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FORM FOR COMPUTERIZED DRIVING LICENCE - …brta.portal.gov.bd/sites/default/files/files/brta.portal.gov.bd...BRTA FORM FOR COMPUTERIZED DRIVING LICENCE Reference Number Register Number

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Page 1: FORM FOR COMPUTERIZED DRIVING LICENCE - …brta.portal.gov.bd/sites/default/files/files/brta.portal.gov.bd...BRTA FORM FOR COMPUTERIZED DRIVING LICENCE Reference Number Register Number

Permanent Address

Present Address (If different from permanent address)

Nationality

Name

Father’s Name

Phone Number

2.

3.

6.

7.

8. Date of Birth Blood Group

DD MM YYYY

9. 10.

12.

Date

DD MM YYYY

17.

Marital Status13.

Married Unmarried

Gender11.

Male Female

Husband’s Name (Applicable for married women only) 5.

Widowed

BRTA

FORM FOR COMPUTERIZED DRIVING LICENCE

Register NumberReference Number

Signature of Vendor

For Office Use Only

Licensing Authority BRTA 1.

Issuing Authority

Most Recent Licence Number 20.

23.

Date of Issue

DD MM YYYY

21. Date of Expiry

DD MM YYYY

22.

Page Number

New Licence Number Printing Date

DD MM YYYY

Mother’s Name4.

Date

DD MM YYYY

To Be Filled In By The Applicant Already Holding A Driving Licence

Please paste one copy of stamp size coloured

photo here. Do not staple.

Class of Vehicle (Tick more than one, if applicable)

Motor cycle Three wheeler PSV OtherHeavy Medium Light

15.Type

Non-ProfessionalProfessional

14.

16. Declaration

Applicant’s thumb impression19.Signature of applicant18.

Signature of L. Authority

Verifier’s Name and Designation

Name of Licensing Authority Signature of Verifier

Verification Date

DD MM YYYY

Authorization Date

DD MM YYYY

1. Items 1-19 must be completed by all applicants.

2. Renewal applicants must additionally complete items 20-23, and attach a copy

of existing licence to this application.

3. This form must be completed using block letters.

4. This form must not be folded, and should not have ink marks.

5. Two copies of this form must be submitted, with a stamp size coloured

photograph pasted onto each form.

Instructions for Completing this Application

DCTB Date of DCTB

DD MM YYYY

Serial No. Expiry Date

DD MM YYYY

I declare that to the best of my knowledge all particulars supplied by me are correct and

complete. I am aware that any false statements will lead to rejection of my

application or to the annulment of licence already granted and may also render me liable

to prosecution under the law of Bangladesh which deals with this application.

District Name