Ajay LL

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TRANSPORT DEPARTMENT

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

Fee Details Rs.350.0/- /UPU/1142542 /06-03-2021 ApplNo: 988303721 Issue Dt. 02-08-2021

1. Licence No. UP16 /0028736/2021

2. Name AJAY KUMAR

3. Father's Name ROTASH SINGH

4. Date of Birth 15-02-2002

5. Optional/Blood Group- A+
RH Factor

6. Present Address NAGLA PAROHI RANHARA GAUTAM


BUDDHA NAGAR,UP,203155
Holder's Signature

7. Permanent NAGLA PAROHI RANHARA GAUTAM


BUDDHA NAGAR,UP,203155

(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:
Motor Cycle with Gear(Non Transport), LIGHT MOTOR VEHICLE,
.......................................................................................................................................

*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 02/08/2021 To 01/02/2022

Signature and Designation of


the Licensing Authority
Warning: ASST.RTO,
GAUTAMBUDHNAGAR
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.

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