FORM L.P.S.A.

[See rule 4 (2) ]

[ Form of application for the grant of an authorisation to drive a public service vehicle ]

To,
The Licensing Authority __________________________________________________________________

I apply for the grant of an authorisation to drive a public service vehicle and forward herewith the driving
licence held by me.
No._________________________________ dated ________________________________________issued by the
Licensing Authority ___________________________________________________________________________
Name of the applicant ___________________________________________________________________________
_____________________________________________________________________________________________

( in block letters)

Present address of the applicant ___________________________________________________________________

_____________________________________________________________________________________________

Date __________________

___________________________________
Signature or thumb impression of applicant

IDP No :
Rs. 200 /At :

APPLICATION FOR INTERNATIONAL DRIVING LICENCE PERMIT

1. Surname and Name
(in capital)
2. Name of Father / Husband
3. Place of Birth
4. Date of Birth
5. Home address in India

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PARTICULARS OF INDIAN DRIVING LICENCE

1. M.D.L.Number
2. Town where issued
3. Date of issue
4. Date of Expiry
5. Class of Vehicles

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PARTICULARS OF PASSPORT
1. Passport No.
2. Town where issued
3. Date of issue
4. Date of Expiry

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APPLICANTS SIGNATURE

Requirements :
1.
2.
3.

Civil Driving Licence

Passport
Town Copies of Photographs

Duplicate Signature

Triplicate Signature

Licensing Authority.