G.C.P. J.No 1441/98-99 - 3,00,000  loose.
FORM L.L.D.

INTIMATION OF LOSS OR DESTRUCTION OF LICENCE & APPLICATION FOR DUPLICATES

(The Andhra Pradesh Motor Vehicle Rules)
  To,
  The Licensing Authority,
  ______________________
             
  I,____________________________________________________________________________________ 
  (Father's Name) ________________________________________________________________________
  of (Full postal Address)___________________________________________________________________
  _____________________________________________________________________________________
  and present Address _____________________________________________________________________
  hereby report that Driving / Licence No._______________________________________________________
  Issued by the Licensing Authority________________________________________________________on or
  about the____________________________________ day of__________________________________19
  has been lost / destroyed in the fallowing circumstances____________________________________________
  _____________________________________________________________________________________
            1. I hereby apply for duplicate licence and enclose Treasury Challan
                No. _______________________ for rupees.
           2. I attach here with two clear copies of a recent photograph of myself
Date :____________________

Signature or Thumb impression 
of applicant