12

Page 3.

PARTICULARS CONCERNING THE DRIVER.

13

(1) A-Motor vehicles of which the laden weight does not exceed

3,500 kilog. (In all languages).

(2) B-Motor vehicles of which the laden weight exceeds ----

3,500 kilog

Surname

Other name$ commentti tam ----

Place of birth

Date of birth

Home address

Photograph

Seal of authority

Page 4. (Name of country)

EXCLUSION.

(2)

5663 S

M. (surname and other names) kami.

authorized as above by the authority of (country)

when composed betaRANS

is deprived of the right to drive in (country) segge k by reason of

Place

(In all languages),

0) C-Motor cycles. with or without side-car.

(1)

12)

0

44)

(In all languages).

-

FORM 1.

FORM OF FISCAL PERMIT UNDER 1911 CONVENTION.

Page J,

HONG KONG

INTERNATIONAL FISCAL PERMIT.

No.

GELAYANAN POLYAN JANA

INTERNATIONAL CONVENTION SIGNED AT GENEVA ON

March 30th, 1991,

[reg. 4.]

The present permit is issued with a view to the exemption from taxes or charges on the circulation or possession of major vehicles granted for one or more periods of stay representing a total period of not more than ninety days spent in cach of the countries to which the said Convention applics. The permit

only valid for one year from the date of issue.

The present fiscal permit is issued to

Dypon na arantija Comet)

living at

joka memang pada Tekn

for the motor vehicle with the following description:

Seat of authority

Date incommommerskiona tarijimet

Signature

Page 5 and following pages should repeat the particulars given on page translated into as many languages as may be necessary to enable The International Permit to be used in all the Contracting States mentioned on page 2.

Type of vehicle

Make of chassis

Number of chassis

A (1)

Scat of (authority,

Here begin last page.

@ (2)

C

Seal of authority,

Scal of authority

(2)

(2)

(0)

Number of engine

(4)

Registration number on the plates of the country issuing the permit Place and date of issucionamento.......

(3)

(6)

调最章

Stamp of authority

These word

s

Appeau Ca

the cover.

* Sarude and other momes of the owner or posmeSSOR.

** Town, sweet, member,

*** Simware of authority of of the organization designated for the mureosa.

* Visa of acibority.

↑ In

permit_Rssued by some oiber country the name of that country wid appear inwest and the pema will be drawn up in the Inguage of that country.

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