Académique Documents
Professionnel Documents
Culture Documents
Commissioner of Transport
Online Application for Appointment with TN36Z - SATHIYAMANGALAM
e-Acknowledgement Id
: TN36Z/2016/T/1094943/GB
Booked Date
: 26-Sep-2016
: GOWRISANKAR S
Date Of Birth
: 24-Nov-1994
S/O
: SHANDHRASEKAR
Door Number
: 2/387
Street
: KARACHIKORAI
Village / Town
: BHAVANISAGAR
District
: Erode
Pincode
: 638451
Purpose
E.Mail
RTO
: TN36Z - SATHIYAMANGALAM
Bannari main Road
Chikkarasampalayam
Sathiyamangalam TK
Appointment Date
: 26-Sep-2016
Appointment Time
: 11-12
Enclosed Documents
638401
(1)
School Certificate
(2)
Form 1
(3)
(4)
RationCard
e-Acknowledgement
: TN36Z/2016/T/1094943/GB
Appointment Date
: 26/09/2016
FORM 1
[See rule 5 (2)]
Application-cum-declaration as to the physical fitness
1. Name of the Applicant
GOWRISANKAR S
2. S/O
SHANDHRASEKAR
3. Permanent Address
2/387, KARACHIKORAI
BHAVANISAGAR,SATHYAMANGALAM
Erode - 638451
4. Temporary Address
Official address (if any)
2/387 KARACHIKORAI
BHAVANISAGAR SATHYAMANGALAM
- 638451
5. a) Date of Birth
b) Age on date of application
:
:
24/11/1994
6. Identification marks
(1)
(2)
Declaration
(a) Do you suffer from epilepsy, or from sudden attacks of loss of consciousness or giddiness from any
Yes / No
cause?
(b) Are you able to distinguish with each eye(or if you have held a driving licence to drive a motor vehicle
Yes / No
for a period of not less than five years and if you have lost, the sight ofone eye after the said period of
five years and if the application is for driving a light motor vehicle other than a transport vehicle fitted
with an outside mirror on the steering wheel side) or with one eye, at a distance of 25 metres in good
day light(with glasses if worn) a motor car
(c) Have you lost either hand or foot or are you suffering from any defect of muscular power of either arm
Yes / No
or leg?
(d) Can you readily distinguish the pigmentary colours,red and green?
Yes / No
Yes / No
(f) Are you so deaf as to be unable to hear (and if the application is for driving a light motor vehicle, with
Yes / No
Yes / No
I hereby declare that to the best of my knowledge and belief, the particulars given above and the declaration
made therein are true.
e-Acknowledgement ID
: TN36Z/2016/T/1094943/GB
Appointment Date
: 26/09/2016
FORM 2
[See rule 10]
FORM OF APPLICATION FOR THE GRANT OF LEARNER'S LICENCE
To
The Licensing Authority,
Space for
SATHIYAMANGALAM
Passport size
Photograph
I hereby apply for a licence authorising me to drive as a learner, the following motor vehicle(s):1 MOTOR CYCLE WITH GEAR
GOWRISANKAR S
__________________________________
SHANDHRASEKAR
__________________________________
5. Date of birth
( Birth certificate / School certificate / affidavit sworn before an Executive
Magistrate or a First Class Judicial Magistrate or a Notary Public to be
6. Duration of stay at the present address
7. Place of birth
8. If place of birth outside India, when migrated to India
9. Educational Qualification
24/11/1994
__________________________________
__________________________________
2/387,
KARACHIKORAI
__________________________________
SATHYAMANGALAM
__________________________________
Erode - 638451
__________________________________
2/387
KARACHIKORAI
__________________________________
BHAVANISAGAR
__________________________________
- 638451
SATHYAMANGALAM
__________________________________
__________________________________
__________________________________
__________________________________
__________________________________
__________________________________
13. I hold an effective driving licence to drive : Motor Cycle / light motor vehicle /
transport vehicle with effect from
14. Particulars of any driving licence previously held by applicant. Whether it was
cancelled and if so, for what reason
15. Particulars of any learners licence previously held by applicantin respect of the
description of vehicle to which the applicant has applied
16. Have you been disqualified for holding or obtaining driving licence of learner's
licence. If so, for what reasons
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
Signature___________________________
Name and full addres of the Parent / guardian
Relationship __________________
______________________________________
(To be signed in the presence if the licensing authority or person authority in this behalf by the licensing authority)