(FORMA) From [Section 7 (2) of the motor Vehicle Ord. 1965] FORM OF APPLICATION FOR LICENSE TO DRIVE A MOTOR VEHICLE NATIONAL IDENTITY CARD NUMBER apply for a license to enable me to drive 284 paid employe other than as a pald employes 01 Motor Cycle 02 Motor Car 03 uv 04 ATV 05 Motor Rickshaw 06 Tractor Agri 07 Tractor Comm 08 Motor Cab 09 Road Roller 10 Invalid Carriage 11 Particulars to be furnished by an applicant 41. Full Nome 2. Father Husband Name 3. Permanent Address 4. Temporary Address 5. Date of Bith_________ Blood Group, Date of Applicant 6. LP. No. Date Valid upto for 7. Particulars of any licens previously held by applicant Date of Applicant 8. Particulars and date of every conviction which has ‘been ordered to be endorsed on only license held by the applicant. 9. Have you been disqualified, for obtaining a license to drive? If to for what reason.10, Have you beon subjected o adrving test as to fitness oF api te rv rive an api Declaration as to physical fitness of applicant. 1. The applicant ie required to answer Do you setter fem epilepsy or from ausden stacks ‘of disabling gldéiness er fainting? (0) Are you abteto sitinguish with each aye a ‘distance of 29 yards in good daylignt with glass worm) a moter ear number plate canta letters and faures? (@Haveyoutosteitherhand or food of you suffering ‘rom any defect in movement contet power ot either Armor leg? (8 Doyou sutter form colour blinéness or nigh bndnest? (2) Doyou setter form defect of hearing? (8 Do,you suter from any other disease or disabity likely to cause your driving of a motor vebicte tobe ‘Source of danger tothe public? 30 give particular | declare that tothe best f my Infarmation and belef the particulars glvenin section I andth éeclaration made in section it here ore true, The. 2 ‘Signaturerthum impression of Applicant CERTIFICATE OF TEST OF ABILITY TO DRIVE lo Motor Voile Ord, 1965: ‘The appicart has passed inthe tos! specified nthe Thied sehedul the testwas conducted on (vth no), data License Wi 2 for Iesuedto the appicant allernocsssary verteFORM B (See Section 7(3) and Section (2)) NATIONAL IDENTITY CARD NUMBER Form of Medical (cerlficate in respect of application for alicense te drive any transport Vaticte orto drive any vehicle as paid employee or otherviews: 70 BE FILLED UP BEA REGISTERED MEDICAL PRACTITIONER 2 ‘ffciency? 3. Des the applicant sutter rom any heart orlung disorder which might interfere 4 (8) Does s applicant sutter from hearing of ordinary sound signals? 5. Dees the applicant nave any deformity or Joss of members, which interfore withthe 6, Dees he show any evidence o! being Addicted fo the excessive use of sicohol 7. Iehelshein your opinion gonerally ft a8 regards (a) bodity in health, and (b)eyesignt? 5. Marks of dentifeation, 2. Blood Group I certty hat tothe Bost of my Knowledge and belie ihe applicant fs the person Jove described and thatthe attached photograph sonably correct likeness. SignaTuRE NAME DOCTOR'S NATIONAL IDENITY CARD NO. PHOTOGRAPH Soca hey AueFemp ip bed WEL gi tusssdinPOLICE DEPARTMENT DRIVING TEST RESULT SHEET 3 Yes | Yes | vos wo | No | NO. c Tuning Sxaminer's[ AT 23] 45 ‘nite na Tae Csi Signal exonnors[ OF [ 2 [Ea] 2] 3] 4] Ss [Fa] 2 | 3[eap 2] a A raSSiag As 7 examiners| HIT 2] 3] 418] ele] 2] [silat sl] as Ke Rtenton L-ittued towards other examiners ET] 2 [ 3[ a [sa] 273] 4 Miscetoneous exaninors[ WT 2 [314 [8] e]7 [slew lal a Part (Riles sna Regulations) 31 [82] es] 34] 35 Yes | Yes| Yes| Yes| Yes No | No| No| No| No {Str ff whichever (Yes et No) is nat appileabe) 4. ‘Trate sons in North Seneca (es| (Mo) Aloette question 2. High way Code (Yes) (Ne) tebe out tothe appican. PART Il (Physical Fitness) (a) | (8) | ce) | (@) Yes | Yes | Yes | Yes No | No | No | No (Bike of whichover (Yes or ho) not appiable) Examiner's Remarks nave enamine Mec 7 serene WON Hehes PessodFated nthe tt ecsiiwes styeenee (Wit his fit name anc designation) Dated