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Application for Driver Fitness Declaration

The document is an application for a physical fitness declaration for driving, submitted by Bhagat Singh. It includes personal details such as name, address, date of birth, and health-related questions that assess the applicant's fitness to drive. The applicant must declare any medical conditions that may affect their driving ability and submit this declaration alongside a medical certificate.

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0% found this document useful (0 votes)
9 views1 page

Application for Driver Fitness Declaration

The document is an application for a physical fitness declaration for driving, submitted by Bhagat Singh. It includes personal details such as name, address, date of birth, and health-related questions that assess the applicant's fitness to drive. The applicant must declare any medical conditions that may affect their driving ability and submit this declaration alongside a medical certificate.

Uploaded by

sachin kumar
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Appl No:2548931025 Dt:28-06- CMV FORM 1

2025 [See rule 5(2)]


Application –cum-declaration as to the physical fitness

TRANSPORT DEPARTMENT. GOVT OF NCT OF DELHI


[Link] of the applicant : BHAGWAT SINGH

2. Father's Name : SHIV SINGH

[Link] address : [Link]. 237 GROUND FLOOR


GALI NO-6 BLK-B PRADEEP VIHAR NEAR NATHUPURA BUS
Burari,North Delhi,DELHI
110084

[Link] address : [Link]. 237 GROUND FLOOR


GALI NO-6 BLK-B PRADEEP VIHAR NEAR NATHUPURA BUS
Official address (if any)
BURARI North Delhi Delhi
110084

5. (a) Date of birth : 14-09-1989


(b) Age on date of application : 35 years
6. Identification marks :

Declaration :

(a) Do you suffer from epilepsy, or from sudden attacks of Yes/No


loss of consciousness or giddiness from any cause ?

(b) Are you able to distinguish with each eye ( or if you have
held a driving licence to drive a motor vehicle for a period of
not less than five years and if you have lost, the sight of one
eye after the said period of five years and if the application Yes/No
is for driving a light motor vehicle other than a transport
vehicle fitted with an outside mirror on the steering wheel
side) or with one eye, at a distance of 25 metres in good
day light (with glasses , if worn) a motor car number plate?

(c) Have you lost either hand or foot or are you suffering Yes/No
from any defect in movement, control or muscular power of either
arm or leg ?

(d) Do you suffer from night blindness ? Yes/No

(e) Are you so deaf as to be unable to hear ( and if the


application is for driving a light motor vehicle, with or without Yes/No
hearing aid) the ordinary sound signal ?

(f) Do you suffer from any other disease or disability likely to Yes/No
cause your driving of a motor vehicle to be a source of danger
to the public, if so, give details?

I hereby declare that, to the best of my knowledge and belief, the particulars given above and the
declaration made therein are true.

Signature or thumb impression of the applicant


( BHAGWAT SINGH )

Note : - (1) An applicant who answers 'Yes' to any of the questions (a),(c),(d), (e) and (f) or 'No' to
either
of the questions (b) should amplify his answers with full particulars, and may be
required to give further information relating thereto.
(2) This declaration is to be submitted invariably with Medical Certificate in Form 1-A.

Common questions

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The CMV Form 1 plays a crucial role in regulating driving eligibility for individuals with disabilities by requiring them to disclose their medical conditions and assess how these may impact their driving ability. By asking specific questions about physical and sensory impairments, the form helps identify applicants who might need special considerations or restrictions. This enables authorities to make informed decisions about granting licenses, thus balancing inclusivity with the necessity to maintain high safety standards on public roads .

The CMV Form 1 safeguards public safety by requiring applicants to disclose any medical or physical conditions that might impair their driving ability, such as epilepsy, deafness, and partial blindness. For those who respond affirmatively to questions about such impairments, the form acts as a filter to determine whether further evaluation is necessary. Applicants with potential impairments are asked to provide additional details and may need to submit a medical certificate, which ensures that driving privileges are awarded only to those who can drive safely .

If an applicant fails to answer the medical questions truthfully on the CMV Form 1, it could lead to severe consequences including legal action, revocation of their driving license, and liability in the event of an accident. Dishonesty in reporting conditions like epilepsy or significant hearing loss undermines the form's purpose of ensuring road safety, potentially putting the applicant and the public at risk. The authorities could impose penalties once the deceit is uncovered, emphasizing the importance of integrity in legal declarations .

Answering 'No' to question (b) on the CMV Form 1 indicates that the applicant is unable to distinguish a motor vehicle number plate from 25 meters in good daylight, which signifies a potential vision impairment. This would require the applicant to provide additional details and likely result in further examination to assess their fitness to drive, as proper eyesight is critical to safely operating a vehicle .

The declaration in the CMV Form 1 is crucial because it ensures that the applicant is physically and medically fit to drive a motor vehicle. This involves self-reporting conditions such as epilepsy, loss of sight, physical disabilities, night blindness, significant hearing loss, or any other medical condition that could make driving dangerous. This is intended to prevent accidents and ensure public safety on the roads .

The CMV Form 1 addresses the needs of individuals with hearing impairments by asking whether they are unable to hear, and if so, whether they require a hearing aid to perceive sound signals. For those applying to drive light motor vehicles, accommodations such as hearing aids may be considered to ensure that their impairment does not compromise safety. The form aims to ensure that only drivers who can safely detect auditory cues are licensed, protecting both the driver and the public .

The CMV Form 1 includes questions targeting physical impairments such as epilepsy, loss of consciousness, and movement disabilities to detect potential risks to a driver's effectiveness. By requiring applicants to self-report these conditions, the form helps identify individuals who may need further evaluation to assess their ability to maintain control over a vehicle. This proactive measure filters out those who might compromise road safety, ensuring that all drivers meet a basic standard of physical fitness required to react appropriately in various driving situations .

If an applicant has lost sight in one eye but had been driving for more than five years before this occurrence, the CMV Form 1 allows them to continue driving a light motor vehicle, provided an outside mirror is fitted on the steering wheel side. This accommodation acknowledges past driving experience and aims to balance the individual's capability to continue driving safely with appropriate modifications .

If the medical conditions outlined in the CMV Form 1 are not adequately assessed during the application process, it could result in individuals with significant impairments being allowed to drive, which would increase the risk of accidents and endanger road safety. Conditions like epilepsy or insufficient eyesight are critical factors that need thorough evaluation to prevent drivers from experiencing episodes that could lead to loss of control while driving. This deficiency in assessment could also compromise public trust in regulatory bodies supposed to ensure driver capability and safety compliance .

An applicant may be required to provide additional information if they answer 'Yes' to questions about medical conditions or disabilities in the CMV Form 1 because these conditions can impact their ability to drive safely. The authorities need further details to assess whether these conditions pose a risk to road safety, and whether any accommodations or restrictions are necessary. This process helps ensure that drivers are capable of operating vehicles without endangering themselves or others .

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