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Drivers License Form

Nehal Gaur is applying for a provisional driver's license. She provides her personal information including her name, address, date of birth, and contact details. She declares that the information provided is true and correct. If approved, her provisional license would allow her to drive a motorcycle, motor car, truck, or tractor. She has included three certified passport photos that are less than six months old with her application as required. The licensing authority will record the results of her road code test and payment details if her application is approved.

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Nehal Gaur
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146 views1 page

Drivers License Form

Nehal Gaur is applying for a provisional driver's license. She provides her personal information including her name, address, date of birth, and contact details. She declares that the information provided is true and correct. If approved, her provisional license would allow her to drive a motorcycle, motor car, truck, or tractor. She has included three certified passport photos that are less than six months old with her application as required. The licensing authority will record the results of her road code test and payment details if her application is approved.

Uploaded by

Nehal Gaur
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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RESET THE ROAD TRAFFIC ACT SAVE PRINT

FORM H3A
APPLICATION FOR PROVISIONAL DRIVER'S LICENCE
Section A - PERSONAL INFORMATION
1. Name (Last, First, Middle) 2. Taxpayer Registration Number (TRN)

GaurNehal 1 3 1 3 7 8 2 2 8
3. Address (Apt. No., Street No. & Name, Postal Zone, Parish ) 4. Date of Birth
1, White Cedar lane, Mangowalk country club, Montego Bay, Year Month Day
St.James
2 0 0 5 0 8 1 0
5. Telephone Number(s) 6. Email Address

(876) 358-4265 [email protected]


Section B - DECLARATION
To: The Licensing Authority / Collector of Taxes

(State Collectorate eg. Kingston/May Pen etc. )

PLACE
APPLICANT'S
I hereby apply for a Provisional Driver's Licence.The vehicle to be used is a
PHOTOGRAPH
Motorcycle, Motor Car, Truck or Tractor (delete whichever is not applicable). I have
HERE
attained at least the age of seventeen (17). I am tendering three (3) identical
certified passport size photographs of myself, which are less than six (6) months
old.
I declare that the above information is true and correct.
(To be certified by a Justice of the
Peace or a Superintendent of Police)

Applicant's Signature Date


FOR OFFICIAL USE ONLY
Road Code Test Result

Remarks:
STAMP/SEAL

Certifying Officer (Island Traffic Authority)

Payment Information For Provisional Driver's Licence:


STAMP/SEAL

Fee Paid $

Receipt Number

Permit Number
Year Month Day
. . . .
Expiry Date 
Collections Officer's Name Collections Officer's Signature Date

Form No. H3A (Revised 2019/12) Island Traffic Authority

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