G.C.P. J.No 1438/98-99 - 2,25,000  loose.
GOVERNMENT OF ANDHRA PRADESH
TRANSPORT DEPARTMENT
FORM 4
(Sec Rule 14)
Form of Application for Licence to drive a Motor Vehicle
The Licensing Authority,
___________________
1 Space for Passport photograph
I apply for a licence to enable me to drive vehicle
of the following description :
(a)  Motor cycle without gear
(b)  Motor cycle with gear
(c)  Invalid carriage
(d)  Light motor vehicle
(e)  Medium goods vehicle
(f)   Medium passenger motor vehicle
(g)  Heavy goods vehicle
(h)  Heavy passenger motor vehicle
(i)   Road roller
(j)  Motor vehicle of the following description

I.
II.
III.
IV.
V.
Particulars to be furnished by the Applicant
1. Name
2. Son/Wife/Daughter of
3. Permanent address (Proof to be enclosed)
4. Temporary address/Official address (if any)
5. Date of birth (Proof to be enclosed)
6. Educational qualifications
:  _________________________________
:  _________________________________
:  _________________________________
:  _________________________________
:  _________________________________
:  _________________________________
7.  Identification Marks

8.   [Optional Blood Group and  RH Factor :]
9.   Have you previously held driving licence?
       If so, give Details
10. Particulars and date of every conviction which
      has been ordered to be endorsed on any licence
      held by the applicant
11. Have you been disqualified for obtaining a
      licence to drive? If so, for what reasons?
12. Have you been subjected to a driving test
      as to your fitness or ability to drive a vehicle
      in respect of which a licence to drive is applied
      for? If so, give the following details
:  (1)_______________________________
   (2)_______________________________
:  _________________________________ 
:  _________________________________

 

:   ________________________________

:  ________________________________

 


: _________________________________

Date of test Testing Authority Result of Test
1. _________________________________________________________________________________
2.  _________________________________________________________________________________
3.  _________________________________________________________________________________
4.  _________________________________________________________________________________
13. I enclosed copies of my recent
      [Passport size photograph (where laminated
      card is used no photographs are required]              :  _________________________________
14. I enclosed the learner's licence No._______________________ dated_____________________ issued by
      licencing authority.
15. I enclosed the driving Certificate No.______________________ dated_______________ issued by
16. I have submitted along with my application for
      Learner's Licence the written consent of parent/guardian    __________________________________
17. I have submitted along with my application for
      Learner's Licence/ I enclose the medical fitness certificate.  __________________________________

18.  I am exempted from the medical test under Rule 6
       of the Central Motor Vehicle. Rules, 1989.__________________________________
19.  I am exempted from preliminary test under
       Rule 11(2) of the central Motor Vehicles. Rules, 1989._____________________________
20.  I have paid the fee of rupees 
       I hereby declare that to the best of my knowledge and belief the particulars given above are  true.

                    Note:- Strike out whichever is inapplicable.

 Date: Signature/Thumb impression
of applicant
Certificate of test of competence to drive
                The Applicant has passed the test prescribed under Rule 15 of the Central Motor Vehicles
          Rules, 1989. The test was conducted on (here enter the registration mark and description of the
          vehicle)____________________ on _________________ date._____________________

          The applicant has failed in the test.
          (The details of the deficiency to be listed out)

          (i)
          (ii)
          (iii)
          (iv)

 Date: Signature of Testing Authority
with Full name and designation.
          Two specimen signatures of the applicant: 1.

                                                                   2.

          *Strike out whichever is inapplicable.