Form of Application for New Licence to Drive a Motor Vehicle

To,
The Licensing Authority
1. Name of the applicant
4. Name of
Application Number
LL DL
UID
Gender
Male Female Others
1.1 Date of birth
(dd-mm-yyyy)
2. Place of Birth
5. Permanent address :(Proof to be enclosed)
Years Months
or 1.2 Age(In Years)
2(a) If place of birth is out side India, Month & Year when migrated to India:
Month Year
3 .Country by Birth
3(a) Email Address
NEW
First Name Middle Name Last Name
Father Mother Guardian Husband
a) Flat Number
b) Flat / House Name
c) House Number/Plot No
d) Street
e) Locality
f) Village / Town / City
g) Taluka / Mandal
h) District
i) State
j) PIN code
k) Phone
l) Mobile
m) Duration of Stay at
this address
6. Present Address
First Name Middle Name Last Name
Present Address is same as Permanent Address
Part A
*
*
*
*
*
*
*
*
*
State
Name of the RTO/DTO
Years Months
Birth Non Indian Naturalization Registration Descent
7. Citizenship Status By
8. Education Qualification
9. Identification marks
10.Blood Group
*
*
*
(Read the instructions on page-5 carefully before filling the form)
*
KA-Karnataka
1909491
KA02 -RTO BANGALOE (WEST), RAJAJINAGAR
23-05-1990
BANGALORE
560040
BANGALORE
9008999321
24
sharath.golem@gmail.com
SHARATH CHANDRA RANGANATH
IND-INDIA
SRI RANGA
426
13TH MAIN, M.C.LAYOUT
VIJAYANAGAR
BANGALORE
KA-Karnataka

RANGANATH SREENIVAS MURTHY

SRI RANGA
426
13TH MAIN, M.C.LAYOUT
VIJAYANAGAR
BANGALORE
Save for Offline
560040
BANGALORE
9008999321
KA-KARNATAKA
32-B E ( other than Mechanical)
B+
11*Requested Transaction Service (with class of vehicle)
Registration Certificate(RC) Number
S.No. DESCRIPTION OF VEHICLE TYPE New LL New DL
Part B
12) List of Enclosures (for Age Proof, Address Proof etc.,)
Document Type
Licence Number/Certificate
No./Badge No., etc
Issuing Authority/Institute
Date of Issue
(DD-MM-YYYY)
Part C
13) I have submitted along with my application for Learners Licence the written consent of
my parent/guardian: - (For Candidates having age below 18 years)
14) I have submitted along with my application for Learners Licence ,
I enclosed all the Necessary Enclosures / Certificates: -
Yes No
15) I am exempted from the Medical test under rule 6 of the Central Motor Vehicles Rules,
1989 :-
Yes No
17) I have been convicted / disqualified / my Licence was cancelled /suspended /
my Licence was revoked
Yes No
16) I am exempted from preliminary test under rule 11(2) of the Central Motor Vehicles
Rules, 1989 :-
Yes No
Yes No
Part - D
Application Number
1 MOTOR CYCLE WITHOUT GEAR(NON TRANSPORT)-(MCWOG )
2 MOTOR CYCLE WITH GEAR (NON TRANSPORT)-(MCWG )
3 LMV -3 WHEELER NT-(3W-NT )
4 LMV-NT-CAR-(LMV )
5 LMV-TRACTOR-NT-(TRCTOR)
6 MOTOR CYCLE WITH GEAR (TRANSPORT)-(MCWGT )
7 MOTOR CYCLE WITH GEAR(TRANSPORT)PSV-(MCWGP )
8 LMV -3 WHEELER CAB-(3W-CAB)
9 LMV -3 WHEELER TRANSPORT GOODS NON PSV-(3W-GV )
10 LMV-TRANSPORT-PSV-CAB-(LMVCAB)
11 LMV (TRANSPORT)-(LMV-GV)
12 LMV-TRACTOR TRAILER(TRANSPORT)-(LMV-TT)
13 TRANSPORT VECHICLE - M/HMV(RIGID CHASSIS) - GOODS-(TRANS )
14 TRANSPORT VEHICLE-M/HMV(RIGID CHASSIS) PSV-BUS-(PSVBUS)
15 TRANSPORT VEHICLE-M/HMV-ARTICULATED-(MVHART)
16 TRANSPORT VEHICLE-M/HMV - TRACTOR TRAILER-(TRCTRL)
17 INVALID CARRIAGE VEHICLE-(INVCRG)
18 ROAD ROLLER-(RDRLR )
19 OTHERS - CONSTRUCTION EQUIPMENTS-(CNEQP )
A-Age-Passport K2102437 GOVT OF INDIA 05-12-2011
P-Address-Passport K2102437 GOVT OF INDIA 05-12-2011
1909491
(If Yes, attach Documents):
If Yes, DL Number Date of Conviction (dd-mm-yyyy)
Reason
I hereby declare that to the best of my knowledge and belief the particulars given above are true and I have enclosed all the
necessary documents required as per the rules.
Signature or Thumb impression of the Applicant Date
UNDER SECTION 7(2) OF THE MOTOR VEHICLES ACT, 1988
Shri / Kumari
son/daughter of who is a minor is under my care and I accept forhis/her driving .
If at a later date I decide not to accept responsibility for his/her driving I shall intimate the licensing authority in writing for the
cancellation of the licence.
I give my consent for his/her obtaining learners licence.
Signature of Parent/Guardian Name and full address of the parent/guardian
Name of the Guardian :
Pincode :
District :
City :
Address :
Relationship :
(To be signed in the presence of the licensing authority or person authorized in this behalf by the licensing authority)
Part - E (Applicable for Learner Licence only if applicant's age is 16 to 18 years )
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FOR OFFICE USE
1) The applicant is exempted from the medical test under r. 6 and the preliminary test under r. 11(2)
of the Central Motor Vehicles Rules, 1989.
Learners licence may be issued
2) The applicant was tested with reference to r. 11(1) of the Central Motor Vehicles Rules, 1989.
He has passed the test.
Learners licence may be issued
3) He / She has failed in
(Reasons should be specified)
Part - F
......................................................................
.............
.............
............. ............. LL DL
4) Registration Mark(s) of the vehicle(s) on which Driving Skill test was conducted
S.No. Class of Vehicle
Registration Mark of
the vehicle
Details of Skill Test
Result
Application Number
12-6-2014
SHARATH CHANDRA RAN
1909491
5) Learners licence may be refused.
6) Signature of licensing authority or other person authorized in this behalf.
Signature of the Issuing Authority
*Strike out whichever is inapplicable.
.............
Application Number
Submit
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Web Application Number : 1909491
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1909491
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Note: Follow Instructions. See Help for Codes in the Annexure given along with this Unified Form for New LL/DL
Instructions for filling up theUnified Application Formfor New Learner Licence / Driving Licence
1. This form can be used for applying for New Learners Licence (LL) or Driving Licence (DL).
2. Please fill up the data in Boxes with CAPITAL letters only.
3. Columns marked as ( *) are mandatory.
4. Enclosures: The Applicant should produce the proof for claims made in the Application where ever necessary. A set of codes defined for each
of such type of enclosures is shown in HELP section ( See Code List -A,B,C).
5. The Licensing Authority Code or RTO Code: The RTO/DTO office under whose jurisdiction the applicant resides or his/her place of business.
6. Name of the Applicant : Fill the Applicant's name in the order of first name, middle name and surname/family name. However ensure that the
name is entered as per the relevant records being produced as proof.
Eg. JANGA REDDY CHEBANDI, DEVSINGH NAIK, SULTAN ISMAIL MOHAMMED
7. Class or type of Vehicle(COV): Different class of vehicles are given in column 11. at least one class / type of vehicle should be selected to fill
the unified application form.
8. Part -A: If you are not holding an LL/DL please fill in all relevant columns i.e. 1 -9 of Part-A
9. Part-B: It is mandatory to specify the class of v ehicles for which the LL/DL is to be issued from column 1 1 (Required Transaction Services) by
putting tick () mark.
10. Part-C: It is mandatory to fill column 1 2 to provide details on the required documents like age proof, qualification proof etc. The reference
number of the document enclosed also should be written as proof. If you are holding a DL or LL , please mention those details also in these
columns.
11. Part-D: The applicant shall fill this part wherever applicable.
12. Part-E: If the Applicant is minor, this form can be filled by her/his parents and the licensing authority shall mention in the endorsement.
13. Part-F: For Office Use only.
Glossary
RTO - Regional Transport Office DTO - District Transport Office LL - Learners Licence
DL - Driving Licence COV - Class/Type of Vehicle
PSV - Public Service Vehicle
HELP for Unified Application Form for Licence to Drive Motor Vehicle
CODE LIST A (TYPE OF ENCLOSURES SUPPORTING THE CLAIM MADE IN THE APPLICATION)
TYPE DESCRIPTION TYPE DESCRIPTION
A Age Proof L Learners Licence (LL)
B Psv Badge M Medical Fitness
C First Aid Certificate N Ration Card
D Driving Licence (DL) P Passport
E Educational Certificate T Driving Training Certificate
F FIR(First Information Report) V Visa
H Hill Driving Training Certificate X Military Licence
I International Driving Permit (IDP) Z Hazardous Training Certificate
CODE LIST B ( EDUCATIONAL QUALIFICATIONS)
S.No DESCRIPTION S.No DESCRIPTION
00 Illiterate 39 Any Other Graduation Not specified above
01 Not specified 50 MA / MBA / M.Com / M.SC
02 Below 8
th
51 Post Graduate Diploma In Science / Arts / Commerce / Management
03 8
th
PASSED 52 Post Graduate Diploma In Engineering / Medicine
04
10
th
Class /SSC / SSLC / CBSE ( X ) /
ICSE ( X )
53 MSc (Agriculture / Vet. Sciences)
06 I T I 54 M E ( other than Mechanical )
07 Certificate course 55 M E (Mechanical)
10 +2 / Intermediate / ICSE (12
th
) / CBSE (12
th
) 56 MS / MD / MHMS / MAMS / MDS
11 Diploma in Engineering (non Mechanical) 57 Master of Education / Law
12 Diploma in Mechanical Engineering 58 CA / ICWA / ICS or equivalent
13 Diploma in Other faculties 59 Any Other Post Graduation / PG Diploma Not specified above
14 DHMS 70
M Phil. ( Sciences / Arts / Commerce/ Education / Law / Management / other
faculties)
30 B A / BBA / B. Com / B Sc 80
Ph.D. ( Sciences / Arts / Commerce/ Education / Law / Management / other
faculties)
31 Bachelor of Agriculture / Vet. Sciences 81 Ph.D in Engineering
32 B E ( other than Mechanical) 82 Ph. D. in Medicine
33 B E (Mechanical) 90 M. Ch. ( Surgery )/ D.M. ( Medicine )
34 MBBS / BHMS / BAMS 91
D. SC. ( Sciences / Arts / Commerce / Education / Law / Management / other
faculties)
35 Bachelor of Education / Law
CODE LIST C (STA TE AND UNION TERRITORY CODE LIST)
CODE STATE NAME CODE STATE NAME CODE STATE/ UT NAME
AP Andhra Pradesh KA Karnataka SK Sikkim
AR Arunachal Pradesh KL Kerala TN Tamil Nadu
AS Assam MP Madhya Pradesh TR Tripura
BR Bihar MH Maharashtra UP Uttar Pradesh
CG Chattisgarh MN Manipur UA Uttarakhand
DL Delhi ML Meghalaya WB West Bengal
GA Goa MZ Mizoram Union Territories
GJ Gujarat NL Nagaland CH Chandigarh
HR Haryana OR Orissa AN Andaman & Nicobar Islands
HP Himachal Pradesh PY Pondicherry DN Dadra & Nagar Haveli
JK Jammu and Kashmir PB Punjab DD Daman and Diu
JH Jharkhand RJ Rajasthan LD Lakshadweep