TRANSPORT DEPARTMENT

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

Fee Details Rs.350.0/- /UPU/3878826 /13-10-2021 ApplNo: 3558536621 Issue Dt. 16-11-2021

1. Licence No. UP65 /0014804/2021

2. Name VIKASH DUBEY

3. Father's Name NAND KISHOR DUBEY

4. Date of Birth 10-01-1998

5. Optional/Blood Group- Unknown

RH Factor

6. Present Address N-15/580G.11-E.10 MADRAHA

SUDAMAPUR KHOJAVA CHHITUPUR
MAHMOORGANJ VARANASI Holder's Signature
Varanasi,UP,221010
7. Permanent N-15/580G.11-E.10 MADRAHA
SUDAMAPUR KHOJAVA CHHITUPUR
MAHMOORGANJ VARANASI
Varanasi,UP,221010
(1)
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:
LIGHT MOTOR VEHICLE, Motor Cycle with Gear(Non Transport),
.......................................................................................................................................

*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 16/11/2021 To 15/05/2022

Signature and Designation of

the Licensing Authority
Warning: RTO, VARANASI

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.