TRANSPORT DEPARTMENT Uttar Pradesh

ASST.RTO, KAUSHAMBI
FORM 3
[See Rule 3(a) and 13]
LEARNER'S LICENCE

Fee Details Rs.350.0/- /UPS/684978 /23-02-2019 ApplNo: 571756319 Issue Dt. 22-03-2019

1. Licence No. UP73 /0001185/2019

2. Name BRAJESH KUMAR

3. Father's Name BABU LAL

4. Date of Birth 01-07-1998

5. Optional/Blood Group- Unknown

RH Factor

6. Present Address SAINI CHAKIYA RAMPUR DHAMAWAN

SIRATHU,KAUSHAMBI,UP,212217
Holder's Signature

7. Permanent SAINI CHAKIYA RAMPUR DHAMAWAN

SIRATHU,KAUSHAMBI,UP,212217

(1)
8. Marks of Identification
(2)
is licenced to drive a Motor Vehicles of the following description through out India and in case of E-
rickshaw or E-cart, in specified areas or routes, as a learner,subject to the provisions of Rule 3 of
the Centeral Motor Vehicle Rules 1989:
Motor Cycle with Gear(Non Transport), LMV-NT,
.......................................................................................................................................

*The holder of the licence has passed the preliminary test referred to in rule 11(1) of the CMV
Rules ,1989.

*The holder of the licence is exempted from the medical test under rule 6 and from the
Preliminary test under rule11(2)of the Central Motor Vehicle Rules,1989

*Strike off which ever is inapplicable

This Licence is valid 22/03/2019 To 21/09/2019

Signature and Designation of

the Licensing Authority
Warning: ASST.RTO, KAUSHAMBI

The attention of the holder of this licence is drawn to rule 3 of CMV Rules, 1989 which prohibits him
from driving any motor vehicle unless he has besides him a person duly licenced to drive the vehicle
and in every case , the vehicle carries "L" plates both in front and in the rear of the vehicle.