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DMW O: Appl Cati R N Conductors' Licence

This document appears to be an application form for renewal of a driver's, provisional, or conductor's license in Guyana. It requests basic personal information such as name, address, identification details. It asks about the applicant's medical fitness by asking questions about conditions like epilepsy, vision, loss of limbs or mobility. Applicants must declare they are medically fit to drive and not a danger to others. Applicants answering "yes" to a mobility question can either undergo a driving test or sign an additional declaration regarding their condition. Details about license classes and expiration dates are also requested.

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PujaUmadat
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129 views

DMW O: Appl Cati R N Conductors' Licence

This document appears to be an application form for renewal of a driver's, provisional, or conductor's license in Guyana. It requests basic personal information such as name, address, identification details. It asks about the applicant's medical fitness by asking questions about conditions like epilepsy, vision, loss of limbs or mobility. Applicants must declare they are medically fit to drive and not a danger to others. Applicants answering "yes" to a mobility question can either undergo a driving test or sign an additional declaration regarding their condition. Details about license classes and expiration dates are also requested.

Uploaded by

PujaUmadat
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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GUYANA ,REVENUE AUTHORITY

A p p l i c at i o n 1 Ren ew al f o r Dr i v er s ' , Pr o v i s i o n al & Co n d u c t o r s ' L i c en c e


Last Name First Name Middle Int.
- IL- - _
Address
I~ 'I
1'-----
Sex
DMwF
I
1_-
Colour of eyes
ID Type
oNational Identification
10 Number
oPassport oOther, please specify. _
TIN
1__ - 1__ -
0,New Licence lu\ ' I Renewal I\ i l Driver Licence oprovisional Licence oConductor Licence
oCar 0Van 0Cycle 0Mini Bus 0Hire Car o Motor Bus 0Tractor 0Lorry
Date ofTest which test was made
Result ofTest , 0
Pass Fail
1 [J :J [J :J DJ J J 1
The Applicant is required to furnish answers to t~e following questions by sel~cting "Yes" or "No" 'Opposite each question. Yes
1. Do you suffer from Epilepsy, sudden attacks 9f disabilitY, giddiness or fainting? 0
2. Are you able to read from a distance pf 25 yds in good daylight (with glasses, if worn) a Motor Vehicle 0
number plate containing six (6) letters and figures? ,
3. Have you lost either hand or foot, or are you suffering from any defect in movemen~control, ' 0
or muscular power of either arm or leg?
if yes, give particulars.
No
o
o
o
I ~- - - - - - - - - - - - - - - - - - - - -
Ideclare that Iam not suffering from any.other disease or disability, which would be likely to cause the driving by me of a motor vehicle to be
a scurce of danger to ttie public. . ,'. :
Ifurther declare thaI to the best of my information and particulars given in the declarations on this application hereof are true. .
Ifurther declare that it is an offen'ce for a person to use a motor vehicle on public road unless there is in fore!! a p!llicy on the insurance or
.a s~curity against third party risks covering. the use by that person of that vehicle.
Si nature
Date
Appiicarit'who answer~"yes" to question 3 in declaration of Physical fitness 'may either (1).claim to be subjected to a driving test,
(11) si~," the E Declar~tion, overleaf, if in the position to do so. .
I [J :J [J :J DJ J J 1
I
MotorVehicles & Road Traffic Regulations
GUYANA REVENUE AUTHORI TY
A p p l i c at i o n I Ren ew al f o r Dr i v er s ' , Pr o v i s i o n al & Co n d u c t o r s ' L i c en c e
I c l ai m t o b e s u b j ec t t o a t es t t o m y f i t n es s o r ab i l i t y t o d r i v e a m o t o r v eh i c l e o f t h e c l as s o r c l as s es s p ec i f i ed i n t h i s ap p l i c at i o n .
1 / ' I .
Si n at u r e -! Dat e
1-= c : r : J = -o - = [J :J = - IVI -= C l IIJ = y = -y r
. I hereby declare that a drivers' certificate under the Motor Vehicles' ordinance, 1935 Drivers' Licence under the Motor Vehicle and Road Traffic
Ordinance, was issued to me on the - - - - - - bythe - - - - r- - - certifying authority to drive a motor vehicle of the type
in respect of which a drivers' licence is now applied for by me and the date my last application for a drivers' certificate the disease or physical
disability from which I am suffering has not become more acute and that I am not suffering from any disease or disability !19t disclosed on such
last application.
Dat e
,
Cl as s o f L i c en c e
Ex p i r at i o n Dat e
1 -
/
L i c en c e Co v er Nu m b er
1'--- -
L i c en c e Nu m b er
Cer t i f i c at e o f Co m p et en c e Nu m b er
Dat e I s s u ed
Fo r ei g n L i c en c e Nu m b er Co u n t r y
1'---- 1 1 _
1c : r : J [J :J ~ 1/
r>: /
Ex p i r at i o n Dat e ,
1c : r : J , [J :J [IIIJ I
I
Mo t o r Veh i c l es & Ro ad Tr af f i c Reg u l at i o n s .

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