(FORM A) From [Section 7 (2) of the motor Vehicle Ord. 1965] FORM OF APPLICATION FOR LICENSE TO DRIVE A MOTOR VEHICLE NATIONAL IDENTITY CARD NUMBER apply for a license to enable me to drive other than as a pald employee 01 Motor Cycle 02 Motor car os Lv 04 ATV 05 Motor Rickshaw 06 Tractor Agri 07 Tractor Comm. 08 Motor Cab 09 Road Roller 10 Invalid Carriage 11 Particulars to be furnished by an applicant 4. Full Name 2. Father Husband Name 3, Permanent Address 4, Temporary Address: 5, Date of Bith________Blood Group Date of Applicant 6. LP. No, Date Valid upto for. 7. Particulars of any license previously held by applicant Date of Applicant Particulars and date of every conviction which has been ordered to be endorsed on only license held by the applicant. Have you been disqualified, for obtaining a license to drive? If to for what reason.10, Have you been subjected toa driving test as te fitness or bility to deve a vehicle in respect of which a ieense to drive a8 applied for? If so give date testing authorities and Declaration as to physical fitness of applicant. (9) Do you sutter from epliepsy or from sudden attacks of alsabling gldéiness or fainting? (©) Are youableto distinguish with each eye at = fistance of 25 yards in good daylignt wth worm) a motor ear number plate containing seven Hers and figures? (@) Have you lost either hand or food or you sutering power of either Arm or log? (4) D0,you sutfer form colour blindness oF nigh blindness? (@) Do you suttor form detect ot hearing? (9 Doyou suitor from any other disease or disablity kaly to cause your driving of a motor vehicle to source of danger to the public? so give particulars 1 declare that tothe best of my information and bi the particu rs given in section I 5 uestin (2) a) nthe laa a ‘may claim tobe subjected to atest as to his com the 20 Signaturelthumb impression of Applicant CERTIFICATE OF TEST OF ABILITY TO ORIVE ‘The applicant has passed in the test specitiod inthe Third schedule to Motor Vehicle Ord 1985 ‘ail the tst was conduct fon veh no.) dates Duplicate signature or thumb Signature of testing Impreasion of applicant ‘authority License Ne. dated for has LUcensing AuthorityFORM B (See Section 7(3) and Section (2)) NATIONAL IDENTITY CARD NUMBER Form of Medical (ceric Vahicle orto drive any vehicle as paid empl ‘TO BE FILLED UP BE A REGISTERED MEDICAL PRACTITIONER 4. wnat isthe applicant's apparent age? Is the applicant to Judgment subject to 3 leant suffer trom any heart, ‘oF lung disorder which might interfere with the performance of his dutios as a 4. (Allethere any detect of wi ithas been corrected by (B} Does is applicant suffer from a ‘of deatness which would provent his hearing of ordinary sound signals? 5. Does the applicant have any deformity oF loss of members, which interfere withthe ‘ffecient performance of his duties as 3 6, Does he show any evidence of being tobacco or druge? 7. Ishelshe in your opinion generally it as (a) Bodily in hesith, and (by eyesigne? 8. Marks of dents 9. Blood Group Leertty nat to te tis the person her is a reasonably correct likeness, the applicant ‘shove described and that the attached photograph aeeee DOCTOR'S NATIONALIDENITY CARDNO. PHOTOGRAPH ~ 5 ateNTIAT; POLICE DEPARTMENT SStieseoseoses | DRIVING TEST RESULT SHEET [Name of Applicant. {Strike of whichever (Yes or No) snot applieable) Astanting B stoping c.Tuming examiners[ AT] 213 [4] 8] 6 [e-1] 2 [6-4] 2] 3] 4 [5 inte aang ang Ta Sigal ‘Signal examiners[ DA 2 [Ea 2] 3] 4] s[Fa] 2 slo als Inile PIG Spe examiners HAT 2] ST 47S 6 2, 3s. 2 7s, a] s Te Rtenion examiners[ I] 21 3 a [oa] aT] @ Inte ME Wisclisneous examiners wei] 2 [3 [« [stel7[elolw[n] ali Parti Roles and Regultions) 31] 82 | 63] 34] 05 Yes | Yes| Yes! Yes) Yes No 1. signs ia North Schedule 2. High way Code (Yes) (No.) Examiner's Remarks Hehas PassedFallod nthe test. Examiner's Signature oan full name and desig tion)