Form B

[see section 4(2), section 7(3) and section 15]

FORM OF MEDICAL CERTIFICATE IN RESPECT OF AN APPLICANT FOR A LICENCE TO DRIVE ANY TRANSPORT VEHICLE OR TO DRIVE ANY VEHICLE AS A PAID EMPLOYEE

(To be filled up by a registered medical practitioner)

1. What is the applicant’s apparent age? _____________________

2. Is the applicant subject to epilepsy, vertigo or any mental ailment likely to affect his efficiency.

3. Does the applicant suffer from any heart or lung disorder which might interfere with the performance of his duties as a driver ? _____________________

4. (a) Is there any defect of visions ? If so, has it been corrected by suitable spectacles?

(b) Can the applicant readily distinguish the pigmentary colours red and green?

(c) Does the applicant suffer from night blindness?___________________

(d) Does the applicant suffer from a degree of deafness which would prevent his hearing the ordinary sound signals? _____________________

5. Has the applicant any deformity or loss of members which would interfere with the efficient performance of his duties as a driver? _____________________

6. Does he show any evidence of being addicted to the excessive use of alcohol, tobacco or drugs?

7. Is he generally fit as regards (a) bodily health, and (b) eyesight?_________

8. Marks of identification _____________________

I certify to the best of my knowledge and belief that the applicant ____________________________ is the person herein above described and that the attached photograph is a reasonably correct likeness of the applicant.

		(Space for photograph)
	Photograph 1[* * *]

Signature______________________

Name_________________________

Designation____________________

Note– Special attention should be directed to distant vision and to the condition of the arms and hands and the joints of both extremities.

Form C

[See Section 8(1)]

DRIVING LICENCE

No._______________ 19___________________

(Name)________________________________________________

son/daughter of (father’s name)_________________________________

of (permanent address)_______________________________________

______________________________________________________

Signature or thumb-impression

¹The words “if necessary” deleted by the Provincial Motor Vehicles (Amendment) Ordinance, 1978 (VIII of 1978).

is licensed to drive, throughout the Province of [“_________________ ”]

vehicles of the following description:- ^{name of the Province}

(a) Motor cycle.

(b) Motor car.

(c) Motor cab.

(d) Delivery van.

(e) Light transport vehicle.

(f) heavy transport vehicle.

(g) Locomotive.

(h) Tractor.

(i) Invalid carriage.

(j) Road-roller.

(k) A motor vehicle hereunder described.

He is also authorized to drive as a paid employee.* This licence is valid from__________________ to ______________________.

(*To be struck out if inapplicable).

Signature and designation

Date________________ 19__ of Licensing Authority

Authorisation to drive public service vehicle– So long as this licence is valid and is renewed from time to time, the holder is authorized to drive a public service vehicle within the Province of [“__________________”]

^{name of the Province}

Signature and designation

Date________________ 19__ of Prescribed Authority

This licence is hereby Signature of

renewed up to Licencing Authority

the__________ day of___________ 19 ___________________

the__________ day of___________ 19 ___________________

the__________ day of___________ 19 ___________________

the__________ day of___________ 19 ___________________

the__________ day of___________ 19 ___________________

ENDORSEMENTS

Date	Section and rule	Fine or other punishment	Signature of Endorsing Authority

Form D

[See Section 9]

FORM OF APPLICATION FOR THE ADDITION OF A NEW CLASS OF VEHICLE TO A DRIVING LICENCE

I hereby apply for the addition of the following class/classes of motor vehicles to the attached licence:-

(a) Motor cycle.

(b) Motor car.

(c) Motor cab.

(d) Delivery van.

(e) Light transport vehicle.

(f) Heavy transport vehicle.

(g) Locomotive.

(h) Tractor.

(i) Road-roller.

(j) Invalid carriage.

(k) Motor vehicle of a specified description.

*I enclose (a) a medical certificate

(b) three copies of a recent photograph.

*(Required only where the applicant is not entitled to drive as a paid employee or a transport vehicle and now wishes to do so).

Date________________ 19__ Signature of applicant

Form E

[See Section 12(2)]

FORM OF APPLICATION FOR RENEWAL OF DRIVING LICENCE

I hereby apply for a renewal of the licence under the [Provincial] Motor Vehicles Ordinance, 1965, which was issued to me on the ____ by _____________________ (state title of Licensing Authority).

I hereby declare that I am not subject to any disease or disability likely to cause my driving of a motor vehicle to be a source of danger to the public.

Date________________ 19__ Signature of applicant