"FORM 2" WebAppl 909947
[See rule 10]
FORM OF APPLICATION FOR THE GRANT OF LEARNER'S
To
The Licensing Authority, Space for Passport
size Photograph
RTO BANGALORE (CENTRAL), KORAMANGALA
I here by apply for a licence authorising me to drive as a learner, the following motor vechicle(s):-
1) MCWG
2) 3W-NT
3) LMV
PARTICULARS TO BE FURNISHED BY APPLICANT
1. Full Name : SAIF AHMED KHIZAR
2. Son of : KHIZAR AHMED NAZEER
3. Permanent address : NO 9/84 1ST FLOOR
(Electoral Roll / Life Insurance Policy / Passport / Pay Slip issued by any 8TH MAIN ROAD 3RD BLOCK EAST RBI
office of the Central Government / State Government or a local body / COLONYJAYANAGAR
Any other documents as may be prescribed by the State Government / BANGALORE KA
Affidavit sworn before an executive magistrate or a First Class Judicial
Magistrate or a Notary Public to
: NO 9/84 1ST FLOOR
4. Temporary address / Official address, if any 8TH MAIN ROAD 3RD BLOCK EAST RBI
COLONYJAYANAGAR
BANGALORE KA
5. Duration of stay at the present address
....................................................
6. Date of birth : 21-Jul-1989
(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. Education Qualification : MA / MBA / M.Com / M.SC
10 Identification Mark(s) : MOLES ON NOSE
11 Declaration of citizenship status
(i) If deemed Citizen or Citizen by Birth ....................................................
(Birth certificate and school certificate)
(In Support of Citizen ship as Indian to be enclosed)
(ii) If Citizenship is acquired by Descent / Registration
(In case Citizenship acquied 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
12 Blood Group : B+
RH(Rhesus) factor
13 I hold an effective driving licence to Drive: Motor Cycle /Light
Motor Vehicle / Transport Vehicle with effect from. ....................................................
14 Particulars of any driving licence previously held by applicant. Whether it was
cancelled and if so, for what reason ....................................................
15 Particulars of any learners licence previously held by applicant in respect of the
description of vehicle to which the applicant has applied. ....................................................
16 Have you been disqualified for holding or obtaining driving licence or learner's licence.
If so, for what reason. ....................................................
17 I enclose three copies of my recent photograph
(Passport size photograph)
18 I enclose medical fitness certificate dated .................................... issued by ................................... doctor
19 I have submitted along with my earlier application for Learner's licence / I enclose the written consent of parent / guardian ( In
the case of applicant being a minor)
20 I enclose driving certificate dated ..................... issued by ............................................... (Name and address of the driving
school)
21 Have paid the fee of Rs...........................................
22 I am exempted from the medical test under rule 6 of the Central Motor Vehicles Rules, 1989.
22 I am exempted from the preliminary test under rule 11(2) of the Central Motor Vehicles Rules 1989.
* Strike out whichever is inapplicable
Date............................
Signature or Thumb impression of
Specimen Signature or Thumb impression of Applicant.
1.
2.
Declaration under sub-section(2) of section 7 of the Motor Vehicle Act 1988
Shri / Smt / Kumari ................................. Son / daughter of ........................................... who is a minor is under my care and I
accept responsibility / for his / her driving. If at a later date I decide not to accept responsibility of his/her driving, I shall
intimate the licence authority in writing for the cancellation of the licence. I give my consent for his/her obtaining learner's
License.
Signature......................................................
Name and full address of the parent / guardian
............................................................................
............................................................................
Relationship....................................................
(To be signed in the presence of the licensing authority or person authorised in the behalf by the Licensing
For official use
The applicant is exempted from the medical test under rule 6 and the preliminary test under rule 11(2) of the Central Motor
Vehicles Rule, 1989.
Learner's licence may be issued.
The applicant was tested with reference of rule 11(1) of the Central Motor Vehicle Rules, 1989.
He has passed the test. Learner's Licence may be issued.
Learner's licence may be refused.
Signature of licensing authority or other
Person authorized in the behalf.
* Strike out whichever is inapplicable.
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
In such cases, the Licensing Authority shall scrutinse the application and intimate the applicant about the acceptance / any /
discrepancy.
In case the application is accepted, the applicant shall be intimated through Electornic mail to report to the Authority concerned on
a appointed date along with the documents for further verification, submission of application fee and examination of the applicant.
