Cmv Form 1 PDF Details

The CMV Form 1, alongside its accompanying CMV Form 1-A, is integral in the process of affirming an individual's physical fitness for driving in certain jurisdictions. These forms serve as a crucial step for applicants to declare their medical suitability to hold a driving license. The CMV Form 1 specifically requires applicants to self-report on various health aspects, including but not limited to epilepsy, vision capabilities, limb function, and hearing abilities, as well as any other conditions that could impair safe driving. Meanwhile, the CMV Form 1-A, to be completed by a registered medical practitioner, offers a professional assessment of the applicant's health, focusing on similar areas such as vision, hearing, and overall physical ability to operate a vehicle safely. These forms not only ensure that drivers meet the necessary health standards but also protect public safety by mitigating the risk of accidents due to medical conditions. The detailed nature of these forms, requiring specifics on any 'Yes' or 'No' answers, coupled with the requirement for a medical certificate, underscores the thorough approach taken to evaluate an individual’s physical fitness to drive. This process reflects a comprehensive effort to balance the need for mobility with the imperative of safety on the roads.

QuestionAnswer
Form NameCmv Form 1
Form Length4 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min
Other namesform1, form 1, form 1 self declaration online, form 1 self declaration rto editable

Form Preview Example

CMV FORM 1

Application –cum-declaration as to the 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 eplipsy 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 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 in movement, control 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 give 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 (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 with Medical Cer-

tificate in Form 1-A.

------------------

CMV Form 1-A

Medical Certificate

[To be filled in by a registered medical practitioner appointed for the purpose by the State Government or person authorised in this behalf by the State Government referred to under sub-section (3) of Section 8]

1.

Name of the applicant

:

2.

Identification marks

:

(1)

(2)

3.(a) Does the applicant to the best of your judgment suffer from any defect of vision? If so, has it been corrected

 

by suitable spectacle ?

Yes / No

(b)

Can the applicant to the best of your judgment readily

 

 

distinguish the pigmentary colours, red and green ?

Yes / No

(c)

In your opinion, is he able to distinguish with his eye

 

 

sight at a distance of 25 metres in good day light a

 

 

motor car number plate ?

Yes / No

(d)In your opinion, does the applicant suffer from a degree of deafness which would prevent his hearing the ordinary

sound signals ?

Yes / No

(e) In your opinion, does the applicant suffer from night

 

blindness ?

Yes / No

(f)Has the applicant any defect or deformity or loss of member which would interfere with the efficient performance of his duties as a driver? If so, give your

reasons in details.

Yes / No

(g) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Optional

(a)Blood group of the applicant (if the applicant so desires that the information may be noted in his driving licence).

(b)RH factor of the applicant (if the applicant so desires that the information may be noted in his driving licence).

______________________________________________________________________

Declaration made by the applicant in Form 1 as to his physical fitness is attached.

Certificate of Medical Fitness

I certify that : -

(i) I have personally examined the applicant Shri/ Smt./Kum ...........

.....................................................................................................,

(ii)That while examining the applicant I have directed special attention to his / her distant vision,

(iii)While examining the applicant, I have directed special attention to his / her hearing ability, the conditions of the arms, legs, hands and joints of both extremities of the applicant, and

(iv)I have personally examined the applicant for reaction time, side vision and glare recovery (applicable in case of persons applying for a licence to drive goods carriage carrying goods of dangerous or hazardous nature to human life.)

and, therefore, I certify that, to the best of my judgment, he is medically fit / not fit to hold a driving licence.]

_____________________________________________________________________.

The applicant is not medically fit to hold a licence for the following reasons : -

______________________________________________________________________.

-----------------------------------

Signature :

Space for passport

1. Name and designation of the

size photograph of

Medical Officer / Practitioner

the applicant.

 

 

(Seal)

 

2. Registration Number of Medical

 

Officer

 

Signature of thumb impression

-----------------------------------

of the candidate

Date ;

Note : - The medical Officer shall affix his signature over the photograph affixed in such a manner that part of his signature is upon the photograph and part on the certificate.]

__________

How to Edit Cmv Form 1 Online for Free

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It is straightforward to finish the form using out practical guide! Here's what you should do:

1. The self declaration form pdf usually requires particular details to be typed in. Make certain the next blank fields are finalized:

form1 conclusion process clarified (portion 1)

2. Right after completing the last section, go on to the subsequent stage and enter all required particulars in these fields - Name of the applicant Son wife, a Do you suffer from eplipsy or, loss of consciousness or giddiness, Yes No, b Are you able to distinguish with, c Have you lost either hand or, any defect in movement control or, Yes No, and Yes No.

Writing section 2 in form1

3. This step is generally easy - complete all of the empty fields in d Can you readily distinguish the, and green, e Do you suffer from night, Yes No, Yes No, and Yes No to finish this segment.

Yes  No, Yes  No, and Yes No in form1

4. This next section requires some additional information. Ensure you complete all the necessary fields - g Do you suffer from any other, Yes No, I hereby declare that to the best, give above and the declaration, Signature or thumb impression of, An applicant who answers Yes to, This declaration is to be, and tificate in Form A - to proceed further in your process!

This declaration is to be, give above and the declaration, and I hereby declare that to the best inside form1

People generally make some errors while filling out This declaration is to be in this section. Remember to read again what you enter here.

5. This last point to conclude this PDF form is crucial. You'll want to fill in the required form fields, such as To be filled in by a registered, Yes No, b Can the applicant to the best of, distinguish the pigmentary colours, c In your opinion is he able to, sight at a distance of metres in, d In your opinion does the, of deafness which would prevent, Yes No, Yes No, and Yes No, prior to using the document. Or else, it could lead to an incomplete and potentially unacceptable paper!

c In your opinion is he able to, To be filled in by a registered, and distinguish the pigmentary colours in form1

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