FORM L.L.D.
INTIMATION OF LOSS OR DESTRUCTION OF Licence &
APPLICATION FOR DUPLICATE DRIVING Licence
(Rule 15 of ANDHRA PRADESH MOTOR VEHICLES RULES, 1989)
To |
The Licensing Authority, |
_______________________. |
I am authorised driving Licence holder with Licence No.____________________________Isuued by______________________ |
hereby report that my driving Licence has been lost/destroyed and apply for duplicate.
Son/Daughter/Wife/Guardial of |
![](../images/inner/box3.jpg) ![](../images/inner/box3.jpg) ![](../images/inner/box3.jpg) ![](../images/inner/box3.jpg) ![](../images/inner/box3.jpg) ![](../images/inner/box3.jpg) ![](../images/inner/box3.jpg) ![](../images/inner/box3.jpg) ![](../images/inner/box3.jpg) ![](../images/inner/box3.jpg) ![](../images/inner/box3.jpg) ![](../images/inner/box3.jpg) ![](../images/inner/box3.jpg) ![](../images/inner/box3.jpg) ![](../images/inner/box3.jpg) ![](../images/inner/box3.jpg) ![](../images/inner/box3.jpg) ![](../images/inner/box3.jpg) ![](../images/inner/box3.jpg) ![](../images/inner/box3.jpg)
![](../images/inner/box3.jpg) ![](../images/inner/box3.jpg) ![](../images/inner/box3.jpg) ![](../images/inner/box3.jpg) ![](../images/inner/box3.jpg) ![](../images/inner/box3.jpg) ![](../images/inner/box3.jpg) ![](../images/inner/box3.jpg) ![](../images/inner/box3.jpg) ![](../images/inner/box3.jpg) ![](../images/inner/box3.jpg) ![](../images/inner/box3.jpg) ![](../images/inner/box3.jpg) ![](../images/inner/box3.jpg) ![](../images/inner/box3.jpg) ![](../images/inner/box3.jpg) ![](../images/inner/box3.jpg) ![](../images/inner/box3.jpg) ![](../images/inner/box3.jpg) ![](../images/inner/box3.jpg) |
1. ADDRESS |
PERMANENT
|
TEMPORARY
|
Door No. |
![](../images/inner/box5.jpg) |
![](../images/inner/box5.jpg) |
Village/town/city |
![](../images/inner/box5.jpg) |
![](../images/inner/box5.jpg) |
Mandal |
![](../images/inner/box5.jpg) |
![](../images/inner/box5.jpg) |
District |
![](../images/inner/box5.jpg) |
![](../images/inner/box5.jpg) |
Pincode |
![](../images/inner/box3.jpg) ![](../images/inner/box3.jpg) ![](../images/inner/box3.jpg) ![](../images/inner/box3.jpg) ![](../images/inner/box3.jpg) ![](../images/inner/box3.jpg) |
![](../images/inner/box3.jpg) ![](../images/inner/box3.jpg) ![](../images/inner/box3.jpg) ![](../images/inner/box3.jpg) ![](../images/inner/box3.jpg) ![](../images/inner/box3.jpg) |
2. Circumstances of loss/Destruction of the Licence ______________________________________
___________________________________________________________________________________________________________ |
3. Paid fee of Rs._______________________(Fee should be paid at the counter)
|
Signature/Thumb impression
of applicant |
|