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    Motor Ve Hicl E or Dina Nce, 1 9 65: Form "B"

    Uploaded by

    Azhar
    This document contains a medical certificate form for applicants seeking a license to drive vehicles professionally. The 8-question form addresses the applicant's age, medical conditions like epilepsy or mental illness, heart/lung disorders, vision, hearing, physical deformities, addiction issues, and overall fitness. Examiners are directed to pay special attention to distant vision, the condition of arms/hands, and joints.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd

    Motor Ve Hicl E or Dina Nce, 1 9 65: Form "B"

    Uploaded by

    Azhar
    17 views1 page
    This document contains a medical certificate form for applicants seeking a license to drive vehicles professionally. The 8-question form addresses the applicant's age, medical conditions like epilepsy or mental illness, heart/lung disorders, vision, hearing, physical deformities, addiction issues, and overall fitness. Examiners are directed to pay special attention to distant vision, the condition of arms/hands, and joints.

    Original Description:

    Form B Driving License

    Original Title

    Form B Driving License

    Copyright

    © © All Rights Reserved

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    This document contains a medical certificate form for applicants seeking a license to drive vehicles professionally. The 8-question form addresses the applicant's age, medical conditions like epilepsy or mental illness, heart/lung disorders, vision, hearing, physical deformities, addiction issues, and overall fitness. Examiners are directed to pay special attention to distant vision, the condition of arms/hands, and joints.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    17 views1 page

    Motor Ve Hicl E or Dina Nce, 1 9 65: Form "B"

    Uploaded by

    Azhar
    This document contains a medical certificate form for applicants seeking a license to drive vehicles professionally. The 8-question form addresses the applicant's age, medical conditions like epilepsy or mental illness, heart/lung disorders, vision, hearing, physical deformities, addiction issues, and overall fitness. Examiners are directed to pay special attention to distant vision, the condition of arms/hands, and joints.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 1

    FORM "B"

    (Se e S ec ti on 4 (2 ) se c ti on 7 (3 ) an d sec ti on 15 )
    F orm of Me d ica l C e rti fi c a te in re sp ec t of a n ap p lic a nt f or a lice n se
    t o d riv e a ny t ra n sp ort ve h ic le or t o d riv e a ny v eh ic le a s a pa id e m p loy ee

    MOTOR VE HICL E OR DINA NCE , 1 9 65

    1. W h a t is th e ap p lic a nt 's ag e ? . .. . . .. . . .. . . .. . . .. . . .. . . .. . . .. . . .. . . .. . . .. . .

    2. I s t h e ap p lic an t su b jec t t o ep ile p sy , v e rti g o or a ny


    me n t a l a lim en t like ly t o a ff e c t h is e ffi c ien c y ? .. . . .. . . .. . . .. . . .. . . .. . . .. . . .. . .

    3. Doe s t he a p p lica n t su ff e r f rom a n y h e a rt or


    lu ng d isord e r w h ic h m ig h t in te rf e re w it h t h e
    pe rf orm a nc e of h is d u ti e s a s a d riv e r? . . .. . . .. . . .. . . .. . . .. . . .. . . .. . . .. . . ..

    4. (a ) I s th e re a ny d ef e ct of v ision ? I f so, ha s it b ee n
    c orre ct e d by a su ita b le pa ir of sp ec t ac le s? .. . . .. . . .. . . .. . . .. . . .. . . .. . . .. . . .. . . .

    (b ) C an t h e ap p lic an t re a d ily d isti n gu ish t h e


    p ig me n t a ry colou rs re d a nd g re e n ? .. . . .. . . .. . . .. . . .. . . .. . . .. . . .. . .

    (c ) D oe s t h e a p p lica n t su ff e r f rom n ig h t b lin d ne ss? . .. . . .. . . .. . . .. . . .. . . .. . . .. . .

    (d ) D oe s t h e a p p lica n t su ff e r f rom a d eg re e of
    d ea f n e ss w h ich w ou ld p rev e n t h im f rom
    h e a rin g ord in a ry sign a ls? .. . . .. . . .. . . .. . . .. . . .. . . .. . . .. . . ..

    5. D oe s t h e a p p lica n t su ff e r f rom a n y de f orm it y


    or lose of se n se s w h ic h w ou ld int e rf e re w ith t h e
    e ffi c ie n t pe rf orm a nc e of h is d u ti e s as a d rive r? . . .. . . …. . . .. . . .. . . .. . . .. . . .. . . ..

    6. D oe s h e sh ow an y e v ide n ce of be in g ad d ic t ed
    t o th e ex c e ssiv e u se of a lc oh ol, tob ac c o or d ru g s?. . . .. . . .. . . … .. . . .. . . .. . . .. . . ..

    7. I s he ge n e ra lly fi t re g a rd in g b od ily h ea lt h
    an d e ye sig h t ? … . .. . . .. . . .. . . .. . . .. . . .. . . .. . . .

    8. Ma rks of id e n ti fi c a ti on … .. . . .. . . .. . . .. . . .. . . .. . . .. . . .. . .

    S pa c e f or p h ot og ra p h S ig n a t u re … . . .. . . .. . . .. . . .. . . .. . . .. . . .. . . ..

    Na m e … .. . . .. . . .. . . .. . . .. . . .. . . .. . . .. . . .. . . ..

    De sig n a ti on …. . . .. . . .. . . .. . . .. . . .. . . .. . . ..

    - - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- - -- -
    Note: Sp ec ia l a tt e n ti on sh ou ld be d ire c te d t o d ista n t v ision an d t o th e con d iti on of
    t h e a rm s a n d h a n d s a n d th e join t s of b ot h ex t re m iti e s.

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