FORM 3 – LEARNER’S LICENCE
[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: (1) ____________________________________ (2) ____________________________________
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.
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Note: This form is for reference only and not to be used for Driving License application. For Driving License application form please visit your near License Authority