Format of Affidavit for Change of Name in Driving Licence
I, _______ Son/Daughter of _______(Father Name) resident of _______, _______(District), _______(State), _______(Country), do hereby solemnly affirm and declare as under:-
1. That I am the permanent resident of above said address.
2. That I am the Driving License Holder bearing its Driving License No. ________.
3. That Change my Driving Licence Name from ________ to ________
4. That my above said statement true and correct.
Deponent
VERIFICATION:- Verified that the contents of above my said affidavit are true and correct to the best of my knowledge and belief and nothing has been concealed therein.
Date of Birth Date ____ Month ____Year_____________
Age on date of application __________________
Identification marks
(1) __________________
(2) __________________
DECLARATION:
(a) Do you suffer from epilepsy or from sudden attacks of loss of consciousness or giddiness from any cause? Yes/No.
(b) Are you able to distinguish with each eye (or if you have held a driving license to drive a motor vehicle for a period of not less than five years and if you have lost, the sight of one eye after the said period of five years and if the application is for driving a motor vehicle other than a transport vehicle fitted with an outside mirror on the steering wheel side) or with eye, at a distance of 25 metres in good day light (with glasses, if worn ) a motor car number plate? Yes/No
(c) Have you lost either hand or foot or are you suffering from a defect or muscular power of either arm or leg? Yes/ No
(d) Can you readily distinguish the pigmentary colours, red and green? Yes/No
(e) Do you suffer from night blindness? Yes/No
(f) Are you so deaf as to be unable to hear (and if the application is for driving a light motor vehicle, with or without hearing aid) the ordinary sound signal? Yes/No
(g) Do you suffer from any other disease or disability likely to cause your driving of a motor vehicle to be a source of danger to the public, if so, give details. Yes/No
I hereby declare that to the best of my knowledge and belief, the particulars gives above and the declaration made therein are true.
(Signature or thumb impression of the application)
Note : (1) Applicant who answers `Yes’ to any of the questions (a), (c), (e), (f) and (g) or `No’ to either of the questions (b) and (d) should amplify his answers with full particulars, and may be required to give further information relating thereto.
(2) This declaration is to be submitted invariably certificate in Form 1-A.
I, _______ Son/Daughter of _______(Father Name) resident of _______, _______(District), _______(State), _______(Country), do hereby solemnly affirm and declare as under:-