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Form I

lsee Rules 5(2)l


physical fitness
Application - Cum - beclaration as to be
I

2 Son / Wl6 / Oaughts ol

'femporary Address

6
b) Ase on date ol aPplic.tion
. {1)
7.
: \2)

Declaration tf" lNo


lo" from sv o$ ?
oo you s!fie. tom eplP3v or toin tuddn athdc
ol ol elddim3'
(a)
,r' a rn'' ,. .i'shdJlsh sh eacn eve (o-,I vou havo h'ld a drivins lrerce to dn6
'' " "^ Ir v", h've ."er oe s'sn or om
:^',1::"::i";;:1"fi v",i"
'.":,,'" i' -o
^1"i# .. .,.i""-" ";i o n,""..vea_t and aPplrqion B ld dnvins a 14ht *nsr dotor
Yos ,
:.::,:j="'::; ;;; ; ,";,cr. nded ;$En ;d,@ rircr on rh' steatrms
1'
l,',]"i;',,;'i *.'" ';;;;" ai'""e or 25 tretrs n o@d d'y rishr (w h eras$s @m)
a molor . "iI
number Plste

had or lool or are you slnaino l6m any detqcr or Fuscr,ar


@ Have you losl eitler
po@rinolheramorleg? Yt, No
(d) Can yu adilv dislirEuish tle Pismed'ry colour' red and 9r.6?
(e) Dorrsllibrfombighlblin<tless? ,*.
r^ tf'plic'Xo
land t'
A,. vu $ d.ai as o be drabl to har
',arrrieutroruhoutsearinqotc,lh'odinarvsoundsiontl?
lh

eu3'
Y lNo,NO

4 o'sabil v llh'ly lo
,dr
'"' Do vo" 5uffer lrom .ny oher d6ss
"*iroteasoureaarserlolhepJbl(
ir$giv'dt'il3
given
Y
sd b'h'lt lh' Fnidl4s ,NO
I declsre lhal lo h bes( oi nv kno$ledqe
h.eby
d*ladion mustbB r!.re o. ac tu
'b@' 'nd
"f
(signaturo ot thumb lmpr*slon oit the Applicant)

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