Form 4-A "Form of Application for Issue of International Driving Permit to Drive a Motor Vehicle in Other Countries." - India

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Download Form 4-A "Form of Application for Issue of International Driving Permit to Drive a Motor Vehicle in Other Countries." - India

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FORM 4-A
FORM OF APPLICATION FOR ISSUE OF INTERNATIONAL DRIVING PERMIT
TO DRIVE A MOTOR VEHICLE IN OTHER COUNTRIES.
To
The Licensing Authority,
- - - - - - - - - - - - - - - - -
. . . . . . . . . . . . . . . . . . . . .. . . . . . . . . .
Space for passport
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
size photograph
- - - - - - - - - - - - - - - --
I apply for an International Driving Permit to enable me to drive vehicles
of the following categories.
CATEGORIES OF VEHICLES FOR WHICH THE PERMIT IS
APPLIED FOR
(A) Motor Cycles Category L
and Category L
.
1
2
(B) Motor vehicles other than those in category (A) above, having
a permissible maximum mass/weight not exceeding 3,500 kg.
(7700 lb) and not more than eight seats in addition to the drivers
seat in Category M1.
(C) Motor vehicles used for the carriage of goods and whose permissible
Maximum mass/weight exceeds 3,500 kg. (7700 lb).
(D) Motor vehicles used for the carriage of passengers and having more
than eight seats in addition to the drivers seat.
(E) Combination of vehicles of which the driving vehicle is in a category
of categories for which the driver is licensed (B and/or C and/or D),
but which are not themselves in that category or categories.
PARTICULARS TO BE FURNISHED BY APPLICANT
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1. Name
:
--- - - -------------------------------------------------------------------------
(Surname)
(Middle Name)
(First Name)
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FORM 4-A
FORM OF APPLICATION FOR ISSUE OF INTERNATIONAL DRIVING PERMIT
TO DRIVE A MOTOR VEHICLE IN OTHER COUNTRIES.
To
The Licensing Authority,
- - - - - - - - - - - - - - - - -
. . . . . . . . . . . . . . . . . . . . .. . . . . . . . . .
Space for passport
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
size photograph
- - - - - - - - - - - - - - - --
I apply for an International Driving Permit to enable me to drive vehicles
of the following categories.
CATEGORIES OF VEHICLES FOR WHICH THE PERMIT IS
APPLIED FOR
(A) Motor Cycles Category L
and Category L
.
1
2
(B) Motor vehicles other than those in category (A) above, having
a permissible maximum mass/weight not exceeding 3,500 kg.
(7700 lb) and not more than eight seats in addition to the drivers
seat in Category M1.
(C) Motor vehicles used for the carriage of goods and whose permissible
Maximum mass/weight exceeds 3,500 kg. (7700 lb).
(D) Motor vehicles used for the carriage of passengers and having more
than eight seats in addition to the drivers seat.
(E) Combination of vehicles of which the driving vehicle is in a category
of categories for which the driver is licensed (B and/or C and/or D),
but which are not themselves in that category or categories.
PARTICULARS TO BE FURNISHED BY APPLICANT
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
1. Name
:
--- - - -------------------------------------------------------------------------
(Surname)
(Middle Name)
(First Name)
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
2. Father’s or
Husband’s name
:
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
3. Place of Birth and Country:
(Proof to be enclosed)
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4. Address
:
(a) Present
:
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(b) Permanent
:
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
5. Date of Birth (Proof to :
to be enclosed)
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6. Educational Qualification :
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
7. Identification marks
: 1.
2.
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8. Blood Group/RH factor
:
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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. Have you been disqualified
for obtaining driving licence
to drive ? If so, for what
reason ?
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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
2
for ? If so, give the following
details.
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Date of Test
Testing Authority
Result of Test
1)
2)
3)
4)
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13. I enclose three copies of my recent passport size photograph.
14. I enclose the copy of driving licence No. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
dated : - - - - - - - - - - - - - - - - - - - issued by - - - - - - - - - - - - - - - - - - - - - - - - - - - -
valid upto: - - - - - - - - - - - - - - - - - - - -.
15. I enclose a medical certificate in Form 1A.
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.
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