FORM 9-A [See Rule 26(1) (20 (30] INTIMATION OF LOSS OR DESTRUCTION OF THE DRIVING LICENSE AND APPLICATION FOR THE ISSUE OF DUPLICATE DRIVING LICNSE. To The Licensing Authority, ............... ............... Sir, The Driving License No ..................... which is valid up to .. ......... has been lost / destroyed / completely written off / spoiled / torn / mutilated in the following circumstances. ................... ................... I/We hereby declare that to the best of my/our knowledge that the Driving License has not been suspended or cancelled under the provision of the Act or Rules made thereunder and the circumstances explained above are true. I/We do hereby apply for the issue of a duplicate Driving License. The written off/spoiled/torn/mutilated certificate of Driving License is enclosed. I/We have reported the lost to the Police Station ............... .(date). Date...... . Signature/Thumb impression of applicant along with full address. Specimen Signature of the Holder of Driving License. 1. 2.
