Type of licence

Forms and documents

Fees required

(original)

Medical Certificate

(See rules 5(1), (3), 14 (d), and 18(d)
To be filled in by a registered medical practitioner appointed for the purose bny the State Government or person authorised in this behalf by the State Government or person authorised in this behalf by the State Government referred to under Sub-Section-3 of Section 8) .
1. Name of the applicant
2. Identification Marks 1)
4)
3.(a) Does the applicant to the best of your judgement suffer from any defect of vision? if so, has it been corrected by suitable spectecle?
(b)Can the applican to the best of your judgement readily distinguish the primary colours, redn and green ? Yes / No
(c) In your opinion, is he able to distinguish with his eye sight of a distance of 25 metres in good day light a motor car number plate. Yes / No
(d) In your opinion does the applicant suffer from a degree of deafness which would prevent his hearing the ordinary sound signals. Yes / No
(e) In your opinion does the applicant suffer from night blindness Yes / No
(f) Has the applicant any defect or deformity or loss of member which would interfere with the efficient performance of his duties as a driver? If so, give your reasons in details. Yes /No
(g) ............................................................................................................

OPTIONAL

(a) Blood Group of the applicant (if the applicant so desires that the information may be noted in his diving licence)
(b) RH factor of the applicant (if applicant so desires that the information may be noted in his driving Licence)
Declaration made by the applicant in Form -1 as to his physical fitness is attached.
I certify that I have personally examined the applicant .......................................... I also certify that while examining the applicant I have directed special attention to the distance vision and hearing ability, the condition of arms, legs, hands and joints of both extremities of the candidate and to the best of my judgement he is medically fit/not fit to hold a Driving Licence.
Thne applicant is not medically fit to hold a licence for the following reasons.
..............................................................................................................................


Signature
1. Name and Designation of the Medical
Officer / Practitioner
(Seal)
2. Registration Number of Medical Officer
Signature of Thumb of Medical Officer
Signature of thumb impression of the Candidate .........................................................................................
Note : The Medical Officer shall affix his signature over the photograph affixed and ensure that part of his signature is upon photograph & part of the certificate.

3. I enclose three copies of my recent photograph of the size 5x6cms (where laminated card is used no photographs are required).

Form of Application for the Grant or Renewal of Learner's Licence

To
The Licensing Authority
I hereby apply for a licence authorizing me to drive as a learner, the following motor vehicle(s).


a) Motor cycle without gear
b) Motor cycle with gear
c) Invalid carriage
d) Light motor vehicle
e) Medium goods vehicle
f) Medium passenger motor vehicle
g) Heavy goods vehicle
h) Heavy passenger motor vehicle
i) Road Roller
j) Motor Vehicles of the folloing description

PARTICULARS TO BE FURNISHED BY THE 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 to be enclosed)

6.Educational qualification

7.Identification marks

8.Blood group and RH factor

9.I hold an effective driving licence to drive
a)Motor cycle/Light motor vehicle/Medium passenger motor vehicle
Medium goods vehicle with effect from
…………………………………………………………….

10.Particulars of any driving licence previously held by applicant
Whether it was cancelled and if so, for what reason:………………………………

11.Particulars of any learner's licence previously held by applicant in respect of the description of vehicles to which the applicant has applied.

12.Have you been disqualified for holding of obtaining a driving licence or learner's licence? If so, for what reasons.

14. I enclose the Learner's Licence No..............dt................. issued by the Licensing Authority.
15. I enclose the Driving Certificate No.................dated.......... issued by..........
16. I have submitted along with the application for Learner's Licence the written consent of parent / guardian.
17. I have submitted along with the application for Learner's Licence / I enclose the medical fitness certificate.
18. I am exempted from the medical test uner Rule 6 of the Central Motor Vehicles Rule, 1989.
19. I am exempted from preliminary test under Rule 11(2) of the Central Motor Vehicles Rules 1989.
20. I have paid the fee of Rupees..................................
I hereby declare that to the best of my knowledge and belief the particulars given above are true.
Note : Strike out whichever is inapplicable.
Date:..................... Signature/Thumb impression of applicant

CERTIFICATE OF TEST OF COMPETENCE TO DRIVE

The applicant has passed the test prescribed under Rule 15 of the Central Motor Vehicles Rules, 1989. The test was conducted on (here enter the registration mark and description of the vehicle).................on date.........................

The applicant has failed in the test
(The details of deficiency to be listed out)

Signature of Testing Authority
Full Name and Designation

Date:

Two specimen signatures of applicant

* Strike out whichever is inapplicable

2.