FORM 2

[See rules 10, 14, 17 and 18]

Appl No:1615305924 Dt:05-05-2024

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

GURUGRAM(BADSHAHPUR) HR-98

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 (LMV NTV)

Adapted Vehicle (vehicles for use by Divyang)

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.
 Appl No:1615305924 Dt:05-05-2024
2. Personal details of the Applicant (in Capital Letters)

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

ARNAV GUPTA

Son/ wife/ daughter of : MAHESH GUPTA

Identification mark :

Gender Date of Birth:

Male Female Transgender
(Tick √)
04-05-2008
(dd/mm/yyyy)

Educational Blood Group

Qualification 10th Standard or Equivalent B+

Email Mobile number

(optional) XXXXXX6302

Landline Number (optional)

3. Name of(Tick √) Father Mother Husband Guardian

First Name Middle Name Last Name

MAHESH GUPTA

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 C-9/16 , S.F. C-9/16 , S.F.

Street/Locality/Police Station Ardee city sector-52 Wazirabad Ardee city sector-52 Wazirabad

Wazirabad(75) Farrukhnagar Gurgaon Wazirabad(75) Farrukhnagar

Location/Landmark
Haryana Gurgaon Haryana

Village/Town

SubDist/Taluk/Mandal Gurugram

District Gurugram Gurugram

State Haryana Haryana

Pin code 122003 122003

 Appl No:1615305924 Dt:05-05-2024
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

Class of Vehicle(s)

Name of the Licencing Authority which issued

the Licence

Validity Period From date To date

7. List of Documents attached (Please refer to the attached annexure and tick)

Self-Declaration as to Physical Fitness

(a) Do you suffer from epilepsy, or from sudden attacks of loss of consciousness or giddiness from any cause ? No

(b) Are you able to distinguish with each eye ( or if you have held a driving licence to drive a motor vehicle for a period of Yes
not less than five years and if you have lost, the sight of one eye after the said period of five years and if the application is
for driving a light motor vehicle other than a transport vehicle fitted with an outside mirror on the steering wheel side) or
with one eye, at a distance of 25 metres in good day light (with glasses , if worn) a motor car number plate?

(c) Have you lost either hand or foot or are you suffering from any defect in movement, control or muscular power of either No
arm or leg ?
No
(d) Do you suffer from night blindness ?

(e) Are you so deaf as to be unable to hear ( and if the application is for driving a light motor vehicle, with or without No
hearing aid) the ordinary sound signal ?

(f) Do you suffer from any other disease or disability likely to cause your driving of a motor vehicle to be a source of danger No
to the public, if so, give details?
DECLARATION
I am willing to donate my organ/tissue in case of death Yes
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.

verified through Aadhaar authentication

Date: 05-05-2024 Signature of the Applicant

DECLARATION under sub-section (2) of section 7 of the Motor Vehicles Act, 1988
ARNAV GUPTA
Shri/Smt./Kumari_______________________________________________________son/daughter of MAHESH GUPTA

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 responsibility for his /her

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

Name of the parent / guardian: MAHESH GUPTA

Relationship with the applicant: Father
Signature of the parent / guardian
 FOR OFFICE USE ONLY

Appl No:1615305924 Dt:05-05-2024

1. The applicant ARNAV GUPTA 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 ARNAV GUPTA 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 Vehicles Rules, 1989 Pass / Fail / Absent/
Exempted
(Name:ARNAV GUPTA)

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

The Learner’s licence / Driving Licence is Issued Refused

Signature of licensing authority (or other person

authorised in this behalf)
 ANNEXURE Appl No:1615305924 Dt:05-05-2024

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

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

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

Appl No:1615305924 Dt:05-05- CMV FORM 1
2024 [See rule 5(2)]
Application –cum-declaration as to the physical fitness

1.Name of the applicant : ARNAV GUPTA

2. Father's Name : MAHESH GUPTA

3.Permanent address : C-9/16 , S.F.

Ardee city sector-52 Wazirabad
Wazirabad(75) Farrukhnagar Gurgaon Haryana
122003

4.Temporary address : C-9/16 , S.F.

Ardee city sector-52 Wazirabad
Official address (if any)
Wazirabad(75) Farrukhnagar Gurgaon Haryana
122003

5. (a) Date of birth : 04-05-2008

(b) Age on date of application : 16 years
6. Identification marks :

Declaration :

(a) Do you suffer from epilepsy, or from sudden attacks of No

loss of consciousness or giddiness from any cause ?

(b) Are you able to distinguish with each eye ( or if you have
held a driving licence to drive a motor vehicle for a period of
not less than five years and if you have lost, the sight of one
eye after the said period of five years and if the application Yes
is for driving a light motor vehicle other than a transport
vehicle fitted with an outside mirror on the steering wheel
side) or with one eye, at a distance of 25 metres in good
day light (with glasses , if worn) a motor car number plate?

(c) Have you lost either hand or foot or are you suffering No
from any defect in movement, control or muscular power of either
arm or leg ?

(d) Do you suffer from night blindness ? No

(e) Are you so deaf as to be unable to hear ( and if the

application is for driving a light motor vehicle, with or without No
hearing aid) the ordinary sound signal ?

(f) Do you suffer from any other disease or disability likely to No

cause your driving of a motor vehicle to be a source of danger
to the public, if so, give details?

I hereby declare that, to the best of my knowledge and belief, the particulars given above and the
declaration made therein are true. verified through Aadhaar
authentication

Signature or thumb impression of the applicant

( ARNAV GUPTA )

Note : - (1) An applicant who answers 'Yes' to any of the questions (a),(c),(d), (e) and (f) or 'No' to
either
of the questions (b) should amplify his answers with full particulars, and may be
required to give further information relating thereto.
(2) This declaration is to be submitted invariably with Medical Certificate in Form 1-A.
 Provisional Appointment for Learner Licence Test
GURUGRAM(BADSHAHPUR) HR-
98
UID: 13638027924412
Date 23-May-2024

Application Number: 1615305924

Dear Mr/Mrs/Ms ARNAV GUPTA S/o. Mr/Mrs/Ms. MAHESH GUPTA

Thank you for using Online Learner Licence Test slot booking facility.
Class of Vehicles : MCWOG
With respect to your booking appointment for Learner Licence Test, your Learner
licence test has been scheduled on 23-05-2024 between 09.00-13.00.
You are requested to visit at Gurugram(Badshshpur) HR--98 on 23-05-2024
approximately 30 MINUTES before the scheduled time for verification of documents
along with originals of document copy uploaded at the time of making application.

The Licensing Authority,

GURUGRAM(BADSHAHPUR) HR-
98.
General Instructions to the Applicant:
Note: * In case of failure in the LL Test, the applicant can reappear for test on the next
day onwards after paying requisite fee.
 Authority Copy
Important Information

· This is electronically generated certificate

no signature required
· For verification of this certificate you may
visit http:// haryanaredcross.in
Registration No. : 2001818638 Certificate No. : 1011896204 · This certificate shall valid till the next
renewal of Driving Licence
CERTIFICATE
BASIC ROAD SAFETY
AND đĞȕčijĆŊ ÿĭċøĭēı
FIRST AID TRAINING FOR DRIVING LICENCE
· ĒĞ èĕĸƃŌĺĮċø ŝč ĝĸ êȋɄ ŮđĭĆ čũ ĞĹ
This is to certify that ARNAV GUPTA ĮÿĝđŐ Įøĝı ĞˑĭƗē øı çęʴøćĭ ċĞıŃ ĞĹI
· èĝŮđĭĆčũøĸĝȑĭčċøĸĮĕðçčhttp://
S/D/W/O MAHESH GUPTA haryanaredcross.in čēÿĭĝøćĸĞœI
· ĒĞŮđĭĆčũĄŌĭèĮęŃúĕĭèĝŐĝøĸæúĕĸ
has attended Basic Road Safety and First Aid Training For Driving
ċęıċıøēĆćøđĭɊĞļúĭI
Licence organized by St. John Ambulance (India), District

GURUGRAM on 05/06/2024 at GURUGRAM

This certificate valid till the next renewal of Driving Licence.

Issuing authority :-

Hony. Secretary/DTO
St. John Ambulance (India), District Center

Note : This is electronically generated certificate no signature required, for

verification of this certificate you may visit http://haryanaredcross.in

Candidate Copy

Student may carry this card

Registration No. : 2001818638 Certificate No. : 1011896204
Basic Road Safety and First Aid Training For Driving Licence
Candidate Name : ARNAV GUPTA Address :
S/D/W/ Of : MAHESH GUPTA
C-9/16, SF ARDEE CITY GURUGRAM
Training Centre : GURUGRAM
GURUGRAM GURUGRAM, Haryana -
Training Date : 05/06/2024 122001
Issuing authority
Hony. Secretary/DTO
St. John Ambulance (India)
Note : This is electronically generated certificate no signature required, for NoteʹAll donations to IRCS Haryana are exempted U/S 80G (5) (VI) of
verification of this certificate you may visit http://haryanaredcross.in Income Tax Act - 1961