H 017868 2.00.000 (2003/01) ] X.

126 V . . .

.. 157 126 C.M.T.Section 126

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APPLICATION FOR RENEWAL OF DRIVING LICENCE

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~t{ u~y. Form should be filled in English. The Sinhala and Tamil translations are given in the last page.

OFFICIAL USE ONLY Application Amount No.

Extensions already Obtained 1. Driving Licence No 4A. Vehicle Class/es 4B. Valid Date

D M Y 2. Date of Issue

D M Y 3. Existing Vehicle Class/es 5. Initials 6. Surname

7. Full Name

8A. Address 8B. City 9. District

10. Divisional Secretariat

11. National Identity Card No. (All citizens of Sri Lanka should state the National Identity Card No)

12. A. Passport No. (only for foreign nationals) 12B. Issuing Authority

D M Y

D M Y

1

13. Date of Birth 14. Sex(M/F) 15. Date of Last Renewal D M Y D M Y

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I declare that the above particulars are true and accurate in every respect to the best of my knowledge. The photograph affixed hereto is that of myself. / ~ /Signature U .. Date

OFFICIAL USE ONLY

Date of Renewal Date of Expiry

D M Y D M Y

. Authorising Officer

OFFICIAL USE ONLY

Affix the photograph here (To the Driving Licence Card Printing Section)

Surname : Initials : DL No. : Authorising Officers Signature / Stamp

2

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Paste the Cash receipt here.

Notes

4