Manish n Patel

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Form of Application for Services on Existing Licence to Drive a Motor Vehicle

To

The Licensing Authority

Application Number

LL DL

UID

2 Name of the applicant

Gender

or 2.2 Age(In Years)

First Name Middle Name Last Name

1. Specify the details of the DL already held by the applicant

Licence Number * Type State Licencing Authority that Issued * Date of Issue

(D D -M M -Y Y Y Y)

Part – A

State

Name of the RTO/DTO Office

EXISTING

Male Female Others

2.3 Place of Birth

2.3(a) If place of birth is out side India, Month & Year when migrated to India:

Month Year

2.3(b).Country by Birth

2.5 Email Address

2.1 Date of Birth

(dd-mm-yyyy)

2.4 Citizenship Status By Birth Non Indian NaturalizationRegistration Descent

*

*

*

*

*

*

*

*

(Read the instructions on page-5 carefully before filling the form)

Part – B

3.1*Requested Transaction Service (with class of vehicle)

(DL Revalidate is renewal of Driving Licence that was expired 5 years back )

S.No. Description of Vehicle TypeDuplicate

LLDL Transactions

Add a new

COV

PSV

Badge

Surrender

of COV

Re

Validate

GJ-Gujarat

1443796

GJ01 -RTO,AHMEDABAD

20-06-1969 44

MANISH N PATEL

570800/AR DL GJ-Gujarat GJ01 -RTO,AHMEDABAD 03-09-1987

Save for OfflineCancelGet DL Details

IND-INDIA

1 MOTOR CYCLE WITHOUT GEAR(NON TRANSPORT)-(MCWOG )

2 MOTOR CYCLE WITH GEAR (NON TRANSPORT)-(MCWG )

3 LMV -3 WHEELER NT-(3W-NT )

4 LMV-NT-CAR-(LMV )

5 LMV-TRACTOR-NT-(TRCTOR)

6 MOTOR CYCLE WITH GEAR (TRANSPORT)-(MCWGT )

7 MOTOR CYCLE WITH GEAR(TRANSPORT)PSV-(MCWGP )

8 LMV -3 WHEELER CAB-(3W-CAB)

9 LMV -3 WHEELER TRANSPORT GOODS NON PSV-(3W-GV )



S.No. Description of Vehicle TypeDuplicate

LLDL Transactions

Add a new

COV

PSV

Badge

Surrender

of COV

Re

Validate

Registeration Certificate Number

If Request is for duplicate LL then specify LL No.

1

2

3

4

LL

LL

LL

LL

3.2.Requested Transactions

S.No.Requested Transactions

(Independent of Class of Vehicle)

Licencing Authority Code




10 LMV-TRANSPORT-PSV-CAB-(LMVCAB)

11 LMV (TRANSPORT)-(LMV-GV)

12 LMV-TRACTOR TRAILER(TRANSPORT)-(LMV-TT)

13 TRANSPORT VECHICLE - M/HMV(RIGID CHASSIS) - GOODS-(TRANS )

14 TRANSPORT VEHICLE-M/HMV(RIGID CHASSIS) PSV-BUS-(PSVBUS)

15 TRANSPORT VEHICLE-M/HMV-ARTICULATED-(MVHART)

16 TRANSPORT VEHICLE-M/HMV - TRACTOR TRAILER-(TRCTRL)

17 INVALID CARRIAGE VEHICLE-(INVCRG)

18 ROAD ROLLER-(RDRLR )

19 OTHERS - CONSTRUCTION EQUIPMENTS-(CNEQP )

1 DL Renewal

2 Duplicate DL

3 Hazardous Goods Driving Endorsement

4 New IDP

5 Change of Address

6 Change of Name

7 DL Replacement

8 New CC/NOC

9 Extract of Licence

10 Endorsement Free Driving Licence

11 Hill Driving Endorsement

12 DL FINE

13 MISCELLANEOUS

14 Change Of Biometrics



Part – C

4) List of Enclosures (for Age Proof, Address Proof etc.,)

Document Type Licence Number/Certificate No./Badge No., etc

Issuing Authority/Institute Date of Issue(DD-MM-YYYY)

b) Applicant is Son of Daughter of Guardian of Wife of


5. if Request includes Change of Name

Father Mother GuardianHusband Self


or

(if Gender is changed) Gender

a)Applicant Name Changed as

Part – D

Male Female Others

f) Village / Town / City

g) Taluka / Mandal

h) District

i) State Code

j) PIN code

Years Months

k) Phone

l) Mobile

m) Duration of Stay at

this address

Present Address is same as Permanent Address

e) Locality

d) Street

6. If Request includes Change of Address: (provide the details)

Permanent Address changed as

a) Flat Number

b) Flat / House Name

c) House Number/Plot No

Present Address changed as

Reasons for Late Renewal / DL Not Attached, etc…

Years Months

Application Number

*

1443796



10. I have been convicted / disqualified / my Licence was cancelled /suspended /

my Licence was revoked

9. I am exempted from preliminary test under rule 11(2) of the Central Motor Vehicles

Rules, 1989 :- Yes No

Yes No

CERTIFICATE OF TEST OF COMPETENCE TO DRIVE

1) The applicant has passed the test prescribed under rule 15 of the Central Motor Vehicles Rules, 1989. The test was

conducted on (Date)

Signature of Testing AuthorityDate

(here enter the registration mark and description of the Vehicle)

Part – F

(If Yes, attach Documents):

If Yes, DL Number Date of Conviction (dd-mm-yyyy)

Reason

I hereby declare that to the best of my knowledge and belief the particulars given above are true and I have enclosed all the

necessary documents required as per the rules.

Signature or Thumb impression of the Applicant

Date Full Name

Designation

2) The applicant has failed in the test.

(The details of the deficiency to be listed out)

................................

................................

................................

...............................................................

...............................................................

..........

Approval of the licencing authortity for considering the requested service made in the application.

Signature of Testing AuthorityDate ................................

..........Approved ..........Rejected

7. I have submitted along with my application for Learner’s Licence,.

I enclosed all the Necessary Enclosures / Certificates: - Yes No

8. I am exempted from the Medical test under rule 6 of the Central Motor Vehicles Rules,

1989 :- Yes No

Part – E

Date

Application Number

SubmitPrint

Your Application Saved Successfully.

Web Application Number : 1443796

Quote this Application number for future reference.Application shall be processed at RTO

only after submission of necessary application & documents.

If you are submitting application online to continue with portal press back button of the

browser. To exit from portal press close button (×) of the browser.

26-2-2014

MANISH N PATEL

1443796

Clear



Instruct ions for fill ing up the Unified Application Form for Exist ing Services on a Licence

This form can be used for applying for services on Existing Learner's Licence (LL) or Driving Licence (DL).

Please fill up the data with CAPITAL letters only.Columns marked as ( *) are mandatory.

Enclosures: The Applicant should produce the proof for claims made in the Application where ever necessary. A set of codes defined for each of such type of enclosuresto the application is shown in HELP section ( See Code List - A,B,C) The Licensing Authority Code or RTO Code: The RTO/DTO/RLA office under whose jurisdiction the applicant resides or his/her place of business.Name of the Applicant : Fill the Applicant's name in the order of first name, middle name and surname/family name. However, ensure that the name is entered as per the

relevant records being produced as proof.Eg. JANGA REDDY CHEBANDI, DEVSINGH NAIK, SULTAN ISMAIL MOHAMMEDClass or type of Vehicle(COV): Different class of vehicles are given in column 3.1. If the requested service is “Add a new COV”, then at least one class / type of vehicle

should be selected to fill the unified application form.

Part- A : Specify the details of the DL already held by the applicant i.e 1 of Part APart - B : It is mandatory to select at least one service from column 3.1 or 3.2. If the service is for duplicate LL, then the LL Number has to be mentioned in column labelled as“If Request is for du plicate LL then specify LL No.”

Part - C: It is mandatory to fill column 4 to provide details on the required documents like age proof, qualification proof etc. If you are holding a DL or LL , please mentionthose details also in these columns.Part - D: Fill column 5 if the requested service is for Change of Name, column 6 if the requested service is for Change of AddressPart - E: The applicant shall fill in this part wherever applicable.Part - F: For Office Use only.

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Manish n Patel

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