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    Form-4 Form of Application For Licence To Drive A Motor Vehicle Application (See Rule 14)

    Uploaded by

    Saswata Bagchi
    This document contains an application form for a license to drive a motor vehicle. It collects information such as the applicant's name, address, date of birth, educational background, medical information, and details of any previous licenses or convictions. The applicant, Antara Bagchi, is applying for a license to drive a motorcycle without gear. She provides her learner's license number and date of issue, confirms submitting a medical fitness certificate, and declares that the information provided is true to the best of her knowledge.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Form-4 Form of Application For Licence To Drive A Motor Vehicle Application (See Rule 14)

    Uploaded by

    Saswata Bagchi
    161 views3 pages
    This document contains an application form for a license to drive a motor vehicle. It collects information such as the applicant's name, address, date of birth, educational background, medical information, and details of any previous licenses or convictions. The applicant, Antara Bagchi, is applying for a license to drive a motorcycle without gear. She provides her learner's license number and date of issue, confirms submitting a medical fitness certificate, and declares that the information provided is true to the best of her knowledge.

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    localhost_CMS V.1_form_4.php_user_id=149

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    This document contains an application form for a license to drive a motor vehicle. It collects information such as the applicant's name, address, date of birth, educational background, medical information, and details of any previous licenses or convictions. The applicant, Antara Bagchi, is applying for a license to drive a motorcycle without gear. She provides her learner's license number and date of issue, confirms submitting a medical fitness certificate, and declares that the information provided is true to the best of her knowledge.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    161 views3 pages

    Form-4 Form of Application For Licence To Drive A Motor Vehicle Application (See Rule 14)

    Uploaded by

    Saswata Bagchi
    This document contains an application form for a license to drive a motor vehicle. It collects information such as the applicant's name, address, date of birth, educational background, medical information, and details of any previous licenses or convictions. The applicant, Antara Bagchi, is applying for a license to drive a motorcycle without gear. She provides her learner's license number and date of issue, confirms submitting a medical fitness certificate, and declares that the information provided is true to the best of her knowledge.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
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    http://localhost/CMS V.1/form_4.php?

    user_id=149

    Form-4

    Form of Application

    FOR LICENCE TO DRIVE A MOTOR VEHICLE

    APPLICATION
    (See Rule 14)
    I apply for a licence to enable me to drive vehicle of the following description

    ☑ a) Motor Cycle without gear

    b) Motor Cycle with gear

    c) Invalid carriage

    d) Medium goods vehicle

    e) Medium passenger motor vehicle

    f) Heavy goods vehicle

    g) Heavy Pasengers motor vehicle

    h) Road roller

    i) Motor vehicle of a specified direction

    j) Light Motor vehicle

    Particular To Be Furnished By The Applicant

    1. Name_______Antara bagchi________________________

    2. Wife of : Saswata bagchi

    3. Permanent address(Proof to be enclosed) ______________1/2/4 Sri nath Chakarbokthy Lane_________

    4. Temporary address/Offitial address(if any) ______________1/2/4 sri nth chakraborty lane_________

    5. Date of Birth ______________1993-05-08_________

    6. Educational Qualification ______________post graduate_________

    7. Identification Marks ______________no_________

    8. Blood Group ______________A-_________

    9. Have you previously help driving licance ? :

    If so give details. _______________________

    10.Particulars and date of every conviction

    which has been ordered to be endorsed

    on any licence held by applicant. :

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    11.Have you been disqualified for obtaining

    a licence to drive ? If so,for what reason _______________________

    12.Have you been subjected to a drive test

    as to your fitness or ability to drive a vehicle

    in respect of which a licence to drive is

    applied for? if so,give the following details. ______________Motor Cycle without gear_________

    Page -2
    Date of Test Testing Authority Result of Test
    2018-04-04 ss Pass

    Space for Photograph

    13. I enclosed three copies of my recent photograph of the size centemeter into six and qater centimeter

    (where leminated card is used no photographers are required).

    14. I enclosed the learner's licence No.______________BBB_________

    dated ______________2011-06-11___________________issued by Licensing


    Authority_______________________BBBBJ________________

    15. I enclosed the Driving Certificate no. ______________12345_________

    dated ______________2011-01-04_________issued by______________ABS_________

    16. I have submitted along with my application for the Learner's Licence the written consent of
    parent/gurdian certificate

    17. I have submitted along with the application for the learner's Licence /I encloed the medical fitneness
    certificate

    18. I exempted from the medical test under the rule 6 if the Central Motor Vehicle Rules 1989.

    19. I exempted from preliminary test under rule 12 of the Central Motor Vehicle Rules ,1989.

    2 of 3 4/6/2018, 10:15 PM
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    20. I have paidthe fee of the rupees15/-

    I hereby declare that to the best of my knowledge and belief the particulars given above are true

    Note -Strike out whichever is not applicable

    Date06/04/2018

    Certificate of test of ability to drive Signatire/Thumb Impress of applicant


    The appliant has passed the test prescribe under rule 17 of the
    Central Vehicals Rules.1989. The test was

    conducted on( hereenter the registration mark and description of the


    vehicle).....2018-04-04..........................on(date)

    The applicant has failed in the test

    (The details of the defiencey to be listed out)

    Signatire of Testing Authority


    .

    Full name and designation


    .

    Two specimen signature of applicant


    Date 06/04/2018

    3 of 3 4/6/2018, 10:15 PM

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