Form LLD

You might also like

Download as pdf or txt
Download as pdf or txt
You are on page 1of 1

FORM L.L.D.

(Rule 2.3 of Delhi Motor Vehicle Rules, 1989)


Intimation of lose or destruction of license and application for duplicate
To
The Licensing Authority,
------------------------------------------------------
------------------------------------------------------
I --------------------------------------------------------------------------------------------------------------------
Son/daughter/wife of ----------------------------------------------------------------------------------------------
With my Permanent Address as -----------------------------------------------------------------------------------
Hereby report that my driving license, the particulars of which are given below has been lost/destroyed.

1. License No. ------------------------------------------------------------------------------------------


2. Name of Licensing Authority ------------------------------------------------------------------------
3. Date of issue ----------------------------------------------------------------------------------------
4. Vehicle of which licensed ---------------------------------------------------------------------------
5. Valid upto --------------------------------------------------------------------------------------------
6. Endorsement, if any --------------------------------------------------------------------------------

I solemnly declare that the license has not been impounded by any authority and I will return
the same to the Licensing Authority if at any stage the license is found.

The duplicate license fee has been vide receipt No. -------------------------------

Signature or thumb impression


of the applicant
Date ----------------------------
(FOR OFFICE USE OF LICENSING AUTHORITY)

1. The particulars as given above have been checked.


2. The adverse entries as per records are as under.
--------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------
---------------------------
3. Duplicate license my be issued/refused on account of reasons given below.
--------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------

(Dealing Clerk)

You might also like