962GOVERNMENT GAZETTE, W.A. [28 February, 1964.

962 GOVERNMENT GAZETTE, W.A. [28 February, 1964. P. 70B (Reverse). (For Office Purposes Only.) To be filled in by Testing Members of the Force A. Eyesight acuity test .,.. (Without R. Eye 61 L. Eye..81 Both eyes 61.................. It. Eye 81 6/ B. Rearing test .... C. Trying Regulation knowledge test .... ing all gears satisfactorily .. .... E. Turning vehicle to proceed in opposite direc- tion.,.. .... ..., ,... .... F. Reversing vehicle in a confined space • G. Road positioning at all times, whether driving forward or in reverse .... .... .... H. Giving codified signals wherever required by Regul ations .,.. .... I. Having control of and being able to stop vehicle quickly in case of emergency J. Stop and restart on a slope .... K. Park vehicle correctly, shift to neutral, apply hand brake, stop motor .... .,. .... L. Any further test considered necessary by Examiner. (Give particulars) .... N.B.—CLASSIFICATION—Poor, Fair, Very Fair, Good. One classification of Poor or two of Fair will fall applicant for Names and addresses of two reputable citizens who have known applicant personally and observed his conduct during the last twelve months Signature Rank No Conditions License is issued under (if any).. License Number issued The Officer in Charge, Date of Issue / /19 Police Traffic Department, PERTH. Date of Expiry / /19 Place of Issue

28 February, 1964.] GOVERNMENT GAZETTE, W.A. 963 P. 70 C. TRAFFIC ACT, 1919 P. 70 C. Application Fee Rec. No Abstract No APPLICATION FOR LICENSE TO DRIVE A PASSENGER VEHICLE I hereby apply for a License to drive a Motor and I furnish the No. QUESTIONS ANSWERS OF APPLICANT

1. What is your full name? (State Mr., Mrs., or Miss) ..., SURNAME CHRISTIAN NAMES (Full name to be in Block Letters)
2. What is your permanent residence? (In full) ....
3. What is your usual occupation ? ....
4. Who is your proposed employer? ....
5. Where were you born? ....
6. What is your date of birth?
7. What is your description? .... .... Height ft inches B. Driver's License .... .... No Issued at
8. Have you ever applied for and been refused a license to drive a Passenger Vehicle? ..., .,.. .... .
9. Have you ever been disqualified from holding or obtain- ing a License anywhere? ..- .... ....
10. Has your Driver's License ever been cancelled or
11. Have you been convicted by ANY COURT of ANY OFFENCE? If ao, give full particulars ....
12. Is your eyesight defective? If so, give particulars ....
13. Is your hearing defective? If so, give particulars ..„ So. give particulars .... .... ... ....
14. Do you suffer from epilepsy or fits? ..
15. Do you suffer from diabetes? .... .... .... ,