[See rule 3 (a), 13]

Licence No :  
Date :  
    Name to be written across the photograph.

    Specimen signature/Thumb impression of the holder of the licence.

    Signature and seal of the Licensing Authority.

1. Name
2. Son/wife/daughter of
3. Date of Birth
4. Optional/Blood Group--RH Factor] :
5. Present address--Permanent
  Temporary/Official (if any)
6. Marks of identification  
is licensed to drive throughout India as a learner subject to the provisions of rule 3 of the Central Motor vehicles Rule, 1989, a motor vehicle of the following description :

* The holder of the licence has passed the medical test under rule 5 and the preliminary test referred to in rule 11(1) of the Central Motor Vehicles Rules, 1989.

* The holder of the licence is exempted from the medical test rule 6 and from preliminary test under rule 11 (2) of the Central Motor Vehicles Rules, 1989.

* Strike out whichever is inapplicable.
This licence is valid from to

Signature and designation of the
Licensing Authority.

Warning. The attention of the holder of this licence is drawn to rule 3 of Central Motor Vehicles Rules, 1989 which prohibits him from driving any motor vehicle unless he has besides him a person duly licensed to drive the vehicle and in every case, the vehicle carries L plates both in front and in the rear of the vehicle.