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    Driver Licence

    Uploaded by

    N Rakesh
    This document contains an application form for a driver's license. It requests information such as the applicant's name, address, date of birth, citizenship status, blood type, previous licenses held, convictions, exemptions from tests, payment of fees, and a certificate of driving test competence. The form must be submitted along with documents like a birth certificate, passport photos, learner's permit, and medical fitness certificate.

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    Attribution Non-Commercial (BY-NC)
    Download as PDF or read online from Scribd

    Driver Licence

    Uploaded by

    N Rakesh
    1K views2 pages
    This document contains an application form for a driver's license. It requests information such as the applicant's name, address, date of birth, citizenship status, blood type, previous licenses held, convictions, exemptions from tests, payment of fees, and a certificate of driving test competence. The form must be submitted along with documents like a birth certificate, passport photos, learner's permit, and medical fitness certificate.

    Original Description:

    Application Form Form 4 for driving licence in the State of Tamilnadu, India

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    This document contains an application form for a driver's license. It requests information such as the applicant's name, address, date of birth, citizenship status, blood type, previous licenses held, convictions, exemptions from tests, payment of fees, and a certificate of driving test competence. The form must be submitted along with documents like a birth certificate, passport photos, learner's permit, and medical fitness certificate.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF or read online from Scribd
    Download as pdf
    1K views2 pages

    Driver Licence

    Uploaded by

    N Rakesh
    This document contains an application form for a driver's license. It requests information such as the applicant's name, address, date of birth, citizenship status, blood type, previous licenses held, convictions, exemptions from tests, payment of fees, and a certificate of driving test competence. The form must be submitted along with documents like a birth certificate, passport photos, learner's permit, and medical fitness certificate.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF or read online from Scribd
    Download as pdf
    of 2

    FORM – 4

    [See Rule 14 (1)]


    FORM OF APPLICANT FOR LICENCE TO DRIVE A MOTOR VEHICLE
    To
    The Licensing Authority
    ...................................... Space for
    ........................................ Passport size
    photograph

    I apply for a licence to enable me to drive vehicles of the following description:


    a) Motor Cycle without gear
    b) Motor Cycle with gear
    c) Invalid carriage
    d) Light Motor Vehicle
    e) Transport Vehicle
    f) Road Roller
    g) Motor vehicle of the following description ...................................................................................................

    PARTICULARS TO BE FURNISHED BY THE APPLICANT


    1. Full Name : .....................................................................................................................................................
    2. Son / Wife / Daughter of : ..............................................................................................................................
    3. Permanent address : .....................................................................................................................................

    (Electoral Roll / Life Insurance Policy / Passport / Pay Slip


    issued by any office of the Central Government / State
    Government or a local body / Any other document or
    documents as may be prescribed by the State Government /
    Affidavit sworn before an Executive Magistrate or a First Class
    Judicial Magistrate or a Notary Public to be enclosed)

    4. Temporary address/Official address, if any : ...............................................................................................


    5. Duration of stay at the present address: ......................................................................................................
    6. Date of Birth : ...........................................................................................................................................
    (Birth Certificate / School Certificate / affidavit sworn before an Executive Magistrate or a First Class
    Judicial Magistrate or a Notary Public to be enclosed)

    7. Place of birth ................................................................................................................................................

    8. If place of birth out side India .when migrated to India. .................................................................................

    9. Educational Qualification. : .............................................................................................................................

    10. Identification Mark(s. : (1) ............................................................................................................................


    ` (2) ............................................................................................................................

    11. Declaration of citizenship status


    (i) If deemed Citizen or Citizen by Birth (Birth Certificate and
    school certificate in support of citizenship has to be enclosed)
    (ii) If citizenship is acquired by Descent/Registration (In case
    Citizenship acquired by Descent, Birth Certificate, land /
    property document of parent / in case of citizenship acquired
    by registration certificate to be enclosed.
    (iii) If Citizenship by Naturalization (Certificate of Naturalization
    and Certificate of Registration to be enclosed)
    (iv) If non-Indian Citizen
    (Valid passport or other travel documents and such other
    document or authority as may be prescribed by law to be
    enclosed.

    12. Blood Group (RH Rhesus) Factor : ............................................................................................................

    13. Have you previously held driving Licence? If so, give details. : ................................................................
    14. Particulars and date of every conviction which has been
    ordered to be endorsed on any licence held by the applicant. : ...............................................................
    15. Have you been disqualified for obtaining
    a licence to drive? If so, for what reasons? : ...................................................................................

    16. Have you been subject to a driving test as to your fitness or


    ability to drive a vehicle in respect of which a licence to drive
    a vehicle in respect of which a licence to drive is applied for?
    If so give the following details : .
    Date of Test Testing Authority Result of Test
    1
    2
    3
    4

    17. I enclose three copies of my recent Passport size photograph (where laminated card is used no
    Photographs are required)

    18. I enclose the learner’ s licence No......................... dated … … … … ….................. … … … .. issued by


    Licencing Authority.

    19. I enclose the Driving Certificate No… …....................... … dated… …...................................… ..issued
    by… … … … … … … … … … … … … … … … … … … … … …

    20. I have submitted along with my application for Learner’s Licence the written consent of parent/
    guardian.

    21. I have submitted along with my application for Learner’s Licence/ I enclose the medical fitness
    certificate.

    22. I am exempted from the medical test under rule 6 of the Central Motor Vehicles Rules 1989.

    23. I am exempted form preliminary test under rule 11 (2) of the Central Motor Vehicle Rules 1989.

    24. I have paid the fee of Rs.....................................................

    * Strike out whichever is inapplicable

    Date:.......................................... Signature /Thumb Impression

    CERTIFICATE OF TEST OF COMPETENCE TO DRIVE


    The applicant has passed the test prescribed under rule 15 of the Central Motor Vehicle Rules,
    1989. The test was conducted on (here enter the registration mark and description of the vehicle)… … … …
    … .… … … … … … … .on (date)...............................................

    The applicant has failed in test

    (The details of the deficiency to be listed out)

    Date: ................................................. Signature of Testing Authority

    .................................................
    ..................................................
    Full Name and Designation.

    Specimen Signature of Applicant:


    1.
    2.
    * strike whichever is applicable

    Note: The application along with the scanned copies of the required documents may also be sent to the
    concerned Licensing Authority through :Electronic Mail, if allowed by the concerned State
    Government / Union Territory Administration.
    In such cases, the Licensing Authority shall scrutinize the application and intimate the applicant
    about the acceptance discrepancy.
    In case the application is accepted, the applicant shall be intimated through Electronic Mail to
    report to the Authority concerned on an appointed along with the documents for further verification,
    submission of application fee and examination.

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