(FORM A) From [Section 7 (2) of the motor Vehicle Ord. 1965] FORM OF APPLICATION FOR LICENSE TO DRIVE A MOTOR VEHICLE NATIONAL IDENTITY CARD NUMBER apply for a license to enable me to drive aid_empl other than as a pald employee 01 Motor Cycle 02 Motor Car os Lv 04 HIV 05 Motor Rickshaw 06 Tractor Agri 07 Tractor Comm 08 Motor Cab 09 Road Roller 10 Invalid Carriage 411 Particulars to be furnished by an applicant 4. Full Name 2. Father Husband Name 3, Permanent Address 4, Temporary Address, 5. Date of Birth Blood Group Date of Applicant 6. LP. No, Date Valid upto for. 7. Particulars of any license previously held by applicant Date of Applicant 8. Particulars and date of every conviction which has been ordered to be endorsed on only license held by the applicant. |. Have you been disqualified, for obtaining a license to drive? If to for what reason.10, Have you been subjected toa driving test as to fitness or Arve a8 applied for? If so give date testing authorities and Declaration as to physical fitness of applicant. each question (8) Do you sutter from epiopsy or from sudden attacks of alsabling gldsiness or fainting? (©) Are you ableto distinguish with each eye at = fistance of 25 yards in good daylignt with worm) a motor ear number plate containing seven Hers and figures? (0) Have you lost either hand or food or you sutering ower of either Arm orleg? (8) 00 you sutfer form colour blindness? (2) Do,you sutfer form detect ot hearing? (9 Doyou suitor from any other disease or disablity key to cause your driving ofa motor vehicle tobe Source of dangerto the pubic? so give particulars 1 dec 0 that tothe best of my information and bi the particu rs given in section I NotesAnapslcant ho answers ye te question (ba [nthe carton and No" tothe questions ‘may claim tobe subjectedtoa tert asta his compstency to rivavebele ota specified ype ort the 2 Signaturelthumb impression of Applicant (CERTIFICATE OF TEST OF ABILITY TO ORIVE “The spplicant has passed in the tat specified in the Third seh ‘ail the test was conducted on (veh ne.) dates Duplicate signature or thumb Signature of testing Impression of applicant ‘authority License Ne. dated for hae LUcensing AuthorityFORM B (See Section 7(3) and Section (2)) NATIONAL IDENTITY CARD NUMBER Form of Medical (cerificate in respect of application fora licens to drive any transport \Vahicle orto drive any vehicle as pald employee or otherviews: ‘TO BE FILLED UP BE A REGISTERED MEDICAL PRACTITIONER 4. whats the appiicant’s apparent age? Is the applicant to best of your Judgment subject o eplepsy, vertigo, ‘ttciency? 3. Does the applicant surfer from any heart or lung disorder which might interfer 4 any defect of vision, iso, hi ithas been corrected by suitable spectacies? (8) Does is applicant suffer from a degree ‘of deatness which would prevent his hearing of ordinary sound signats? 5. _Doos the applicant have any deformity or loss of members, which interforo withthe ‘etfecient performance of his duties as 3 ‘river? 6, Does he show any evidence of being dicted to the excessive use of alcohol tobacco or druge? 7. Isheishe in your opinion generally fit as Js (a) Bodily in health, and (b) eyesignt? 8. Marks of identi 9. Blood Group the applicant — "is the person here as above described and that the attached photograph is a reasonably correct ikeness, SIGNATURE RMP NO DOCTOR'S NATIONAL IDENITY GARD NO, SPACE PHOTOGRAPH borin Tega iy AePeopiG6ed espe asnnetteENTTAT; POLICE DEPARTMENT SStioseaseoses DRIVING TEST RESULT SHEET "Name of pliant. {Stik off whichever (Yes or No) snot appliable) Astanting B stoping [Link] examiners[A7] 213 [4] 8] 6 [e-1] 2 [6-4] 2] 3] 4 [5 Inte aang Paring Ta SSigat ‘Signal examiners[ Dal 2 [eq 213] 4] s[ra] 2 slog als nile TPG Spe examinors[ HAT 2] ST 47S 6 s[4[s We Rtenon examiners KA] 21 3] 4 [oa] aT ST « Inte Me Miscellaneous examiners wei] 2 [3 [4 [s]e]7 [elo] w[ulala Inte Part Rules and Regulations) et | ez | ea] 34] 05 Yes | Yer| Yos| Yer] Yes No [No | No] No| No {Strike of whichever (Yes or No) isnot applicable) 4. Trafe sgns in Nerth Schedule ‘(We (No) At eas the question 2. igh way Code (Yes) (No) tobe out fo the applicant, PART Ill (Physical Fitness) (a) | (6) | (ey T (ay Yes | yes | ves | ves No | No |No| No ine ot nicivover (Yes or No) notappticebigy Examiner's Remarks ‘have examined Wr. Hos PassoaFallod in th test. Vehicle Examiner's Signature cot fullname and designation) Dated