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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