FORM CLD.

PART I.

Form of intimation of loss or destruction

of licence and application for duplicate.
(See Rule 66.)

To
The Licensing Authority,

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

I.................................................. of (permanent address)...................................................................................

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

hereby report that conductor’s licence No..................... issued by the day of .............................has been lost or
destroyed in the following circumstances:-

2. I hereby apply for a duplicate licence and tender a sum of Rs................................ In cash/treasury receipt.

3. I attach two clear copies of a recent photograph of myself.

.......................................
Date: Signature of Applicant.

* Strike out alternate not required, or strike out item, if it is not applicable.
(parts I, II and III will be printed on a separate sheet and will be used if the application is made to an authority other
than the original licensing authority).

Forwarded to the licensing Authority for verification and completion of Part III.

....................................
Date: Licensing Authority.

PART II.

Returned to the Licensing Authority

The photograph and signature, thumb-impression (*) have been compared with my records.

No such conductor’s licence appears to have been issued by this office.

I am satisfied that the applicant was the holder of the conductor’s licence issued by this office as follows:-

(1) Number :...............................................................................................

(2) Date of issue :...............................................................................................

(3) Last renewed by the Licensing Authority :...............................................................................................

(4) Date of expiry :...............................................................................................

(5) The licence carried the following endorsements:-

..................................
Date: Licensing Authority.

• Strike out alternative not required, or strike out the item if it is not applicable.
 Part III
Returned to the Licensing Authority for record.

* A duplicate conductor’s licence has been issued by me on the day ...............................of...........................

* I have in my letter No.......................,dated the............................................ declined to issue the duplicate

conductor’s licence applied for and i attach a copy of that letter..

................................
Date: Licensing Authority.

*Strike out alternative not required, or strike out the item, if it is not applicable.