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8/12/2019 Manish n Patel
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Form of Application for Services on Existing Licence to Drive a Motor Vehicle
To
The Licensing Authority
Application Number
LL DL
UID
2 Name of the applicant
Gender
or 2.2 Age(In Years)
First Name Middle Name Last Name
1. Specify the details of the DL already held by the applicant
Licence Number * Type State Licencing Authority that Issued * Date of Issue
(D D -M M -Y Y Y Y)
Part – A
State
Name of the RTO/DTO Office
EXISTING
Male Female Others
2.3 Place of Birth
2.3(a) If place of birth is out side India, Month & Year when migrated to India:
Month Year
2.3(b).Country by Birth
2.5 Email Address
2.1 Date of Birth
(dd-mm-yyyy)
2.4 Citizenship Status By Birth Non Indian NaturalizationRegistration Descent
*
*
*
*
*
*
*
*
(Read the instructions on page-5 carefully before filling the form)
Part – B
3.1*Requested Transaction Service (with class of vehicle)
(DL Revalidate is renewal of Driving Licence that was expired 5 years back )
S.No. Description of Vehicle TypeDuplicate
LLDL Transactions
Add a new
COV
PSV
Badge
Surrender
of COV
Re
Validate
GJ-Gujarat
1443796
GJ01 -RTO,AHMEDABAD
20-06-1969 44
MANISH N PATEL
570800/AR DL GJ-Gujarat GJ01 -RTO,AHMEDABAD 03-09-1987
Save for OfflineCancelGet DL Details
IND-INDIA
1 MOTOR CYCLE WITHOUT GEAR(NON TRANSPORT)-(MCWOG )
2 MOTOR CYCLE WITH GEAR (NON TRANSPORT)-(MCWG )
3 LMV -3 WHEELER NT-(3W-NT )
4 LMV-NT-CAR-(LMV )
5 LMV-TRACTOR-NT-(TRCTOR)
6 MOTOR CYCLE WITH GEAR (TRANSPORT)-(MCWGT )
7 MOTOR CYCLE WITH GEAR(TRANSPORT)PSV-(MCWGP )
8 LMV -3 WHEELER CAB-(3W-CAB)
9 LMV -3 WHEELER TRANSPORT GOODS NON PSV-(3W-GV )
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S.No. Description of Vehicle TypeDuplicate
LLDL Transactions
Add a new
COV
PSV
Badge
Surrender
of COV
Re
Validate
Registeration Certificate Number
If Request is for duplicate LL then specify LL No.
1
2
3
4
LL
LL
LL
LL
3.2.Requested Transactions
S.No.Requested Transactions
(Independent of Class of Vehicle)
Licencing Authority Code
Licencing Authority Code
Licencing Authority Code
Licencing Authority Code
10 LMV-TRANSPORT-PSV-CAB-(LMVCAB)
11 LMV (TRANSPORT)-(LMV-GV)
12 LMV-TRACTOR TRAILER(TRANSPORT)-(LMV-TT)
13 TRANSPORT VECHICLE - M/HMV(RIGID CHASSIS) - GOODS-(TRANS )
14 TRANSPORT VEHICLE-M/HMV(RIGID CHASSIS) PSV-BUS-(PSVBUS)
15 TRANSPORT VEHICLE-M/HMV-ARTICULATED-(MVHART)
16 TRANSPORT VEHICLE-M/HMV - TRACTOR TRAILER-(TRCTRL)
17 INVALID CARRIAGE VEHICLE-(INVCRG)
18 ROAD ROLLER-(RDRLR )
19 OTHERS - CONSTRUCTION EQUIPMENTS-(CNEQP )
1 DL Renewal
2 Duplicate DL
3 Hazardous Goods Driving Endorsement
4 New IDP
5 Change of Address
6 Change of Name
7 DL Replacement
8 New CC/NOC
9 Extract of Licence
10 Endorsement Free Driving Licence
11 Hill Driving Endorsement
12 DL FINE
13 MISCELLANEOUS
14 Change Of Biometrics
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Part – C
4) List of Enclosures (for Age Proof, Address Proof etc.,)
Document Type Licence Number/Certificate No./Badge No., etc
Issuing Authority/Institute Date of Issue(DD-MM-YYYY)
b) Applicant is Son of Daughter of Guardian of Wife of
First Name Middle Name Last Name
5. if Request includes Change of Name
Father Mother GuardianHusband Self
First Name Middle Name Last Name
or
(if Gender is changed) Gender
a)Applicant Name Changed as
Part – D
Male Female Others
f) Village / Town / City
g) Taluka / Mandal
h) District
i) State Code
j) PIN code
Years Months
k) Phone
l) Mobile
m) Duration of Stay at
this address
Present Address is same as Permanent Address
e) Locality
d) Street
6. If Request includes Change of Address: (provide the details)
Permanent Address changed as
a) Flat Number
b) Flat / House Name
c) House Number/Plot No
Present Address changed as
Reasons for Late Renewal / DL Not Attached, etc…
Years Months
Application Number
*
1443796
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10. I have been convicted / disqualified / my Licence was cancelled /suspended /
my Licence was revoked
9. I am exempted from preliminary test under rule 11(2) of the Central Motor Vehicles
Rules, 1989 :- Yes No
Yes No
CERTIFICATE OF TEST OF COMPETENCE TO DRIVE
1) The applicant has passed the test prescribed under rule 15 of the Central Motor Vehicles Rules, 1989. The test was
conducted on (Date)
Signature of Testing AuthorityDate
(here enter the registration mark and description of the Vehicle)
Part – F
(If Yes, attach Documents):
If Yes, DL Number Date of Conviction (dd-mm-yyyy)
Reason
I hereby declare that to the best of my knowledge and belief the particulars given above are true and I have enclosed all the
necessary documents required as per the rules.
Signature or Thumb impression of the Applicant
Date Full Name
Designation
2) The applicant has failed in the test.
(The details of the deficiency to be listed out)
................................
................................
................................
...............................................................
...............................................................
..........
Approval of the licencing authortity for considering the requested service made in the application.
Signature of Testing AuthorityDate ................................
..........Approved ..........Rejected
7. I have submitted along with my application for Learner’s Licence,.
I enclosed all the Necessary Enclosures / Certificates: - Yes No
8. I am exempted from the Medical test under rule 6 of the Central Motor Vehicles Rules,
1989 :- Yes No
Part – E
Date
Application Number
SubmitPrint
Your Application Saved Successfully.
Web Application Number : 1443796
Quote this Application number for future reference.Application shall be processed at RTO
only after submission of necessary application & documents.
If you are submitting application online to continue with portal press back button of the
browser. To exit from portal press close button (×) of the browser.
26-2-2014
MANISH N PATEL
1443796
Clear
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Instruct ions for fill ing up the Unified Application Form for Exist ing Services on a Licence
This form can be used for applying for services on Existing Learner's Licence (LL) or Driving Licence (DL).
Please fill up the data with CAPITAL letters only.Columns marked as ( *) are mandatory.
Enclosures: The Applicant should produce the proof for claims made in the Application where ever necessary. A set of codes defined for each of such type of enclosuresto the application is shown in HELP section ( See Code List - A,B,C) The Licensing Authority Code or RTO Code: The RTO/DTO/RLA office under whose jurisdiction the applicant resides or his/her place of business.Name of the Applicant : Fill the Applicant's name in the order of first name, middle name and surname/family name. However, ensure that the name is entered as per the
relevant records being produced as proof.Eg. JANGA REDDY CHEBANDI, DEVSINGH NAIK, SULTAN ISMAIL MOHAMMEDClass or type of Vehicle(COV): Different class of vehicles are given in column 3.1. If the requested service is “Add a new COV”, then at least one class / type of vehicle
should be selected to fill the unified application form.
Part- A : Specify the details of the DL already held by the applicant i.e 1 of Part APart - B : It is mandatory to select at least one service from column 3.1 or 3.2. If the service is for duplicate LL, then the LL Number has to be mentioned in column labelled as“If Request is for du plicate LL then specify LL No.”
Part - C: It is mandatory to fill column 4 to provide details on the required documents like age proof, qualification proof etc. If you are holding a DL or LL , please mentionthose details also in these columns.Part - D: Fill column 5 if the requested service is for Change of Name, column 6 if the requested service is for Change of AddressPart - E: The applicant shall fill in this part wherever applicable.Part - F: For Office Use only.
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