Driving Licence Eyesight Report Form To rve you must meet certain medical ness standard. Fo this purpose vehicles are classed 28 Group 1 and Group 2. \Wyeu are appiyng fora vehicle in both Groups (See note 2 overea!) pleas tick Group 3 and 2on this form. Where an applicant ‘meets the medical criteria for Group 2 vehicles, they wil automatically meet the medica criteria for Group 1 veces. Port Dever Intrmaton apptcartrame LIAM IsTotal IoTelebe 1 Iclalelstolsb 1 Inv lates | 8 1913416151310 Alm won WW bb) hlakk (Please X the appropiate box) re onde! 20] e} ets] 1 ofpsence of Rowrhtedcal Practaconer/Opt Smee ‘This form must be submitted to National Driver Licence Service with an application for 2 drving icence/leaner permit within three months of its completion by a Medical Practitioner or Optometrist. Part 2: Tobe completed by a Medical Practitioner or Optometrist whose name ison the General Register of Medical Practitioners or on the Register of Optometrists in ireland. | the undersignes reeaniparpmeP AAR cEaEA 19 ster optometrist (delete 3 appropriate), report tha gre the declaration in my presence wd the eyesight ofthe applicant by reference othe prescribed standard and in (esse Xe spprepiate bes blow 1 ron weet gee Group 2 vehicles o 7 Ai ‘Needs to wear corrective lenses to meet the standard set out overlea! yes LD io BSL Hy cpion as. (SER WPLEANTS FAME KI HOCK CAMTALS _SUAIA INIA: DARE CARDSO TPKE ne Signature of MigengrOpded aneran Optometrist whose name son the register in ireland 2) Soy ln Zr) fos) [aelzie) Stamp o meager Optometrist whose nme onthe epterin eand FINES OPTICIANS LTD EYECAP™ PROFESSIONALS ain TEL 061-417722 "1 eT —7 — og) 7-4 Fane ometnst intial any alteration or char