FORM L.L.D.
INTIMATION OF LOSS OR DESTRUCTION OF LICENCE &
APPLICATION FOR DUPLICATE DRIVING LICENCE
(Rule 15 of VEHICLES RULES, 1989)

To

The Licensing Authority,

_______________________.

I am authorised driving licence holder with Licence No.____________________________Isuued by______________________

I, Shri/Smt./Kumari

  hereby report that my driving licence has been lost/destroyed and apply for duplicate.

Son/Daughter/Wife/Guardial of

1. ADDRESS	PERMANENT	TEMPORARY
Door No.
Village/town/city
Mandal
District
Pincode

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