Downloading rate at CICs at the cost of Rs.2 per page FORM 2 [See rule 10] FORM OF APPLICATION FOR THE GRANT OR RENEWAL OF LEARNER'S LICENSE To. The Licensing Authority, .................... .................... I hereby apply for a license authorising me to drive as a learner, the following motor vehicle (s): (a) Motor Cycle 3 [without Gear] (b) Motor Cycle with Gear (c) Invalid Carriage (d) Light motor vehicle 1[(e) Transport vehicle] (f) Medium passenger motor Vehicle 2[***] (i) Road Roller (j) Motor vehicle of the following description ................................. ................................. PARTICULARS TO BE FURNISHED BY APPLICANT 1. Name ......................... 2. Son / Wife / Daughter of ......................... 3. Permanent Address ......................... (Proof to be enclosed) 4. Temporary address / ......................... Official address (if any) 5. Date of birth ......................... (Proof of age to be enclosed) 6. Educational Qualification ......................... 7. Identification Marks Space for 2 [Passport size photograph] (1) ......................... (2) ......................... 3 [8. Optional Blood group ......................... RH factor] 9. I hold an effective driving license to drive: (a) Motor Cycle / light motor vehicle / medium passenger motor vehicle / medium goods vehicle with effect from ......................... 10. Particulars of any driving license previously held by applicant. Whether it was cancelled and if so, for what reason; 11. Particulars of any learner's license previously held by applicant in respect of the description of vehicle to which the application has applied. ................... 12. Have you been disqualified for holding or obtaining driving license or learner's. If so for what reasons. ......................... 13. I enclose 3 copies of my recent photograph (passport size photograph). ......................... 14. I enclose medical fitness certificate dated .......... issued by (doctor). 15. I have submitted alongwith my earlier application for learner's license / I enclose the written consent of parent / guardian (in the case of applicant being a minor). 16. I enclose driving certificate dated ............ issued by ......... (Name and address of the driving school) 17. I have paid the fee of Rs. ............ 18. I am exempted from the medical test under rule 6 of Central Motor Vehicle Rules, 1989. 19. I am exempted from the preliminary test under rule 11(2) of the Central Motor Vehicle Rules, 1989. * Strike out whichever is inapplicable Date ........ 1[Signature or thumb impression of Applicant] 1[Specimen signature or thumb impression of Applicant] 1. ............... 2. ............... Declaration under sub-section (2) of Section 7 of the Motor Vehicles Act, 1988 Shri / Kumari ............. Son / daughter of ....... who is a minor is under my care and I accept responsibility for his / her driving. If at a latter date I decide not to accept responsibility for his / her driving I shall intimate the licensing authority in writing for the cancellation of the license. I give my consent for his / her obtaining learner's license. Signature .............................. Name and full address of the parent / guardian .............................. Relationship .......... (To be signed in the presence of the licensing authority or person authorized in this behalf by the licensing authority). For office use * The applicant exempted from the medical test under rule 6 and the preliminary test under rule 11(2) of the Central Motor Vehicles Rules, 1989. Learner's license may be issued. * The applicant was tested with reference to rule 11(1) of the Central Motor Vehicles Rules, 1989. He has passed the test. Learner's license may be issued. He has failed in the test. (Reasons should be specified). Learner's license may be refused. Signature of licensing authority or other person authorized in this behalf * Strike out whichever is applicable 1. Subs. By G. S. R. 338 (E), dated 26th March, 1993 (w.e.f. 26-3-1993). 2. Subs. By G. S. R. 933 (E), dated 28th October, 1989. 3. Subs. By G. S. R. 684 (E), dated 5th October, 1999 (w.e.f. 22-10-1999) and again subs. By G. S. R. 76 (E), dated 31st January, 2000 (w.e.f. 31-1-2000). 4. Subs. By G. S. R. 221 (E), dated 28th March 2001 (w.e.f. 28-3-2001). 5. Items (g) and (h) omitted by G. S. R. 684(E), dated 5th October, 1999 (w.e.f. 22-10-1999) and ins. By G. S. R. 76 (E), dated 31st January, 2000 (w.e.f. 31-1-2000) and omitted by G. S. R. 221 (E), dated 28th March 2001 (w.e.f. 28-3-2001). 6. Subs. By G. S. R. 933 (E), dated 28th October, 1989. 7. Sub. by G. S. R. 933 (E), dated 28th October, 1989. TGPA-26-04-2004 20,000 J. C. No. 10902
