[See Rule 10]

FORM 2

Appointment Schedule
Date Time Place Reference ID :26/11/2011 : 2:20 pm :BHOPAL RTO :MP041100761368

Form Of Application for Learner's License

To
The Licensing Authority BHOPAL RTO Please affix a photo of the size 5 cm. X 6 cm.

I here by apply for a license authorizing me to drive as a learner. The following motor vehicle(s) : a)
Light Motor Vehicle-Non Transport

1. Full Name of the Applicant 2. Son/Wife/Daughter of 3. Permanent Address (Proof to be enclose) 4. Temporary Address/Official Address if any 5. Date of Birth (Proof to be enclose) 6. Educational Qualification 7. Identification Mark(s) 8. Blood Group RH Factor

RAJESH YADAV JAGDISH YADAV 167/1-H OPP. BRIGHT PARA. SCH RAJHARSH COLONY KOLAR ROAD-BHO 167/1-H OPP. BRIGHT PARA. SCH RAJHARSH COLONY KOLAR ROAD-BHO

17-Jul-1977

ENGINEER SCAR ON LEFT HAND B +ve

9. I hold an effective driving license to drive: a) motor cycle/light motor vehicle/medium passenger motor/medium goods vehicle with effect from 10.Particulars of any driving license previously held by applicant,whether it was cancelled and if so ,for what reason 11.Particulars of any learner's license previously held by applicant in respect of the description of vehicle to which the applicant has applied. 12.Have you been disqualified for holding or obtaining driving license or learner's license if so for what reason 13.I enclose 3 copies of my recent photograph to be size of 5 cm. X 6 cm. 14.I enclose medical fitness certificate date Issued by doctor

( For non transport vehicle license bring Self attested medical certificate and for transport vehicle bring medical certificate form prescribed medical officer.) 15.I have submitted along with my earlier application for learner's license / I enclose the written consent of parent /guardian (in case applicant being minor). 16.I enclose driving certificate date name and address of the driving school. 17.I have paid the fee of Rs. 18.I am exempted from the medical test under rule 6 of Central motor Vehicle rule 1989. Rule 6 and 11(2) of Central Motor Vehicle act are given on http://122.168.193.74/APPOINTMENTSYSTEM/CentralMotorRule.aspx 19.I am exempted from the prelimiary test under rule 11(2) of Central motor Vehicle rule 1989. Strike out whichever is inapplicable Date Specimen signatures or thumb-impression of applicant Declaration under sub section (2) of section 7 of the motor Vehicle Act 1988 Shri / Kumari Son /Daughter of who is minor is under my care and i accept responsibility for his/her driving. If at a later date I decide not to accept responsibility or is/her driving I shall intimate the licensing the authority in writing for the cancellation of the license I give my consent for his / her obtaining learner's licenses. Signature Name and Full address of the Parent / Guardian Relationship (To be signed in the presence of the Licensing Authority or Person authorized in theis behalf by the licensing Authority.)
Signature of applicant

Issued by

For Office Use

The applicant exempted from the medical test under rule 6 and prelimiary test under rule 11(2) of the Central Motor Vehicle rule 1989. Learner's License may be issued. * The applicant was tested with reference to rule 11(1) of the Central motor Vehicle Rules 1989. He has passed the test Learner's License may be issued. * He has failed in the test.Reason Should be specified. * Learner's License may be refused. Strike out whichever is inapplicable Signature of Licensing Authority or Other person authorized in this behalf

Remarks :
RTO Address :-

Smart Card Centre, MPSRDC Bus Depo, 7 No Stop, RTO Office Bhopal (MP) - 462016

* The applicant should reach at RTO 15 minutes before the appointment time * Bring following documents along with the [ Form -2 ] a) Address & Age proof 1) Life Insurance Policy 2) Passport 3) Pay slip issued by any office of the Central Government or State Government or a local body 4) School certificate b) Medical certificate (For non transport vehicle license bring medical certificate and for transport vehicle bring medical certificate form prescribed medical officer.) * Please bring either attested photocopies or original document along with application form * If you had committed any mistake in data entry while taking appointment then you can correct that in form 2 using red ink and put your signature. Name and date of birth can not be changed.