TRANSPORT DEPARTMENT Uttar Pradesh

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

Fee Details Rs.400.0/- /UPS/3316357 etc /29-08-2019 ApplNo: 1977371219 Issue Dt. 18-10-2019

1. Licence No. UP25 /0042429/2019

2. Name ROOP CHAND

3. Father's Name SOM PAL

4. Date of Birth 20-06-1998

5. Optional/Blood Group- B+
RH Factor

6. Present Address H NO 30 LADPUR BHOJI PURA Lad Pur

Bareilly,UP,243202
Holder's Signature

7. Permanent H NO 30 LADPUR BHOJI PURA Lad Pur

Bareilly,UP,243202

(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 without Gear (Non Transport), LIGHT MOTOR VEHICLE,
.......................................................................................................................................

*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 18/10/2019 To 17/04/2020

Signature and Designation of

the Licensing Authority
Warning: RTO, BAREILLY

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.