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FORM 3

[See Rule 3(a) and 13]


LEARNER'S LICENCE

Fee Details Rs.350.0/- /di/33486 /25-10-2021 ApplNo: 3694642821

1. Licence No. MN01 /0009971/2021

2. Name KERINA LAISHRAM

3. Father's Name LAISHRAM IBOMCHA MEITEI

4. Date of Birth 01-04-1998

5. Optional/Blood Group- B+
RH Factor

6. Present Address KEISHAMPAT THOKCHOM LEIKAI PO PS


IMPHAL DIST-IMPHAL WEST,MN,795001
Holder's Signature

7. Permanent KEISHAMPAT THOKCHOM LEIKAI PO PS


IMPHAL DIST-IMPHAL WEST,MN,795001

(1)
8. Marks of Identification
(2)

is licenced to drive throughout India as a learner subject to the provisions of rule 3 of the Central
Motor Vehicles Rules 1989, a motor vehicle of the following description

LIGHT MOTOR VEHICLE, Motor Cycle with Gear(Non Transport),


.......................................................................................................................................

*The holder of the licence has passed the preliminary test referred to in rule 11(1) of the CMV
Rules ,1989.

*The holder of the licence is exempted from the medical test under rule 6 and from the
Preliminary test under rule11(2)of the Central Motor Vehicle Rules,1989

*Strike off which ever is inapplicable

This Licence is valid 26/10/2021 To 25/04/2022

Licensing Authority
Warning: DTO, IMPHAL WEST
The attention of the holder of this licence is drawn to rule 3 of CMV Rules, 1989 which prohibits him
from driving any motor vehicle unless he has besides him a person duly licenced 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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