INTIMATION OF LOSS OR DESTRUCTION OF LICENCE & APPLICATION FOR DUPLICATE

The Licensing Authority,

----------------------

I --------------------------------------------------------------------------------------------------

of (permanent address)----------------------------------------------------------------------------

of (present address)

Father's Name ------------------------------------------------------------------------------------

hereby report that driving licence No.--------------------------------------------------------------

issued by Licensing Authority----------------------------------------------------------------------

--------------day of --------------has been lost/destroyed in the following circumstance

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----------------------------------------------------------------------------------------------------

2. I hereby apply for duplicate licence and tender twety-five rupees as fee through cash reciept/treasury challan No.------------dated--------------------

3. I attach two clear copies of a recent photograph of myself ------------------------------------

4. I also attach an affidavit to the effect that the licence is not with any challan with any authority in India

Date--------------- Signature or thumb impression of applicant

_______________________________________________________________________

FOR USE IN THE OFFICE OF THE LICENSING AUTHORITY

PART--I

(1) Duplicate of driving licence No............................................................................for grand on ......................has been issued by me this ....................................day of.........................................

(2) Application refused in letter no...............................................date the.................................. to the applicant giving reasons.

Date....................... Licensing Authority

___________________________________________________________________________

PART--II

Forwarded to the Licensing Authority ...........................................................................for verification and completion of Part-III

Date............................ Licensing Authority

.............................

PART III

Returned to the Licensing Authority................................................................................................ The Photograph and Signature/thumb-impression have been compared with my records. No such licence appears to have been issued by this office. I am not satisfied that the applicant was the holder of the licence described.

I am satisfied that the applicant was the holder of a licence issued by this office as follows:-

1) Number
2) Date of issue
3) Last renewal by the Licensing Authority
4) Date of expiry
5) Class of vehicles
6) The licence

a) entitled the holder to drive as a paid employee.

b) carried an authorisation to drive a public service vehicle, graned by...........................................

c) carried the following endorsements.

.......................................................................................................................................................

Date...................... Licence Authority

...........................

PART-IV

R eturned to the Licencing Authority.............................for recod
A duplicate licence has been issued by me on the ..........................
day of ............................ A copy of the photograph affixed there to
is attachedI have is my letter No. ............................. date the ..........
...................declined to issue the duplicate licence applied for,A copy
of that letter is attached.

Licencsing Authority

Date .......................... .......................

__________________________________________________________________________

Learner's Licence

Licence No. .......................... Date.............................

Name to be written across the photograph Specimen signature/
Thumb impression of the holder of licence .

Signature and seal of Licensing authority

1. Name
2. Son/Wife/Daughter of
3. Date of birth
4. Blood Group and RH factor
5. Present address-Permanent / Tamporary/Official if any
6. Marks of identification	1. 2.

is licence to drive throughout India as learner subject to the provision of rule 3 of the Central Motor Vehicle Rules , 1989, a motor Vehicle of the following description .

The holder of the licence has passed the medical test under rule 5 and preliminary test refered to in rule 11(1) of the Central Motor Vehicle Rules ,1989.

The holder of the licence is exempted from the medical test under rule6 and from preliminary test under rule 11(2) of the Central Motor Vehicle Rules, 1989.

This licence is valid from .............................................to......................................................

x Strike out which ever is inapplicable.

Signature and designation of the Licensing Authority

Warning:

The attention of the holder of this drawn to rule 3 of Central Motor Vehicle Rule,1989, which prohibits him from driving any motor vehicle unless he has beside him a person fully licenced to drive the vehicle carries "L" Plates both in the front and back of the vehicle.