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FORM - L.L.D.

[See rule 13(1)]


Application for a duplicate driving licence
To,
The Licencing Authority, Full Name ………………………
Address of the ………………….
applicant ………………………..

1. I hereby report that the driving licence held by me is lost/destroyed/torn/defaced/mutilated in


the following circumstance ……………
2. I hereby apply for a duplicate driving licence and tender the fee prescribed in rule 6.
3. The particulars of such driving licence held by me is as follows :-
Driving licence no…………….. issued for …………… (here enter the class of motor
vehicles) in the name of …………… by the licencing authority …………….. on
……………….. and expiring on ……………...
4. I hereby declare that my driving licence is not impounded by any authority and that
there have been no/following endorsement by the court since the date of
grant/renewal.
Signature of the applicant.
Date :
Place :
Specimen signature of the applicant
1.
2.
*Strike out whichever is either required or not applicable.

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