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