FORM L.L.D.
INTIMATION OF LOSS OR DESTRUCTION OF Licence &
APPLICATION FOR DUPLICATE DRIVING Licence

(Rule 15 of ANDHRA PRADESH MOTOR 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