FORM 9-A

[See Rule 26(1) (20 (30]

INTIMATION OF LOSS OR DESTRUCTION OF THE DRIVING LICENSE AND
APPLICATION FOR THE ISSUE OF DUPLICATE DRIVING LICNSE.

To
The Licensing Authority,



Sir,
The Driving License No . which is valid up
to .. has been lost / destroyed / completely written off / spoiled / torn / mutilated
in the following circumstances.



I/We hereby declare that to the best of my/our knowledge that the Driving License has not
been suspended or cancelled under the provision of the Act or Rules made thereunder and the
circumstances explained above are true.

I/We do hereby apply for the issue of a duplicate Driving License.

The written off/spoiled/torn/mutilated certificate of Driving License is enclosed.

I/We have reported the lost to the Police Station .(date).




Date. Signature/Thumb impression
of applicant along with
full address.



Specimen Signature of the Holder of Driving License.

1.

2.