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CMV Form 1: Physical Fitness Application

The document is an application-cum-declaration for physical fitness submitted by MD Nasim Akhtar, detailing personal information such as name, address, date of birth, and identification marks. The applicant confirms he does not suffer from any medical conditions that would impair his ability to drive safely. The declaration must be submitted along with a Medical Certificate in Form 1-A.

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Md Nasim Akhtar
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0% found this document useful (0 votes)
17 views1 page

CMV Form 1: Physical Fitness Application

The document is an application-cum-declaration for physical fitness submitted by MD Nasim Akhtar, detailing personal information such as name, address, date of birth, and identification marks. The applicant confirms he does not suffer from any medical conditions that would impair his ability to drive safely. The declaration must be submitted along with a Medical Certificate in Form 1-A.

Uploaded by

Md Nasim Akhtar
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:4296432025 Dt:18-10- CMV FORM 1

2025 [See rule 5(2)]


Application –cum-declaration as to the physical fitness

[Link] of the applicant : MD NASIM AKHTAR

2. Father's Name : MD IMRAN

[Link] address :
Rampur Milik
Krityanand Nagar,Purnia,BR
854304

[Link] address :
Rampur Milik
Official address (if any)
Krityanand Nagar,Purnia,BR
854304

5. (a) Date of birth : 11-04-1996


(b) Age on date of application : 29 years
6. Identification marks : [Link] MARK ON LEFT INDEX FINGER
[Link] SCRATCH ON RIGHT WRIST

Declaration :

(a) Do you suffer from epilepsy, or from sudden attacks of 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
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 No
from any defect in movement, control or muscular power of either
arm or leg ?

(d) Do you suffer from night blindness ? 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 No
hearing aid) the ordinary sound signal ?

(f) Do you suffer from any other disease or disability likely to 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


( MD NASIM AKHTAR )

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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An absence of a 'Yes' response might be insufficient as applicants could inadvertently or intentionally fail to disclose certain conditions due to lack of awareness, fear of denial, or oversight. Health conditions not covered explicitly by the questions might also go unnoticed. Therefore, relying solely on applicants' declarations without further verification, such as mandatory medical certificates, could overlook individuals who should not be approved without thorough evaluation. Robust health assessments and cross-verification processes are necessary to uphold safety standards .

The inclusion of an 'official address' section is significant as it helps in verifying the applicant's residential credibility and permanency. This helps in accountability and traceability of the applicant, crucial in legal and administrative contexts, such as correspondence regarding their driving privileges, enforcement of penalties, and updates to their driver's license status .

The declaration regarding diseases or disabilities is crucial for public safety as it ensures that only individuals capable of safe driving are granted a license. Conditions such as epilepsy, uncorrected vision loss, or hearing impairment may significantly hinder driving ability, thus posing a risk to the driver and other road users. By requiring applicants to confirm the absence of such conditions or provide full details if present, the form helps to identify individuals who may require additional medical evaluations or restrictions on their driving privileges to mitigate potential hazards .

An applicant may face challenges such as finding a qualified medical professional who can provide the certification, as well as potential costs associated with the medical examination. For those with conditions or disabilities, there might be additional evaluations required to determine if they meet driving standards. These assessments can be time-consuming and may affect the timeline for obtaining or renewing a driving license, especially if multiple appointments or referrals to specialists are necessary .

The clarity and complexity of language and instructions can significantly impact an applicant's understanding of the form's requirements. If the language is too technical or unclear, applicants might misinterpret questions, leading to incomplete or inaccurate responses. Additionally, non-native speakers or those with limited literacy may struggle to provide correct information. Ensuring language simplicity and providing instructions in multiple languages can improve comprehension and accuracy, thereby enhancing the integrity of the application process .

The applicant's signature or thumb impression serves as a form of authentication, affirming that the information provided is true and accurate to the best of the applicant's knowledge. This holds the applicant accountable for any false declarations, thereby deterring intentional misrepresentation. It also serves as a final step in committing to the legal and safety obligations required for driver licensing, making the process binding and enforceable under the form's terms .

The application addresses potential biases by requiring full particulars when disabilities or conditions are disclosed. This approach mandates a more thorough assessment rather than an automatic disqualification based on affirmative responses. It acknowledges that individuals with disabilities may still be able to drive under certain conditions or with medical certification, thus providing a balanced consideration that aims to uphold inclusivity while ensuring safety standards .

Answering 'Yes' to questions (a), (c), (d), (e), or (f) suggests that the applicant might have a health condition that could impair their ability to drive safely. If an applicant answers 'Yes' to any of these questions, they must provide full particulars and further information as prompted by the form instructions. For question (b), a 'No' answer also requires elaboration. This is to ensure that all potential risks are properly assessed, and to determine if the applicant may still qualify for a license under any exceptions or with specific conditions .

Declaring identification marks like scars or scratches on the application form serves to uniquely identify the applicant, which is critical in processing, verifying identity, and reducing fraudulent entries. This information becomes an integral part of their driver's license profile, helping authorities match individuals to their records accurately based on physical characteristics should there be any need for confirmation in the future .

The ability to distinguish a motor vehicle number plate at 25 metres serves as a criterion for ensuring that applicants have adequate vision necessary for safe driving. Good eyesight is crucial for reading road signs and detecting hazards from a distance, which prevents accidents and enhances overall road safety. This specific measurement ensures consistency in evaluating visual capability, allowing applicants who have controlled sight issues (e.g., corrected by glasses) to demonstrate sufficient visual acuity for driving .

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