TRANSPORT DEPARTMENT

FORM 3
[See Rule 3(a) and 13]
LEARNER'S LICENCE

Fee Details Rs.350.0/- /UPT/3523825 /18-10-2020 ApplNo: 3003122220 Issue Dt. 13-01-2021

1. Licence No. UP32 /0003670/2021

2. Name GAJENDRA SINGH

3. Father's Name KAYAM SINGH

4. Date of Birth 27-06-1984

5. Optional/Blood Group- B+
RH Factor

6. Present Address 26/5 VISHNUPURI COLONY ALIGANJ

LUCKNOW Lucknow (M Corp.)
Lucknow,UP,226002 Holder's Signature

7. Permanent Ahaladpur Karhal,Mainpuri,UP,205264

(1) VACCINATION MARK IN RHS HAND

8. Marks of Identification
(2)
is licenced to drive a Motor Vehicles of the following description through out India and in case of E-
rickshaw or E-cart, in specified areas or routes, as a learner,subject to the provisions of Rule 3 of
the Centeral Motor Vehicle Rules 1989:
Motor Cycle with Gear(Non Transport), LIGHT MOTOR VEHICLE,
.......................................................................................................................................

*The holder of the licence has passed the preliminary test referred to in rule 11(1) of the CMV
Rules ,1989.

*The holder of the licence is exempted from the medical test under rule 6 and from the
Preliminary test under rule11(2)of the Central Motor Vehicle Rules,1989

*Strike off which ever is inapplicable

This Licence is valid 13/01/2021 To 12/07/2021

Signature and Designation of

the Licensing Authority
Warning:

The attention of the holder of this licence is drawn to rule 3 of CMV Rules, 1989 which prohibits him
from driving any motor vehicle unless he has besides him a person duly licenced to drive the vehicle
and in every case , the vehicle carries "L" plates both in front and in the rear of the vehicle.