6. Particulars of existing Licence (Learner’s or Permanent)
Name of the Licencing Authority which issued the Licence
7. List of Documents attached (Please refer to the attached annexure and tick)
DECLARATION
I am willing to donate my organ/tissue in case of death YES/NO
I declare that the facts stated above and documents submitted are true and genuine to the best of my knowledge and
belief. I also state that I have/ have not been disqualified from holding a Driving Licence.
Date: Signature of the Applicant
DECLARATION under sub-section (2) of section 7 of the Motor Vehicles 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 for his /her driving, I shall inform the
licensing authority in writing for the cancellation of the licence. I give my consent for his / her obtaining the
learner’s licence.
Name of the parent / guardian:
Relationship with the applicant: Signature of the parent / guardian
FOR OFFICE USE ONLY
1. The applicant is exempted from production of a medical certificate under Rule 6 of the
Central Motor Vehicles Rules, 1989;
Learner’s licence may be issued.
2. The applicant is exempted from the Preliminary Test under sub-rule (2) of Rule 11 of
the Central Motor Vehicles Rules, 1989;
Learner’s licence may be issued.
3. Preliminary Test to check adequate
knowledge and understanding of the matters
namely traffic sighs, traffic signals, duties of
driver in case of his vehicle being involved in
an accident, or documents to be carried while
driving etc,. Sub-rule (1) of Rule 11 of the
Central Motor Vehicles Rules, 1989
Pass /
Fail /
Absent /
Exempted
Driving Test (Rule 15 of the Central Motor
Vehicles Rules, 1989)
The Learner’s licence / Driving Licence is Issued Refused
Signature of licensing authority
(or other person authorised in this behalf)