Page 503 - The Central Motor Vehicles Rules, 1989

FORM 2 THE CENTRAL MOTOR VEHICLES RULES, 1989 475
1
[Self-Declaration as to Physical Fitness
(a) Do you suffer from epilepsy or from sudden attacks of loss Yes/No
of consciousness or giddiness from any cause?
(b) Are you able to distinguish with each eye (or if you have held Yes/No
a driving licence to drive a motor vehicle for a period of not
less than five years and if you have lost the sight of one eye
after the said period of five years and if the application is for
driving a light motor vehicle other than a transport vehicle
fitted with an outside mirror on the steering wheel side) or
with one eye, at a distance of 25 metres in good day light
(with glasses, if worn) a motor car number plate?
(c) Have you lost either hand or foot or are you suffering from Yes/No
any defect of muscular power of either arm or leg?
(d) Do you suffer from night blindness? Yes/No
(e) Are you so deaf so as to be unable to hear (and if the Yes/No
application is for driving a light motor vehicle, with or
without hearing aid) the ordinary sound signal?
(f) Do you suffer from any other disease or disability likely to Yes/No
cause your driving of a motor vehicle to be a source of danger
to the public, if so, give details
I hereby declare that, to the best of my knowledge and belief, the particulars given
above and the declaration made therein are true. (Signature or thumb expression of the
applicant)
Note : (1) An applicant who answers “Yes” to any of the questions (a), (c), (e), (f)
and (g) or “No” to either of the questions (b) and (d) should amplify his answers with
full particulars, and may be required to give further information relating thereto.]
DECLARATION
Under sub-section (2) of section 7 of the Motor Vehicles Act, 1988
Shri/Smt./Kumari ......................................... son/daughter ........................................
of .................................... who is a minor is under my care and I accept responsibility for
his/her driving. If at a later date I decide not to accept responsibility for his/her driving,
I shall inform the licensing authority in writing for the cancellation of the licence. I give
my consent for his/her obtaining the learner’s licence.
Name of the parent/guardian:
Relationship with the applicant: Signature of the parent/guardian
FOR OFFICE USE ONLY
1. The applicant is exempted from production of a medical certificate under YES/NO
Rule 6 of the Central Motor Vehicles Rules, 1989;

Learner’s licence may be issued.

1 Inserted vide GSR 240(E), dt. 31-3-2021, w.e.f. 1-4-2021.