FO
R
M
- L.L.
D
.
[
S
ee rule 13(1)]
A
pplica
t
ion
f
or a duplica
t
e dri
v
ing licence
To,
The Licencing Authority, Full Name ………………………
Address of the ………………….
applicant ………………………..
1. I hereby report that the driving licence held by me is lost/destroyed/torn/defaced/mutilated in
the following circumstance ……………
2. I hereby apply for a duplicate driving licence and tender the fee prescribed in rule 6.
3. The particulars of such driving licence held by me is as follows :
-
Driving licence no…………….. issued for …………… (here enter the class of motor
vehicles) in the name of …………… by the licencing authority …………….. on
……………….. and expiring on ……………...
4. I hereby declare that my driving licence is not impounded by any authority and that
there have been no/following endorsement by the court since the date of
grant/renewal.
S
ignature of the applicant.
Date :
P
lace :
S
pecimen signature of the applicant
1.
2.
*
S
trike out whichever is either required or not applicable.
