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To,

The Licensing Authority,
I apply for a licence to enable me to drive vehicles Of the following description:-

(a) Motor Cycle without gear
(b) Motor Cycle with gear
(c) Light Motor Vehicle
(d) Medium Goods Vehicle
(e) Medium Passenger Motor Vehicle
(f) Heavy Goods Vehicle
(g) Heavy Passenger Motor Vehicle
(h) Road Roller

Full name:

Son/Wife/Daughter of:

Permanant address (Evidence to be produced):

Temporary address/official address (if any)

Date of Birth (Proof to be enclosed):

Educational Qualification:

Identification Mark 1:

Identification Mark 2:

Blood Group with Rh factor:

Give details if driving license is held previosuly:

Particulars and date of every conviction which has been ordered to be endorsed on any licence held by the applicant:

Have you been disqualified for obtaining a licence to drive? If so, for what reason?

Have you been subjected to a driving test as to your fitness or ability to drive a vehicle in respect of which a licence to drive is applied for? If so, give the following details :-

	Date of Test	Testing Authority	Result of Test
(1)
(2)
(3)
(4)

Signature or thumb impression of applicant

Form Application for license to drive a Motor Vehical

Please enter the information in the form below