Page 507 - The Central Motor Vehicles Rules, 1989

FORM 4A THE CENTRAL MOTOR VEHICLES RULES, 1989 479

4. Address : .........................................................................
(a) Present ..........................................................................
(b) Permanent ..........................................................................
1 [(c) Mobile
(d) Email Id]
5. Date of birth (proof to be enclosed) ..........................................................................
6. Educational Qualification ..........................................................................
7. Identification marks (1) ....................................................................
(2) ....................................................................
8. Blood group/RH factor ..........................................................................
9. Have you previously held International ..........................................................................
Driving Permit? If so, give details
10. Particulars and date of every conviction ..........................................................................
which has been ordered to be endorsed on
any driving licence held by the applicant
11. 2 [(a) Have you been disqualified for ..........................................................................
obtaining a driving licence to drive? If so, for
what reason?
(b) Have you been barred by the current
country to drive in that country? If so, for
what reason?]
12. Have you been subjected to a driving test as ..........................................................................
to your fitness or ability to drive a vehicle in
respect of which a driving licence is applied
for? If so, give the following details:
Date of test Testing authority Result of test
(1)
(2)
(3)
(4)
13. I enclose three copies of my recent passport size photograph.
14. I enclose the copy of driving licence No. .... dated ... Issued by .... Valid up to ....
2
[15. Present address where I wish to collect my IDP, (applicable only in case if applicant
is applying from a Foreign Country after expiry of IDP issued during his current
stay)....................................]
16. I have paid the fee of Rs. .........................
I hereby declare that the particulars given above are true to the best of my
knowledge and belief.
Date :............... Signature/Thumb impression of Applicant.
*Strike out whichever is inapplicable.]

1 Inserted vide GSR 15(E), dt. 7-1-2021, w.e.f. 15-2-2021.
2 Substituted, ibid.