Application Form of Haryana Conductor's Licence

FORM LICENCE CONDUCTOR
(Rule 4.47(4) of the Punjab Motor Vehicle Rule 1940)
FORM IF APPLICATION OF HARYANA CONDUCTOR'S LICENCE
1. Name : … … … … … … … ............................… … … … … ..
2. Father's Name : … … … … … … … ............................… … … … … ..
3. Permanent Home Aggress : ..........................… … … … … … … … …
… … … … … … … … ..............................
… … … … … … … … ..............................
4. Present Address : … … … … … … … … … … … … ..............................
… … … … … … … … … … … … ..............................
5. I have not previously held a Conductor Licence permanently held a Conductor Licence issued
by.
6. I am not/disqualified for holding Conductor's Licence.
7. I hereby declare that I am not less that eighteen years of age that the above statement are true
and correct to the my best of knowledge. I attach two copies of recent photograph of my self.
Dated : … … … ..............
Signature or thumb impression
of applicant
Duplicate signature or
Impression of Applicant
Licence No. ...................
Badge No. ....................
The ............. 200.........
Licensing Authority
POLICE REPORT
Verification of Application for a Conductor Licence
Application … ............................... Age… ............S/o
Sh… … .........................................................R/O Vill.......................... Post Office… ................Police
Station ......................Tehsil .................... Distt. ........................ has been identified from the
photograph attached and vouched for by the following respectable persons of the locality.
He is living at the above Address for the last ........... Yr.
He is living at the present Address with his wife and children/ relatives/parents.
He bears a good/her character or has the following convocation.
Signature of the S.H.O.
Police Station :
Tehsil :
Distt. :
Signature or Thumb
Impression of the applicant
FORM C. OF CONDUCTOR
(Rule 4.47(5) of the Punjab Motor Vehicle Rules 1940)
FORM OF MEDICAL CERTIFICATE FOR CONDUCTOR
1. Name of the person examined : .......................… … … … … … … … … … … … .
2. Father's Name : … … … … … … … … … … … … … … … … … … .........................
3. Age : … … … .........................
4. Is the person examined, to the best of your judgment fit physically and mentally to perform the duties of a stage carriage ?
5. Does the show any evidence of being dedicated to the excessive of alcohol or drugs ?
6. Marks of Identification 1 .......................… … … … … … … ...
2 .......................… … … … … … … ...
I certify that person examined has affixed his signature of the thumb impression here to in my presence and that to the my best of my knowledge and belief and above statement are true and that the attached photograph is a responsible correct likeness of the person described.
Signature or Thumb
Impression of the person
Name .........................… … … .
(In Block Letter)
Signature ....................… … …
Designation .................… … …