SlideShare a Scribd company logo
FORM 1
[See Rule 5(2)]
APPLICATION-CUM-DECLARATION AS TO PHYSICAL FITNESS
1. Name of the applicant : ……………………………………………………………………………
2. Son/Wife/Daughter of : ……………………………………………………………………………
3. Permanent address : ……………………………………………………………………………
……………………………………………………………………………
……………………………………………………………………………
……………………………………………………………………………
4.Temporary address
Official address (if any)
5. (a) Date of birth
(b) Age on date of application
: ……………………………………………………………………………
……………………………………………………………………………
……………………………………………………………………………
……………………………………………………………………………
: …………………………………………………………………………..
6.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 licence 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 light motor vehicle other than a transport
vehicle fitted with an outside mirror on the steering wheel side) or with one 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 any defect of 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 so 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 given above and the declaration
made therein are true.
(Signature or thumb impression of the Applicant)
Note: (1) An applicant who answers "Yes" to any of the questions (a), (c), (e), (f) and (g) or "No" to either of
the questions (b) and (s) 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 with medical certificate in Form 1 A.

More Related Content

Similar to Form1

Ppapp1
Ppapp1Ppapp1
Ppapp1
digambarp549
 
Ppapp1
Ppapp1Ppapp1
Ppapp1
digambarp549
 
Ppapp1
Ppapp1Ppapp1
Application form
Application formApplication form
Application form
Abhishek kumar
 
Form 6A-Application for inclusion of name in electoral roll by an overseas el...
Form 6A-Application for inclusion of name in electoral roll by an overseas el...Form 6A-Application for inclusion of name in electoral roll by an overseas el...
Form 6A-Application for inclusion of name in electoral roll by an overseas el...
Green Realtech Projects Pvt. Ltd
 
form1a.pdf
form1a.pdfform1a.pdf
form1a.pdf
Firozkumar2
 
Form1a
Form1aForm1a
Form1a
Jayapal Jp
 
APPLICATION FOR DEPARTMENTAL EXAMINATION FOR PRELIMINARY GRADE MEDICAL OFFICE...
APPLICATION FOR DEPARTMENTAL EXAMINATION FOR PRELIMINARY GRADE MEDICAL OFFICE...APPLICATION FOR DEPARTMENTAL EXAMINATION FOR PRELIMINARY GRADE MEDICAL OFFICE...
APPLICATION FOR DEPARTMENTAL EXAMINATION FOR PRELIMINARY GRADE MEDICAL OFFICE...
Thamal Ravindu De Silva ACMA, CGMA
 
ET Case managment discussion 4109312
ET Case managment discussion 4109312ET Case managment discussion 4109312
ET Case managment discussion 4109312
Douglas GARDINER
 

Similar to Form1 (9)

Ppapp1
Ppapp1Ppapp1
Ppapp1
 
Ppapp1
Ppapp1Ppapp1
Ppapp1
 
Ppapp1
Ppapp1Ppapp1
Ppapp1
 
Application form
Application formApplication form
Application form
 
Form 6A-Application for inclusion of name in electoral roll by an overseas el...
Form 6A-Application for inclusion of name in electoral roll by an overseas el...Form 6A-Application for inclusion of name in electoral roll by an overseas el...
Form 6A-Application for inclusion of name in electoral roll by an overseas el...
 
form1a.pdf
form1a.pdfform1a.pdf
form1a.pdf
 
Form1a
Form1aForm1a
Form1a
 
APPLICATION FOR DEPARTMENTAL EXAMINATION FOR PRELIMINARY GRADE MEDICAL OFFICE...
APPLICATION FOR DEPARTMENTAL EXAMINATION FOR PRELIMINARY GRADE MEDICAL OFFICE...APPLICATION FOR DEPARTMENTAL EXAMINATION FOR PRELIMINARY GRADE MEDICAL OFFICE...
APPLICATION FOR DEPARTMENTAL EXAMINATION FOR PRELIMINARY GRADE MEDICAL OFFICE...
 
ET Case managment discussion 4109312
ET Case managment discussion 4109312ET Case managment discussion 4109312
ET Case managment discussion 4109312
 

More from Jayapal Jp

Form25
Form25Form25
Form25
Jayapal Jp
 
Trigonometric tables
Trigonometric tablesTrigonometric tables
Trigonometric tables
Jayapal Jp
 
Trigonometric tables
Trigonometric tablesTrigonometric tables
Trigonometric tables
Jayapal Jp
 
E business intranets inrernet extranet www
E business intranets inrernet extranet wwwE business intranets inrernet extranet www
E business intranets inrernet extranet www
Jayapal Jp
 
Mbse primer2nd edition_chapter1
Mbse primer2nd edition_chapter1Mbse primer2nd edition_chapter1
Mbse primer2nd edition_chapter1
Jayapal Jp
 
3 rd term syllabus
3 rd term syllabus3 rd term syllabus
3 rd term syllabus
Jayapal Jp
 
Key differences between e b and ec
Key differences between e b and ecKey differences between e b and ec
Key differences between e b and ec
Jayapal Jp
 
Computer memory
Computer memoryComputer memory
Computer memory
Jayapal Jp
 
ACCOUNTING STANDARDS
ACCOUNTING STANDARDS ACCOUNTING STANDARDS
ACCOUNTING STANDARDS
Jayapal Jp
 

More from Jayapal Jp (9)

Form25
Form25Form25
Form25
 
Trigonometric tables
Trigonometric tablesTrigonometric tables
Trigonometric tables
 
Trigonometric tables
Trigonometric tablesTrigonometric tables
Trigonometric tables
 
E business intranets inrernet extranet www
E business intranets inrernet extranet wwwE business intranets inrernet extranet www
E business intranets inrernet extranet www
 
Mbse primer2nd edition_chapter1
Mbse primer2nd edition_chapter1Mbse primer2nd edition_chapter1
Mbse primer2nd edition_chapter1
 
3 rd term syllabus
3 rd term syllabus3 rd term syllabus
3 rd term syllabus
 
Key differences between e b and ec
Key differences between e b and ecKey differences between e b and ec
Key differences between e b and ec
 
Computer memory
Computer memoryComputer memory
Computer memory
 
ACCOUNTING STANDARDS
ACCOUNTING STANDARDS ACCOUNTING STANDARDS
ACCOUNTING STANDARDS
 

Recently uploaded

United Nations World Oceans Day 2024; June 8th " Awaken new dephts".
United Nations World Oceans Day 2024; June 8th " Awaken new dephts".United Nations World Oceans Day 2024; June 8th " Awaken new dephts".
United Nations World Oceans Day 2024; June 8th " Awaken new dephts".
Christina Parmionova
 
在线办理(ISU毕业证书)爱荷华州立大学毕业证学历证书一模一样
在线办理(ISU毕业证书)爱荷华州立大学毕业证学历证书一模一样在线办理(ISU毕业证书)爱荷华州立大学毕业证学历证书一模一样
在线办理(ISU毕业证书)爱荷华州立大学毕业证学历证书一模一样
yemqpj
 
Combined Illegal, Unregulated and Unreported (IUU) Vessel List.
Combined Illegal, Unregulated and Unreported (IUU) Vessel List.Combined Illegal, Unregulated and Unreported (IUU) Vessel List.
Combined Illegal, Unregulated and Unreported (IUU) Vessel List.
Christina Parmionova
 
A proposed request for information on LIHTC
A proposed request for information on LIHTCA proposed request for information on LIHTC
A proposed request for information on LIHTC
Roger Valdez
 
Contributi dei parlamentari del PD - Contributi L. 3/2019
Contributi dei parlamentari del PD - Contributi L. 3/2019Contributi dei parlamentari del PD - Contributi L. 3/2019
Contributi dei parlamentari del PD - Contributi L. 3/2019
Partito democratico
 
Border towns and spaces of (in)visibility.pdf
Border towns and spaces of (in)visibility.pdfBorder towns and spaces of (in)visibility.pdf
Border towns and spaces of (in)visibility.pdf
Scalabrini Institute for Human Mobility in Africa
 
PPT Item # 5 - 318 Tuxedo Ave. (sign. review)
PPT Item # 5 - 318 Tuxedo Ave. (sign. review)PPT Item # 5 - 318 Tuxedo Ave. (sign. review)
PPT Item # 5 - 318 Tuxedo Ave. (sign. review)
ahcitycouncil
 
Practical guide for the celebration of World Environment Day on june 5th.
Practical guide for the  celebration of World Environment Day on  june 5th.Practical guide for the  celebration of World Environment Day on  june 5th.
Practical guide for the celebration of World Environment Day on june 5th.
Christina Parmionova
 
原版制作(英国Southampton毕业证书)南安普顿大学毕业证录取通知书一模一样
原版制作(英国Southampton毕业证书)南安普顿大学毕业证录取通知书一模一样原版制作(英国Southampton毕业证书)南安普顿大学毕业证录取通知书一模一样
原版制作(英国Southampton毕业证书)南安普顿大学毕业证录取通知书一模一样
3woawyyl
 
Item #s 8&9 -- Demolition Code Amendment
Item #s 8&9 -- Demolition Code AmendmentItem #s 8&9 -- Demolition Code Amendment
Item #s 8&9 -- Demolition Code Amendment
ahcitycouncil
 
World Food Safety Day 2024- Communication-toolkit.
World Food Safety Day 2024- Communication-toolkit.World Food Safety Day 2024- Communication-toolkit.
World Food Safety Day 2024- Communication-toolkit.
Christina Parmionova
 
IEA World Energy Investment June 2024- Statistics
IEA World Energy Investment June 2024- StatisticsIEA World Energy Investment June 2024- Statistics
IEA World Energy Investment June 2024- Statistics
Energy for One World
 
TRUE BOOK OF LIFE 1.15 OF TRUE JESUS CHRIST
TRUE BOOK OF LIFE 1.15 OF TRUE JESUS CHRISTTRUE BOOK OF LIFE 1.15 OF TRUE JESUS CHRIST
TRUE BOOK OF LIFE 1.15 OF TRUE JESUS CHRIST
Cheong Man Keong
 
Item # 10 -- Historical Presv. Districts
Item # 10 -- Historical Presv. DistrictsItem # 10 -- Historical Presv. Districts
Item # 10 -- Historical Presv. Districts
ahcitycouncil
 
快速办理(Bristol毕业证书)布里斯托大学毕业证Offer一模一样
快速办理(Bristol毕业证书)布里斯托大学毕业证Offer一模一样快速办理(Bristol毕业证书)布里斯托大学毕业证Offer一模一样
快速办理(Bristol毕业证书)布里斯托大学毕业证Offer一模一样
3woawyyl
 
PAS PSDF Mop Up Workshop Presentation 2024 .pptx
PAS PSDF Mop Up Workshop Presentation 2024 .pptxPAS PSDF Mop Up Workshop Presentation 2024 .pptx
PAS PSDF Mop Up Workshop Presentation 2024 .pptx
PAS_Team
 
PPT Item # 4 - 434 College Blvd. (sign. review)
PPT Item # 4 - 434 College Blvd. (sign. review)PPT Item # 4 - 434 College Blvd. (sign. review)
PPT Item # 4 - 434 College Blvd. (sign. review)
ahcitycouncil
 
原版制作(DPU毕业证书)德保罗大学毕业证Offer一模一样
原版制作(DPU毕业证书)德保罗大学毕业证Offer一模一样原版制作(DPU毕业证书)德保罗大学毕业证Offer一模一样
原版制作(DPU毕业证书)德保罗大学毕业证Offer一模一样
yemqpj
 
Antyodaya saral portal haryana govt schemes
Antyodaya saral portal haryana govt schemesAntyodaya saral portal haryana govt schemes
Antyodaya saral portal haryana govt schemes
narinav14
 
CBO’s Outlook for U.S. Fertility Rates: 2024 to 2054
CBO’s Outlook for U.S. Fertility Rates: 2024 to 2054CBO’s Outlook for U.S. Fertility Rates: 2024 to 2054
CBO’s Outlook for U.S. Fertility Rates: 2024 to 2054
Congressional Budget Office
 

Recently uploaded (20)

United Nations World Oceans Day 2024; June 8th " Awaken new dephts".
United Nations World Oceans Day 2024; June 8th " Awaken new dephts".United Nations World Oceans Day 2024; June 8th " Awaken new dephts".
United Nations World Oceans Day 2024; June 8th " Awaken new dephts".
 
在线办理(ISU毕业证书)爱荷华州立大学毕业证学历证书一模一样
在线办理(ISU毕业证书)爱荷华州立大学毕业证学历证书一模一样在线办理(ISU毕业证书)爱荷华州立大学毕业证学历证书一模一样
在线办理(ISU毕业证书)爱荷华州立大学毕业证学历证书一模一样
 
Combined Illegal, Unregulated and Unreported (IUU) Vessel List.
Combined Illegal, Unregulated and Unreported (IUU) Vessel List.Combined Illegal, Unregulated and Unreported (IUU) Vessel List.
Combined Illegal, Unregulated and Unreported (IUU) Vessel List.
 
A proposed request for information on LIHTC
A proposed request for information on LIHTCA proposed request for information on LIHTC
A proposed request for information on LIHTC
 
Contributi dei parlamentari del PD - Contributi L. 3/2019
Contributi dei parlamentari del PD - Contributi L. 3/2019Contributi dei parlamentari del PD - Contributi L. 3/2019
Contributi dei parlamentari del PD - Contributi L. 3/2019
 
Border towns and spaces of (in)visibility.pdf
Border towns and spaces of (in)visibility.pdfBorder towns and spaces of (in)visibility.pdf
Border towns and spaces of (in)visibility.pdf
 
PPT Item # 5 - 318 Tuxedo Ave. (sign. review)
PPT Item # 5 - 318 Tuxedo Ave. (sign. review)PPT Item # 5 - 318 Tuxedo Ave. (sign. review)
PPT Item # 5 - 318 Tuxedo Ave. (sign. review)
 
Practical guide for the celebration of World Environment Day on june 5th.
Practical guide for the  celebration of World Environment Day on  june 5th.Practical guide for the  celebration of World Environment Day on  june 5th.
Practical guide for the celebration of World Environment Day on june 5th.
 
原版制作(英国Southampton毕业证书)南安普顿大学毕业证录取通知书一模一样
原版制作(英国Southampton毕业证书)南安普顿大学毕业证录取通知书一模一样原版制作(英国Southampton毕业证书)南安普顿大学毕业证录取通知书一模一样
原版制作(英国Southampton毕业证书)南安普顿大学毕业证录取通知书一模一样
 
Item #s 8&9 -- Demolition Code Amendment
Item #s 8&9 -- Demolition Code AmendmentItem #s 8&9 -- Demolition Code Amendment
Item #s 8&9 -- Demolition Code Amendment
 
World Food Safety Day 2024- Communication-toolkit.
World Food Safety Day 2024- Communication-toolkit.World Food Safety Day 2024- Communication-toolkit.
World Food Safety Day 2024- Communication-toolkit.
 
IEA World Energy Investment June 2024- Statistics
IEA World Energy Investment June 2024- StatisticsIEA World Energy Investment June 2024- Statistics
IEA World Energy Investment June 2024- Statistics
 
TRUE BOOK OF LIFE 1.15 OF TRUE JESUS CHRIST
TRUE BOOK OF LIFE 1.15 OF TRUE JESUS CHRISTTRUE BOOK OF LIFE 1.15 OF TRUE JESUS CHRIST
TRUE BOOK OF LIFE 1.15 OF TRUE JESUS CHRIST
 
Item # 10 -- Historical Presv. Districts
Item # 10 -- Historical Presv. DistrictsItem # 10 -- Historical Presv. Districts
Item # 10 -- Historical Presv. Districts
 
快速办理(Bristol毕业证书)布里斯托大学毕业证Offer一模一样
快速办理(Bristol毕业证书)布里斯托大学毕业证Offer一模一样快速办理(Bristol毕业证书)布里斯托大学毕业证Offer一模一样
快速办理(Bristol毕业证书)布里斯托大学毕业证Offer一模一样
 
PAS PSDF Mop Up Workshop Presentation 2024 .pptx
PAS PSDF Mop Up Workshop Presentation 2024 .pptxPAS PSDF Mop Up Workshop Presentation 2024 .pptx
PAS PSDF Mop Up Workshop Presentation 2024 .pptx
 
PPT Item # 4 - 434 College Blvd. (sign. review)
PPT Item # 4 - 434 College Blvd. (sign. review)PPT Item # 4 - 434 College Blvd. (sign. review)
PPT Item # 4 - 434 College Blvd. (sign. review)
 
原版制作(DPU毕业证书)德保罗大学毕业证Offer一模一样
原版制作(DPU毕业证书)德保罗大学毕业证Offer一模一样原版制作(DPU毕业证书)德保罗大学毕业证Offer一模一样
原版制作(DPU毕业证书)德保罗大学毕业证Offer一模一样
 
Antyodaya saral portal haryana govt schemes
Antyodaya saral portal haryana govt schemesAntyodaya saral portal haryana govt schemes
Antyodaya saral portal haryana govt schemes
 
CBO’s Outlook for U.S. Fertility Rates: 2024 to 2054
CBO’s Outlook for U.S. Fertility Rates: 2024 to 2054CBO’s Outlook for U.S. Fertility Rates: 2024 to 2054
CBO’s Outlook for U.S. Fertility Rates: 2024 to 2054
 

Form1

  • 1. FORM 1 [See Rule 5(2)] APPLICATION-CUM-DECLARATION AS TO PHYSICAL FITNESS 1. Name of the applicant : …………………………………………………………………………… 2. Son/Wife/Daughter of : …………………………………………………………………………… 3. Permanent address : …………………………………………………………………………… …………………………………………………………………………… …………………………………………………………………………… …………………………………………………………………………… 4.Temporary address Official address (if any) 5. (a) Date of birth (b) Age on date of application : …………………………………………………………………………… …………………………………………………………………………… …………………………………………………………………………… …………………………………………………………………………… : ………………………………………………………………………….. 6.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 licence 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 light motor vehicle other than a transport vehicle fitted with an outside mirror on the steering wheel side) or with one 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 any defect of 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 so 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 given above and the declaration made therein are true. (Signature or thumb impression of the Applicant) Note: (1) An applicant who answers "Yes" to any of the questions (a), (c), (e), (f) and (g) or "No" to either of the questions (b) and (s) 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 with medical certificate in Form 1 A.