FORM-4 CENTRAL MOTOR VEHICLE RULE -1989 (See Rule -10) FORM OF APPLICATION FOR THE LICENCE TO DRIVE A MOTOR VEHICLE To, The Licensing Authority Apply for the Licence the enable me to drive vehicle of the following description. a. Motor Cycle without Gear b. Motor Cycle with gear c. Invalid Carriage d. Lighter Motor Vehicle e. Medium Good Vehicle f. Medium passenger motor vehicle g. Heavy Passenger motor Vehicle h. Road Roller i. Motor Vehicle of the following Description. PARTICULARS TO BE FURNISH BY APPLICANT 1.Full Name _____________________________________________ 2.Son /Wife /Daughter of ____________________________________________ 3.Permanent Address ____________________________________________ 4.Proof to be enclosed ____________________________________________ 5.Temporary Address (If any) ____________________________________________ 6.Official Address (If any) ____________________________________________ 7.Date of Birth proof of age to be enclosed ____________________________________________ 8.Educational Qualification ____________________________________________ 9.Blood Group and R.H factor ____________________________________________ 10.Have you previously held driving ____________________________________________ 11.License .if so give detail ____________________________________________ 12.Particulars and date of every conviction with has been ordered to be ____________________________________________ 13.endrosed on any license held be the applicant ____________________________________________ Have you been disqualified for obtaining a licence to drive? If so for what reason . Have you been subject to a driving test as to your fitness or ability to drive a vehicle in respect to which a licence to drive is added for ? if so give the following details. Date of Test Testing Authority Results of Test I enclosed these copies is my recent photograph of the size five centimeter in to six centimeter where limited card is used on photograph are required) I enclosed the Learner's Licence No _________ date ______________ issued by licensing Authority ____________________________ I enclosed the driving certificate No: ____________________________ Issued by ____________________________ I have submitted along with my application for learner's licence the written concent parents/guardian I have submitted along with the application for learner's enclose the medical fitness certificate. I am exempted from priliminary test under Rule 6 of the central motor vehicle Rule 1989. I am exempted from priliminary test under Rule 112 (2) of case central motor vehicle Rule 1989. have paid the fees of Rupees _________________________ I have declare that to be best of my knowledge and particular give above are true. Date : Signature Thumb Impression of Applicant Certificate of that competency to drive The applicant has passed the test prescribed Rule of the central motor vehicle 1989 the test was conducted (here either the registration mark and description the vehicle_____________________________ of date . The applicant has failed in the test he details of the deficiency of the listed out. Date : Signature of the testing Authority Full name and Address : Specimen Signature of Applicant :
