Page 498 - The Central Motor Vehicles Rules, 1989

470 THE CENTRAL MOTOR VEHICLES RULES, 1989 FORM 1A
1
[xxx] FORM 1
FORM 1A
[Refer Rules 5(1), (3), 7, 10(a), 14(d) and 18(d)] FORM 1A
Space for
Passport
size
Photograph
MEDICAL CERTIFICATE
(To be filled in by a registered medical practitioner appointed for the purpose by
the State Government or person authorised in this behalf by the State Government
referred to under sub-section (3) of section 8)

1. Name of the applicant ...............................
2
[1A Son/wife/daughter of
1B. Permanent Address
1C. Date of Birth]
2. Identification marks (1)...........................

(2)...........................
3. (a) Does the applicant, to the best of your judgment, Yes/No
suffer from any defect of vision? If so, has it been
corrected by suitable spectacles?
3
[xxx] Yes/No]
(c) In your opinion, is he able to distinguish with his Yes/No
eyesight at a distance of 25 metres in good day light a
motor car number plate?
(d) In your opinion, does the applicant suffer from a Yes/No
degree of deafness which would prevent his hearing
the ordinary sound signals?
(e) In your opinion, does the applicant suffer from Yes/No
night blindness?
(f) Has the applicant any defect or deformity or loss Yes/No
of member which would interfere with the efficient
performance of his duties as a driver? If so, give your
reasons in details.
(g) Optional
(a) Blood group of the applicant (if the applicant so
desires that the information may be noted in his
driving licence)

1 Form 1 omitted vide GSR 240(E), dt. 31-3-2021, w.e.f. 1-4-2021.
2 Inserted vide GSR 240(E), dt. 31-3-2021, w.e.f. 1-4-2021.
3 Words “(b) Can the applicant, to the best of your judgment, readily distinguish the pigmentary colours,
red and green? Yes/No” omitted vide GSR 401(E), dt. 24-6-2020, w.e.f. 24-6-2020.