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To,
The
Licensing Authority,
______________________
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I,____________________________________________________________________________________
(Father's Name)
________________________________________________________________________
of
(Full postal
Address)___________________________________________________________________
_____________________________________________________________________________________
and present Address
_____________________________________________________________________
hereby report that Driving / Licence
No._______________________________________________________
Issued by the Licensing
Authority________________________________________________________on
or
about the____________________________________
day of__________________________________19
has been lost / destroyed in the fallowing
circumstances____________________________________________
_____________________________________________________________________________________
1. I hereby apply for duplicate licence and enclose
Treasury Challan
No. _______________________ for rupees.
2. I attach here with two clear copies of a recent
photograph of myself
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Date
:____________________
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Signature or
Thumb impression
of
applicant
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