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FORM H1 Learners Form 2

This document contains an application form for a learner's permit in Jamaica. It requests personal information such as name, address, date of birth, and contact details. It requires the applicant to declare that they have attained the age of 17 and are submitting the necessary documents, which include a birth certificate, proof of identity, proof of residence, medical certificate, and three passport photos. It notes that making false statements is an offense. Upon approval, it provides spaces to record the road code test results, remarks, and payment details including the fee paid, receipt number, permit number, and expiration date.

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Kamal Graham
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3K views

FORM H1 Learners Form 2

This document contains an application form for a learner's permit in Jamaica. It requests personal information such as name, address, date of birth, and contact details. It requires the applicant to declare that they have attained the age of 17 and are submitting the necessary documents, which include a birth certificate, proof of identity, proof of residence, medical certificate, and three passport photos. It notes that making false statements is an offense. Upon approval, it provides spaces to record the road code test results, remarks, and payment details including the fee paid, receipt number, permit number, and expiration date.

Uploaded by

Kamal Graham
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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FORM H1 (Regulation 155(1))

Application for Learner’s Permit


FORM H1
THE ROAD TRAFFIC ACT, 2018
___________
THE ROAD TRAFFIC REGULATIONS, 2022
___________
APPLICATION FOR LEARNER’S PERMIT
Section A – PERSONAL INFORMATION

1. Name (Last, First, Middle) 2. Taxpayer Registration Number (TRN)


| | | | | | | | | |
3. Address (Apt. No., St. No. & Name, Postal Zone, Parish) 4. Date of Birth
Year Month Day
| | | | | | | |
5. Telephone Number E-mail

Section B – DECLARATION

To: The Island Traffic Authority

________________________________________________
(Branch/Location)

I hereby apply for a Learner’ Permit to learn to drive a –


motor cycle motor car PLACE, APPLICANTS
truck; or tractor. PHOTOGRAPH HERE

I have attained at least the age of 17 years. I am tendering all of the following:
(To be certified by a Justice of the
 Birth Certificate Peace, Superintendent of Police)
 Proof of Identity
 Proof of Place of Residence
 Medical Certificate
 Three (3) identical certified passport size photographs of myself, which were taken within the
last six (6) months.

I declare that the above information is true and correct.

__________________________ ___________________________
Applicants’ Signature Date

NOTE: The applicant who makes a false statement commits an offence.

FOR OFFICIAL USE ONLY

Road Code Test Result

Remarks: STAMP/ SEAL

_________________________
Certifying Officer (Island Traffic Authority)

Payment Information for Learners Permit:


STAMP/ SEAL
Fee Paid:_______________________________________________________

Receipt Number _________________________________________________

Permit Number __________________________________________________


Year Month Day
Expiry Date | | | | | | |

Cashier’s Name Cashier’s Signature Date

Inland Revenue Department

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