Smart Card DL

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SMART CARD LICENCE FORM

Date Token No.


DL. No. :OR
TOBE FILLED IN BLOCK LETTR ONLY (English Only).
LL. N o . J PASSPORT SIZE
PHOTO
DATE OF EXPIRY (LL)
DD MM YYYY
NAME FIRST

MIDDLE LAST
SON/ FIRST
W/D
OF MIDDLE LAST
ADDRESS

PIN CODE
DATE OF BIRTH

CONTACT No.
DD
H MM YYYY

QUALIFICATION
BLOOD GROUP RH
RECEIPT No. FEE AMOUNT Rs.

M/CW/O Gear <50CC M/CW/O Gear


LICENCE APPLIED FOR MC with Cear Light Motor Vehicle-NT
LMV-Transport LMV-TractorTrailor
LMV- AR-NT LMV-AR-CAB
LMV - AR -GV Light Transport Vehicle
Heavy Transport Vehicle Invalid Carriage
"Road Roller Others

FOR RENEWAL/ENDORSEMENT/ DUPLICATETO SMART-CARD LICENCE


LICENCE NUMBER
DATE OFISSUE VALID FROM
DD MM YYòY DD MM YYYY
BADGENUMBER VALID TO
DD MM YYYY
TESTING AUTHORITY

APPLICANTS SIGNATURE CLERK / HEAD CLERK LICENCING AUTHORITY

Ane goverance initiatiue ofTranport Department, Government ef Orissa -

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