Form 4 - Form Of Applicant For Licence To Drive A Motor Vehicle
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1
2
3FORM 4
[See Rule 14(1)]
FORM OF APPLICANT FOR LICENCE TO DRIVE A MOTOR VEHICLE
To
The Licensing Authority,
………………………….
………………………….
Space for
Space for passport
passport size
size photograph
photograph
I apply for a licence to enable me to drive vehicles of the following description:-
Motor cycle without gear
(a)
Motor cycle with gear
(b)
Invalid carriage
(c)
Light Motor vehicle
(d)
Transport vehicle
(e)
Road roller
(f)
Motor vehicle of the following description, namely …………………………………………………
(g)
(h) E-rickshaw
(i) E-cart
PARTICULARS TO BE FURNISHED BY 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 outside India, when migrated to
:
India
…………………………………………………………….
9. Educational Qualification
:
1…………………………………………………………..
10. Identification mark(s)
:
2……………………………………………………………
11. * * *
* * * - S . N o 1 1 . - Omitted vide G.S.R 708 (E) dated 30.08.2010
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