Learner'S Licence: Form 3 (See Rule 3 (A) and 13)

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FORM 3

[See Rule 3(a) and 13]


LEARNER'S LICENCE

Fee Details Rs.355.9/- /CGX/526036 /03-09-2024 ApplNo: 3269253824

1. Licence No. CG12 /0010873/2024

2. Name DEVESH KUMAR DUBEY

3. Father's Name ANAND KUMAR DUBEY

4. Date of Birth 08-06-2006

5. Optional/Blood O+
Group-RH Factor

6. Present Address H/NO-23 NAGAR NIGAM COLONY


KOSABADI KORBA,CG,495677
Holder's Signature

7. Permanent H/NO-23 NAGAR NIGAM COLONY


KOSABADI KORBA,CG,495677

(1)
8. Marks of Identification
(2)

is licenced to drive throughout India as a learner subject to the provisions of rule 3 of


the Central Motor Vehicles Rules 1989, a motor vehicle of the following description

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 03/09/2024 To 02/03/2025

Licensing Authority
Warning: DTO,KORBA
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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