Poppy Seeds
NEW
Application Number Form of Application for New Licence to Drive a Motor Vehicle (Read the instructions on page-5 carefully before filling the form) To, The Licensing Authority State * Name of the RTO/DTO UID
263048 *
LL DL
KA-Karnataka
*
KA01 -RTO,KORAMANGALA
Part – A
First Name 1. Name of the applicant Gender
*
Middle Name
Last Name
Male
Female Others or 1.2 Age(In Years) 29
*
1.1 Date of birth * (dd-mm-yyyy) 2. Place of Birth
2(a) If place of birth is out side India, Month & Year when migrated to India: Month 3 .Country by Birth 3(a) Email Address 4. Name of Year
*
IND-INDIA bhatmamta@gmail.com Father First Name* Mother Husband Guardian Middle Name Last Name
*
5. Permanent address :(Proof to be enclosed)
6. Present Address Present Address is same as Permanent Address
a) Flat Number b) Flat / House Name c) House Number/Plot No d) Street e) Locality f) Village / Town / City g) Taluka / Mandal h) District i) State j) PIN code * k) Phone l) Mobile
A-207 ISHA LAKE FRONT
A-207 ISHA LAKE FRONT
SOMASUNDARA PALYA HARLKUNTE VILLAGE
HSR LAYOUT SECTOR 2
SOMASUNDARA PALYA HARLKUNTE VILLAGE
HSR LAYOUT SECTOR 2
BANGALORE
KA-Karnataka
560102
BANGALORE
KA-KARNATAKA
560102
9901199226
9901199226 9901199226
Months Descent Naturalization Years 9 Non Indian Months
*
9901199226
Years 9
m) Duration of Stay at this address 7. Citizenship Status By
* *
Birth
Registration
8. Education Qualification 9. Identification marks
32-B E ( other than Mechanical)
10.Blood Group *
O+
Part – B
11*Requested Transaction Service (with class of vehicle) S.No. DESCRIPTION OF VEHICLE TYPE
Application Number
263048
New DL
New LL
1
2
MOTOR CYCLE WITHOUT GEAR(NON TRANSPORT)-(MCWOG )
MOTOR CYCLE WITH GEAR (NON TRANSPORT)-(MCWG )
3
4 5
6 7
LMV -3 WHEELER NT-(3W-NT )
LMV-NT-CAR-(LMV ) LMV-TRACTOR-NT-(TRCTOR)
MOTOR CYCLE WITH GEAR
Application Number Form of Application for New Licence to Drive a Motor Vehicle (Read the instructions on page-5 carefully before filling the form) To, The Licensing Authority State * Name of the RTO/DTO UID
263048 *
LL DL
KA-Karnataka
*
KA01 -RTO,KORAMANGALA
Part – A
First Name 1. Name of the applicant Gender
*
Middle Name
Last Name
Male
Female Others or 1.2 Age(In Years) 29
*
1.1 Date of birth * (dd-mm-yyyy) 2. Place of Birth
2(a) If place of birth is out side India, Month & Year when migrated to India: Month 3 .Country by Birth 3(a) Email Address 4. Name of Year
*
IND-INDIA bhatmamta@gmail.com Father First Name* Mother Husband Guardian Middle Name Last Name
*
5. Permanent address :(Proof to be enclosed)
6. Present Address Present Address is same as Permanent Address
a) Flat Number b) Flat / House Name c) House Number/Plot No d) Street e) Locality f) Village / Town / City g) Taluka / Mandal h) District i) State j) PIN code * k) Phone l) Mobile
A-207 ISHA LAKE FRONT
A-207 ISHA LAKE FRONT
SOMASUNDARA PALYA HARLKUNTE VILLAGE
HSR LAYOUT SECTOR 2
SOMASUNDARA PALYA HARLKUNTE VILLAGE
HSR LAYOUT SECTOR 2
BANGALORE
KA-Karnataka
560102
BANGALORE
KA-KARNATAKA
560102
9901199226
9901199226 9901199226
Months Descent Naturalization Years 9 Non Indian Months
*
9901199226
Years 9
m) Duration of Stay at this address 7. Citizenship Status By
* *
Birth
Registration
8. Education Qualification 9. Identification marks
32-B E ( other than Mechanical)
10.Blood Group *
O+
Part – B
11*Requested Transaction Service (with class of vehicle) S.No. DESCRIPTION OF VEHICLE TYPE
Application Number
263048
New DL
New LL
1
2
MOTOR CYCLE WITHOUT GEAR(NON TRANSPORT)-(MCWOG )
MOTOR CYCLE WITH GEAR (NON TRANSPORT)-(MCWG )
3
4 5
6 7
LMV -3 WHEELER NT-(3W-NT )
LMV-NT-CAR-(LMV ) LMV-TRACTOR-NT-(TRCTOR)
MOTOR CYCLE WITH GEAR