SAMPLE FORM OF DRIVING LICENSE RENEWALMTA 30/2 (OFFLINE)

DEPARTMENT OF MOTOR TRAFFICSRI LANKA
Motor Traffic Act Chapter 203 Section 124, 126(1), 128(1)APPLICATION FOR DRIVING LICENCE
Application for:

New

(Tick Appropriate Box)

ExtendRenewalDuplicate

Change ofParticulars

Conversion

Extend - Public Transport

FORM SHOULD BE FILLED IN ENGLISHAPERSONAL DETAILS

1. ID Type(ALL TRANSACTIONS)
NIC(Tick Appropriate Box)

Sri Lanka Passport

1234567891000V
T HE NN A KOON
MUD I Y AN SE L AG E
N I H A L KUM AR A

2. ID/Passport Number
3. Surname

4. Other Names*Passport no is not acceptable.

5. Name to be printed on the card

T H E N N A K OON MU D I Y A N S E L AG E
N I H A L K UM A R A
Male

6. SexFemale

1 9 7 8 / 0 1 / 2 8 8. Age 4 2

7. Date of Birth(Tick Appropriate Box)

Y

BYYYM

M

DD

ADDITIONAL PERSONAL DETAILS (ALL TRANSACTIONS)

2. Blood Group O +5 .0 5
4. Permanent Address
5 7 4, G A L LE RO AD,CO L OMB O3
5. Phone Number080 -1234 -5678
1. HeightFT

3. Organ DonorYesInches

No(Tick Appropriate Box)

(Address to wherethe card will be posted)

6. Divisional Secretariat
7. Driver Restrictions(Tick Appropriate Box)

Four Digit CodeNone

Corrective Lenses

Artificial Limb

C NTMI MEDICAL, POLICE, OLD LICENCE AND GRAMA NILADARI CERTIFICATE DETAILS
1. Date of NTMI Medical Certificate( EXTEND, RENEW & EXTEND PT)

2020 / 06 / 09
YYY

YYYYYMMM

M

DD

DD

2. NTMI Medical Certificate Number(EXTEND, RENEW & EXTEND PT)/3. Date of Police Report(DUPLICATE & EXTEND PT)/

4. Police Station(DUPLICATE & EXTEND PT)

5. Old Driving Licence Number(CONVERSION)

6. Issue Date
(CONVERSION)

B1234567D
2012 /05 / 04
YYYYM

M60775

8. Grama Niladari Certificate Number(CHANGE OF PARTICULARS)*Pl. give us your email address
ex: slembassytokyo123@gmail.com
Page 4Page 1

DD

7. Expiry Date
(CONVERSION)

2020 /05 / 04
YYYYM

M

DD

SAMPLE FORM OF DRIVING LICENSE RENEWALSECTION F, G, H AND I FOR OFFICE USE ONLY
2. VEHICLERESTRICTIONS

1. DRIVING LICENCE CLASSESD

3. TRANSACTION
TYPE

0- None1- Automatic Transmission
2- Physically Disabled
3- Electrically Powered

Please tick the appropriate box with an X

012CONRENEXT

34. ISSUE DATE OF OLD
CLASS / CLASSES= Conversion= Renewal= Extension

CON REN

Y

0Motorcycle Engine Capacity > 100cc
0Motor Tricycle - Tare < 500kg, GVW > 1000kg
0All Cars/Dual Purpose - GVW < 3500kg, Passengers < 8, Trailer < 250kg
0A
B1BYYYM

M

DD

2 0 1 2 0 5 0 4
2 0 1 2 0 5 0 4
2 0 1 2 0 5 0 42 0 1 2 0 5 0 4Motorcycle Engine Capacity < 100cc

A1

1. Payment Type(CONVERSION)EXTPAYMENT DETAILSFBANK.

4. Cashier Surname

GWRITTEN AND PRACTICAL TEST DETAILS

2. Authorized By

CEHeavy Motor Lorry - GVW > 17000kg, Trailer > 750kg

3. Practical Test Pass Date

DEHeavy Motor Coach - Trailer > 750kg

G1

Two Wheel Tractor with a Trailer

GAgricultural Land Vehicle with or without a Trailer/

1. Written Test Pass Date

Motor Lorry - GVW > 17000kg, Trailer < 750kg

Motor Coach - Passengers > 32, Trailer < 750kg

New(Tick Appropriate Box)

CD(Only When Cashier)

3. Initials of the Cashier

Light Motor Lorry - 3500kg < GVW < 17000kg, Trailer < 750kg

Light Motor Coach - Passengers < 32, Trailer < 750kg

CASHIER

2. Amount Paid

C1

D1(ALL TRANSACTIONS)

4. Vehicle ClassY

YYYYYY/
M

M

YM

M

B1B/
A1

A

ExtendExtend - Public Transport

Number of Classes
DDDD/
C1CCE

D1

DDE

G1

GJ

PT

J

PT

JPT

5. Name of the EMV

02 0 1 2 0 5 0 4H

PRACTICAL TEST DETAILS/

1. Practical Test Pass DateY

JSpecial Purpose Vehicle

PT

Public Transport Endorsement

A1

2. Vehicle ClassVoidCommercial Class

A. Learners Licence is valid for 18 months only.
B. All names must be written in FULL.
C. Age Limits:
Over 18: A, A1, B, B1, G, G1
Over 21: C, C1, CE, D, D1, DE and J
Over 23: PT

A

M

B1

B

2. Vehicle Class(Compulsory for Applicant who completed a written test during application)

FINGERPRINT LEFT HAND

FINGERPRINT RIGHT HAND

Please indicate which finger on right hand was used for the fingerprint:(Tick the appropriate box where applicable)YOUR
FINGERPRINTRIGHT THUMB

Left Thumb

Left Index Finger

M

Right Thumb

DC1CCE

D1New/
A1YAY/YM

B1BM

Number of Classes
DC1DCCE

D1DDE

Right Ring Finger

Left Little Finger

Right Little Finger

JYM

M

GOFFICER DETAILS AND SIGNATURE (ALL TRANSACTIONS)/SIGNATURE OF OFFICER

2 0 2 0 / 0 9 / 1 0Y

G1

Right Index Finger

Left Ring Finger

YG

Extend - Public Transport

Right Middle Finger

YG1

3. Name of the EMVAPPLICANT DECLARATION I declare that I am not suffering from any mental or physical disability or any disease as would be likely to cause
my driving to be a source of danger to the public. I also declare that the particulars given above are true and accurate to the best of myknowledge and I fully realize that if any of above particulars is found to be incorrect or false I am liable to be prosecuted or dealt with otherwise.
SIGNATURE
DATE

60775

DE

ExtendY

Page 2

D

Authorized Officer Name

Left Middle Finger

YOUR
SIGNATURE

Extend - Public Transport

Number of Classes
D(Tick Appropriate Box)Y

Please indicate which finger on left hand was used for the fingerprint:(Tick the appropriate box where applicable)/Y

1. Practical Test Pass DateE PHOTOGRAPH, FINGERPRINTS, SIGNATURE AND DECLARATION (ALL TRANSACTIONS)YOURFINGERPRINTLEFT THUMBYPRACTICAL TEST DETAILSI

In your own interest, you should read the notes below carefully:

PHOTO

Y

Extend

3. Name of the EMV

ActivateNotes:(Photograph should be pasted on the application)

New(Tick Appropriate Box)

DDPage 3YYY/M

M

DOFFICER'S STAMPD