Form L. L. D. Intimation of loss or destruction of driving licence and application for duplicate (See Rule 25) To The Licensing Authority, ..................................... 1............................................................ of (Permanent Address)........................................................................ ........................................................................................................................................................................... ... and(present address)...................................................................................................................................... .... (Father's Name) .............................................. hereby report that driving Licence No .................................. .... issued by Licensing Authority ............................................................................................ .......... on or about the day of .................................... in No .................................. and on ................................ ................ for the period up to .................................................. has been lost / destroyed (i) in the following circumstances: 2. I furnish below further details of the licence a) Class of vehicles for which the licence is valid ................................................................................................... ....................................................... b) The number and date of the Authorisation and the Licensing Authority which issued the authorisation to drive as apaid employee (if so authorised) ................................................................................................................................................... .......... c) Whether authorised to drive transport vehicles if so, the date and authority .................................................................................................................................................. ............. d) Serial number of Badge, if any, issued and by whom issued? ............................................................................................................................................... ................ e) Endorsement of punishments ................................................................................................................................................ ............... 3. I hereby apply for a duplicate licence and tender Rupees........................................................ ............. 4. I attach two clean copies of a recent photograph of myself (i) 5. I hereby declare that the above particulars are to the best of my knowledge correct. ............................... ............. Date : Signature of applicant Note : (i) 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.
