FORM L.P.S.A.
[See rule 4 (2) ]
[ Form of application for the grant of an authorisation to drive a public service vehicle ]
To,
The Licensing Authority __________________________________________________________________
I apply for the grant of an authorisation to drive a public service vehicle and forward herewith the driving
licence held by me.
No._________________________________ dated ________________________________________issued by the
Licensing Authority ___________________________________________________________________________
Name of the applicant ___________________________________________________________________________
_____________________________________________________________________________________________
( in block letters)
Present address of the applicant ___________________________________________________________________
_____________________________________________________________________________________________
Date __________________
___________________________________
Signature or thumb impression of applicant
IDP No :
Rs. 200 /At :
APPLICATION FOR INTERNATIONAL DRIVING LICENCE PERMIT
1. Surname and Name
(in capital)
2. Name of Father / Husband
3. Place of Birth
4. Date of Birth
5. Home address in India
:
:
:
:
:
PARTICULARS OF INDIAN DRIVING LICENCE
1. M.D.L.Number
2. Town where issued
3. Date of issue
4. Date of Expiry
5. Class of Vehicles
:
:
:
:
:
PARTICULARS OF PASSPORT
1. Passport No.
2. Town where issued
3. Date of issue
4. Date of Expiry
:
:
:
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APPLICANTS SIGNATURE
Requirements :
1.
2.
3.
Civil Driving Licence
Passport
Town Copies of Photographs
Duplicate Signature
Triplicate Signature
Licensing Authority.