................................... (3) Certified that I am holding a valid Adult First Aid Certificate No...... dated ....... Issued by St. John Ambulance Brigade, New Delhi. (4) Certified that I am not less than 18 years of age and this above statements are true. (5) I attach two copies of latest photographs of myself (in case of issue of new licence) Dated: Signature or thumb impression of applicant Duplicate signature or thumb impression of applicant:
