FORM 2

[See rules 10, 14, 17 and 18]

Appl No:1051462220 Dt:12-03-2020

Form of Application for Learner’s Licence Or Driving Licence Or Addition of a New Class of Vehicle Or Renewal of Driving Licence Or Change
of Address Or Name

To,

The Licencing Authority

RTO,NUAPADA

Services applying for (Please Tick mark against single or multiple service, wherever applicable)

Issue of New Learner’s Licence

Issue of New Driving Licence

Addition of Class of Vehicle to Driving Licence

Renewal of Driving Licence

Duplicate Driving Licence

Change / Correction of Address in Driving Licence

Change / Correction of Name in Driving Licence

1. Class of Vehicles (COV): Applicable for New Learner’s Licence or New Driving Licence

Motor Cycle Without Gear (MCWOG)

Motor Cycle With Gear (MCWG)

Light Motor Vehicle as Non Transport Vehicle (LMV NTV)

Adapted Vehicle (vehicles for use by Divyang)

Light Motor Vehicle as Transport Vehicle

Medium or Heavy Goods or Passenger Vehicle as Transport Vehicle

E-Rickshaw

E-Cart

Others; which is not covered in any of the above categories including, Harvester, Excavator, Fork lift, Trailers,
Crane mounted vehicles, Agricultural tractor and power tiller, Tow trucks, Breakdown Van and Recovery
vehicles, Construction equipment vehicles

Explanation :-
1. Non - Transport Vehicles include Motor Cycle with or without sidecar for personal use, Mopeds, Three Wheeled vehicles for
personal use, Motor Car for personal use, Fork Lift;
2. Transport vehicle includes a public service vehicle, a goods carriage, an educational institution bus or private service vehicle;

3. Light motor vehicle includes a transport vehicle or omnibus the gross vehicle weight of either of which or a motor car or tractor or
road-roller the unladen weight of any of which, does not exceed 7,500 kilograms;
4.
Medium goods vehicle includes any goods carriage other than a light motor vehicle or a heavy goods vehicle;

5. Heavy goods vehicle includes any goods carriage the gross vehicle weight of which, or a tractor or a roadroller the unladen weight
of either of which, exceeds 12,000 kilograms.
2. Personal details of the Applicant (in Capital Letters) Appl No:1051462220 Dt:12-03-2020

Details of Aadhar card, if already available with the Aadhar Card number
applicant.
Not Furnished

Aadhar Card application number

Details of Aadhar application number if applied.

First Name Middle Name Last Name

GOPAL BHOI

Gender Date of Birth:

Male Female Transgender
(Tick )
18-06-1989
(dd/mm/yyyy)

Educational Blood Group

Qualification 8th Passed O+

Email Mobile number

(optional) XXXXXX4716

Landline Number (optional)

3. Name of(Tick ) Father Mother Husband Guardian

First Name Middle Name Last Name

LILAMBAR BHOI

4. Address (proof to be enclosed, in case of New Learner’s Licence or New Driving Licence or Change of Address)

Present Address (shall be printed on Licence)

Permanent Address

House/Door/Flat No

Street/Locality/Police Station Khariar (NAC) Khariar (NAC)

Location/Landmark KHARIAR,Nuapada,OD KHARIAR,Nuapada,OD

Village/Town Khariar (NAC) Khariar (NAC)

SubDist/Taluk/Mandal KHARIAR KHARIAR

District Nuapada Nuapada

State Odisha Odisha

Pin code 766107 766107

 Appl No:1051462220 Dt:12-03-2020
5. In case of request for Addition of a Class of Vehicle in Transport Category, please fill the following:

Driving School Name

Enrollment number in the Driving School

Enrollment date in the Driving School

Certificate number issued by the Driving School

Certificate date as issued by the Driving School

Training period in the Driving School From date To date

6. Particulars of existing Licence (Learner’s or Permanent)

Licence Number OD26 /0001600/2020

Class of Vehicle(s) MCWG

Name of the Licencing Authority which issued RTO,NUAPADA

the Licence

Validity Period From date 07-02-2020 To date 06-08-2020

7. List of Documents attached (Please refer to the attached annexure and tick)
DECLARATION
I am willing to donate my organ/tissue in case of death YES/NO

I declare that the facts stated above and documents submitted are true and genuine to the best of my knowledge and belief. I also state thatI
have/ have notbeen disqualified from holding a Driving Licence.

Date: 12-03-2020 Signature of the Applicant

DECLARATION under sub-section (2) of section 7 of the Motor Vehicles Act, 1988
Not Applicable
Shri/Smt./Kumari_______________________________________________________son/daughter of Not Applicable

who is a minor is under my care and I accept responsibility for his/her driving. If at a later date I decide not to accept

I shall inform the licensing authority in writing for the cancellation of the licence.I give my consent for his / her obtaining the

Name of the parent / guardian: Not Applicable

Relationship with the applicant: Not Applicable

Signature of the parent / guardian

 FOR OFFICE USE ONLY

Appl No:1051462220 Dt:12-03-2020

1. The applicant GOPAL BHOI is exempted from production of a medical certificate under Rule
6 of the Central Motor Vehicles Rules, 1989;
YES/NO

Learner’s licence may be issued.

2. The applicant GOPAL BHOI is exempted from the Preliminary Test under sub-rule (2) of
Rule 11 of the Central Motor Vehicles Rules, 1989;
YES/NO

Learner’s licence may be issued.

3. Preliminary Test to check adequate knowledge and

understanding of the matters namely traffic sighs, traffic Date of Test Result ( ) Testing Authority
signals, duties of driver in case of his vehicle being
involved in an accident, or documents to be carried
while driving etc,. Subrule (1) of Rule 11 of the Central
Motor Pass / Fail / Absent/
Exempted
(Name:GOPAL BHOI)

Driving Test (Rule 15 of the Central Motor Vehicles Rules, Date of Test
Result Pass / Fail
1989)

The Learner’s licence / Driving Licence is Issued Refused

Signature of licensing authority (or other person

authorised in this behalf)
 ANNEXURE Appl No:1051462220 Dt:12-03-2020

LIST OF DOCUMENTS TO BE SUBMITTED OR UPLOADED BY THE APPLICANT

Proof of Address and Age. (Select only one if the proof is common for Address and Age)

1. Aadhar Card

2. Electoral Roll

3. Life Insurance Policy

4. Passport

5. School Certificate

6. Birth Certificate

7.
Pay slip issued by any office of the State Government or Central Government or a local Body

8.
Affidavit sworn before an Executive Magistrate or Notary Public or First Class Judicial Magistrate

9. A certificate granted by a Registered Medical Practitioner not below the rank of Civil Surgeon as to the age of the
applicant

10. Any other document or documents as may be specified by State Government

Other documents to be enclosed or uploaded if applicable

1. Self Declaration for Physical Fitness in Form – 1

2. Medical Certificate in Form- 1A (to be provided if the applicant is applying for renewal and is above 40 years of
age or applying for Transport Licence)

3. Driving Certificate issued by Driving School or Establishments in Form 5

4. Parent or Guardian Declaration in case of applicant who is a minor

5. Photograph

6. Valid proof of passport andvisa (for International Driving Permit only)

7.
Proof of legal presence in India in addition to proof of residence in case of Foreigners

8. Other documents, if any

The copy of police complaint made(in case the Driving Licence was lost or mutilated or defaced or damaged, lost).
9.

10. For change of name -

(a) Existing name _______________________________

(b) Name to be changed as _______________________

(c) Documents enclosed:-

(i) Affidavit sworn before a First Class Judicial Magistrate or a Notary Public

(ii) Marriage certificate

(iii) Copy of newspaper advertisement