MOTOR VEHICLE REGISTRATION / LICENSING APPLICATION FORM

I. PERSONAL INFORMATION:
1. NAME OF APPLICANT : .
2. GENDER : ..
3. CITIZENSHIP ID CARD #: ..
4. DATE OF BIRTH : ..
5. NATIONALITY :...
6. BLOOD GROUP : ..
7. OCCUPATION : ......
8. FATHERS NAME : ..
9. IDENTIFICATION MARK (IF ANY):
II. PERMANENT ADDRESS:
A. VILLAGE : .
B. GEWOG : .
C. DUNGKHAG :
D. DZONGKHAG : .
E. COUNTRY : .............................................................................................
III. PRESENT ADDRESS:
A. DZONGKHAG :
B. ADDRESS :

C. MOBILE NUMBER: ......
D. PHONE NUMBER : ....
E. EMAIL ADDRESS : .

DOCUMENTS AND OTHER REQUIRED

FOR MOTOR VEHICLE REGISTRATION: FOR LEARNER/DRIVING LICENSE (DL):

1. Copy of Citizenship Identity Card 1. Copy of Citizenship Identity Card
2. One Recent Passport Size Photograph 2. One Recent Passport Size Photograph
3. Original Challan and Invoice 3. Medical Certificate (for Learners License)
4. Tax Clearance Certificate 4. One Day Refresher Course Certificate (for
5. Produce Vehicle for Physical Inspection DL)
6. Certificate of Incorporation (for Private 5. Attend personally for necessary tests (for
Company only). DL)

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 UNDERTAKING

I, ........................................................................................................................, will inform

the Authority about changes in any information related to the present address, mobile
number etc. immediately, and also I will update documents on time. I will be held
responsible and accountable for any lapses as per the Road Safety & Transport Act 1999
and the Regulations for defaulting these undertaking.

I declare that to the best of my knowledge the particulars furnished above are true.

Place: Affix Legal

Stamp here
Date:
&
Signature

FOR OFFICIAL USE ONLY

VERIFIED BY: UPDATED BY: ................

DEGSINATION: DEGSINATION:

SIGNATURE & DATE SIGNATURE & DATE

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