LEARNER'S LICENCE

Form 3
[See Rules 3(a),13]

Licence No. OD33 /0010744/2019

Issue Dt. 10-09-2019
Fee Details: Rs.200.0/- /ODS/71583 /07-09-2019
1. Name AJAYA KUMAR SAMANTARAY
Father's Name KABIRAJ SAMANTARAY
2.
3. Date of Birth 12-06-1979

4. Blood Group A+
5. Present Address Badatota Jatani,Khordha,OD,752050

6. Permanent Address Badatota Jatani,Khordha,OD,752050

7. Marks of Identification (1)

(2)
Specimen Signature/Thumb impression of
8. Qualifications 10+2 or Equivalent the holder of the
is licenced to drive throughout India as a learner subject to the provisions of rule 3 of the Central Motor Vehicles Rules 1989, a motor
vehicle of the following description
*The holder of the licence has exempted from the medical test under
MCWG,
.................................................................................................................................
*The holder of the licence has passed the Preliminary test under rule11(1)of the Central Motor Vehicle Rules,1989

*Strike off which ever is inapplicable

This Licence is valid from 10/09/2019 To 09/03/2020

Licensing Authority
Warning: RTO,BHUBANESWAR-II
The attention of the holder of this licence is drawn to rule 3 of CMV Rules, 1989 which prohibits him from driving any motor vehicle unless
he has besides him a person duly licenced to drive the vehicle and in every case , the vehicle carries "L" plates both in front and in the rear
of the vehicle.