1964_ROAD_TRAFFIC_(DRIVING_LICENCES)_REGULATIONS — Page 3

PARTICULARS Concerning THE DRIVER

Photograph

Seal of authority

(1)

(2)

(3)

(4)

(5)

* In a permit issued by some other country the name of that country will appear instead and the permit will be drawn up in the language of that country.

** This should be a reference to the last page of the permit.

Page 4 (Name of country)

M. (surname and other names)

EXCLUSION

authorized as above by the authority of (country)

is deprived of the right to drive in (country)

by reason of

Seal of authority

Place

Date

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.

A(1)

Seal of authority

(1) A

(2) B

(3) C

(1)

(2)

(3)

(4)

(5)

Here begin last page.

B(2)

Seal of authority

C(3)

Seal of authority

Motor vehicles of which the laden weight does not exceed - 3,500 kg (In all languages)

Motor vehicles of which the laden weight exceeds - 3,500 kg (In all languages)

Motor cycles, with or without side-car. (In all languages)