Licence Authority, by
I, Shri/Smti/Kumari ..Son/Wife/Daughter of Shri/Late ..hereby apply for the renewal of my driving licence which is attach and particulars of vehicle are as follows :-
(a) Licence No ..
(b) Date of Issue .
(c) Licensing Authority, by which the licence was issued .
(d) Licensing Authority, by which the licence was renewed .
(e) Class of vehicles authorized to drive .
(f) Date of expiry of licence to drive ..
(1) Transport Vehicle .
(2) Vehicle other than transport vehicles .
My address is
If this address is not entered on the licence I do/do not wish that it should be soon entered.
If the licence is not attached, reaseons why it si not available :-
If the licence is not renewed within 30 (thirty) days of the date of expiry, reason for delay. .
The renewal of licence is not refused by any licensing authority.
I have not been disqualified for holding or obtaining a driving licence, My licence has not been invoked.
I enclose medical fitness certificate form - 1
I enclose three copies of recent photographs (5 cms by 8 cms)
I have paid the fee of Rs 15/= Rs. 25/=
I hereby declare that in the best of my knowledge and belief the particulars given above are true.
Signature of thumb impression of applicant.
Driving Licence No ..Authorizing to drive ScooterMotor Cycle/LMV/HMV/PSV received on .for renewal.
Signature of D/A
MV Branch, ADC's