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Wolverhampton Docs

The document provides a summary of a driving licence for Mr. Mohammad Yasin, including details such as the licence validity dates and medical certification requirements for driving a hackney carriage or private hire vehicle. It outlines the medical examination process, including the need for identification and the frequency of medical assessments based on age. Additionally, it includes sections for medical practitioners to report on the applicant's fitness to drive, vision assessment, and any medical conditions that may affect driving ability.

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21 views13 pages

Wolverhampton Docs

The document provides a summary of a driving licence for Mr. Mohammad Yasin, including details such as the licence validity dates and medical certification requirements for driving a hackney carriage or private hire vehicle. It outlines the medical examination process, including the need for identification and the frequency of medical assessments based on age. Additionally, it includes sections for medical practitioners to report on the applicant's fitness to drive, vision assessment, and any medical conditions that may affect driving ability.

Uploaded by

wolvifyeverything
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF or read online on Scribd
| ae Driver & Vehicle Licensing Agency You can share this licence information summary with, someone else lke your employer ora car ice firm. Licence summary PUM ately ieee aly (eCiae aim iel im iectare) 0 Offences elias} es Your check code: 2k SC 7T WW «Is case-sensitive «is valid for 21 days * can only be used once | os tc na mn at eS ERS SP Driver's full name MR MOHAMMAD YASIN Date summary generated 20 February 2025 12:14 Driving licence number ¥00000001 40M99HR Licence issue number n Licence valid from ‘to july 2021 Licence valid to 13 January 2030 What to do next owtothreyurtenc summary Whertovewastardinncesmimary_Chackcodenot wating? ancenter thes 8 caractersofthenng ys. ore code hs been viewed Driving licence number: 20000001 40M9SHR Page: 1 of 2 Check code: 2k SC 77 ww 2025 This document is valid until 31 December 2025, subject to legal amendments. CiTYor WOLVERHAMPTON City of Wolverhampton Council Licensing Services OU cit Inpro wth Hackney Carriages and Private Hire Vehicle Driver Medical Certificate sum sutrasvecomet Full Name of Applicant (Capitals), Mohammpp Yaoi Address: PLAT. 7 | ALCENTRAL Ave NUE PosteodeG JAK hereby authorise my doctor(s) and specialists to release reports/medical information to the Medical Practitioner, should they require further information about condition(s) relevant to my fitness to drive to group 2 standard. Signature of applicant *_/G-2 -2025 (Tobe signed inthe presence of he medical praciioner signing Ws cerca) You are Assessing Fitness to Drive at DVLA Group 2 Standard, a guidance for medical professionals is available online at hitos:/[Link]/quidance/assessing finess-to-drive-e-quide-for-medicalrotessionals This medical must be completed in person and not remotely. You must include the full Group 2 Medical Assessment completed with this document for clarification. The applicant has provided one from each type of the solowing forms of identification, Type 1: Passport Driving Licence poe Type 2: Utilty Bill (gas, electric, telephone, water) Bank Statement O Birth Certificate O Marriage/Civil Partnership Certificate: Q Date of Birth of applicant J4 jo) //460 Age of applicant_6.5 Medical certification frequency requirement + Anew certificate must be produced every 5 years after the applicant's 45" birthday. ‘* Once the age of 65 is reached, a medical certificate must be produced every year. Earlier medical certification frequency requirement The above medical certification frequency is not sufficient: LI (tick box if applicable) and | recommend that the applicant is examined no later than: (insert date) feauy that | have on this day examined the applicant, who signed this form in my physical presence and showed two forms of identification as indicated above and they have provided me with their full medical records obtained within the last month for which | have reviewed to ascertain their medical fitness to Group 2 Standards and completed the attached D4 Form and | declare that they meet the below: Medically Fit eee unfit C1 to drive a hackney carriage or private hire vehicle. Name of GMC registered Medical Practitioner ZAIN CAMA Signature of GMC registered Medical Practitioner. Lda 18 10212005 GMC Reference Number FLFl¢ q [26 Taxi Medical Motor Medicals Led Motor Medicals LTD tamed 0161 241 9622 ‘Manchester, M2 3HZ [Link]/taxi ACFE HERS Please note — this certificate is only valid for four months from the date of assessment. ‘TAXI MEDICAL PROVIDER - Motor Medicals LTD - [Link]/taxi TAXI MEDICAL PROVIDER - [Link]/taxi ae Medical examination report Driver & Vehicle for a Group 2 (bus or lorry) licence Licensing Fer acoso how fi ti fo, ea he left MEAD vaae a wn govukreappl-dungscence-medical-conaion as ue task rc nen youn rap Peg on ere eee a ogre Ea apelle [eeapey fap eperegie ad eclaration on page 8. Important information for doctors carrying. Important: This report is only valid for eee es Before you in tis must check the aplcants en cee identy and doce you are ableton he vse, Name assassment on page 2 you aro unable todo is, you Mo D ] il ‘must inform the applicant that they will need to ask an 4 ‘optician or optometrist to fil in the Vision assessment. ‘ = Examining medical professional Bas rio ho of aa Belew Re) ARN EAM ea | | | é B las WearpaTy erplojed ou a Boca + N é ElFo RD ‘you to cary out this examination? Yes|X] No_] iN an 1F Yes, you must give the company's deals below. e If 'No’, you must give your practice address details below. Postcode HEI {Rte to section C of INF&D) Contact nan Company oF practice acess of] ey B mjo|tlojR| |mlelp| 1 {cla pe UN|TIE[RIN|A|T| 1 /O[N|A A alr |t 46 jo Holulsle| |6l1) |miols: aim AL io | s|t/R|e|e|T Date fist hoansed to ive a bus or omy Manic /Hle|s|T|E|R 3\H\Z yu dot wana ie sry vats by ame Hom aS DWApemtree Be te ‘Your doctor's details (only fill in if different 4)1\9 from examining doctor's details) 28 email adc epee U[N|F|ol@|mlo|r Dit |e} ptt tf jf} Aitis|.|clo|m I } ‘GMC registration number ieee je lelgialifel | | SlelR bolo] Wie ‘A |b ean confi that have checked the applicant's | documents to prove their identity. glezITIERT- ‘Signature of examining doctor 0 |7 a i ‘Applicants height (em) 0 SF Finch Contact number ‘Number of alcohol units consumed each week 0.1. © | tits pr weak ‘Brel siiness ‘Does the applicant smoke? Yes (net | Do you have acces tothe sppleant fll media reco? ves oT] Important: Signatures must be provided at the end of this report INVESTORS IN PEOPLE” We invest in people Gold pes ae Medical examination report Driver & Vehicle Ucersng «= Vision assessment Agency ‘To be filled in by an optician, optometrist or doctor 14. Please confinn{/) the scale you are using to express. the applicap?® visual acutis, Sreten| 7 Snen exresoad as adcirall_] Logan ‘2 The visual acuity standard for Group 2 ckiving Isat least 6/75 none eye and at least 6/60 In the other. (@) Please provide uncorected visual acuities for each eye. Snelien readings witha plus () ‘oF minus () afb not acceptable. If 67.5, 6/60 standard is not met, the applicant may need further assessment by en optician. wLZ/4 | 6/4 le (b) Are corrective lenses worn for ving? O TENo, go to 8. It Yes, please provide the visual aoutes using ‘the correction woen for devin. Snoion readings with a plus (+) or minus () are not acceptable 1¥ 617.5, 6/60 standard is not mat, the applicant may need futher assessment by an optician. al G/6 |le/b _| {What kind of corctvelanses are wor tommest ths jafidard? Gases Y Contact nsee|] oth together] (6) glasses are worn for cving, isthe corrective power greater than pls ()8 dlopires in any mesiian of thor lens? {@) Itcorrection is worn for driving, Is it well tolerated? ITNo, please give fll details in Q7. Yes No 8. Is there a history of any medical condition that may affect the applicant's binocular field of vision (central andor peripheral? [_) It Yes, please give ful detals below, Yes No If formal visual lid testing is considered necessary, DVLA will commission ths ata lator date. 4. Ie there cpopla? =e (ate conto? oo Pease neat below and give ul tals in G7 Pach or Glass Other lasses with with/wthout (other please trosted glass [_] prism provide detals) [_] Fo) fo Sionature, ‘5. Does the applicant report symptoms of any of the following that imps their abit Please indicate below and give fll details to drive? in Q7 below. {@) Intolerance to glare (causing incapacity rather than slscomtort) and/or (©) Impaired contrast sensitvty andor (©) Impaired twiight vision 6. Does the appicant have any other ophthalmic condition affecting their sual aculty or visual ld? It Yes, please give full detals in Q7 below. 7. Details or adklitional information Name of examining doctor, optician or optometrist Undertaking vision assessment 4 eet I Telalon 2) asl Z| al t | confirm that this report was filed in by me at ‘examination and the applicants history has been ‘taken into ‘consideration. ‘optician or optometrist Inte: 61 Mosley Stree Manchester, M2 3! info@motormed! Alm |a |e Se ‘Applicant's full name | mee 1 |é]o Please do not detach this page ae Medical examination report tossing’ “” Medical assessment Agency Must be filled in by a doctor Pare tae ts Rete Chasanisaysenecectaneercaged YS N° Does the apart have dabets metus? disor see codons n queters 11011 bow? |_| [4 No, go to section 3, Cardiac IFNo, goto section 2, Diabetes mettus If es, please answer ll questions below. if Ys, please anwar il questions Below and enclose levant 4. the diabetes managed by: Yes: No oe (@ Insulin? rae Yes No IINo, goto 1¢ C 4. Has the applicant had any frm of geieure? (_] [| It Yes, please give date] 7] a a ean ‘ne seu episode ere ous weeks {b) IF Yes, please give date of first and last episode. of blood glucose readings wee on oo rst ef T ‘a memory meter oF meters’ ieee IfNo, please give details in section 9, page 7. — J (0 otter injectable wetmens? : Ce eal oo (6) A Sulphonylures ofa inide? it Yes, pleas fil inthe medication section 8, page 6. (9 Ort tyreghowamic sont nc et? fu (a ino longer e316 an of) 10), pease fl (© Vested, wend the mediation section 8, page 6. a treatment end? aes ( Diet only? U (6) Has the applant had a brain scan? Is, pease give detain secon 9, page 2a Des peat ee Dee He (0, Has the applicant had an EEG? oO ea every (~ Ifyou have answered Ye to any of abo © Does espa es at tes ree ‘must supply medical reports, fo ding (no more than 2 hours before bo oe ae the start of the first journey and every 2 Has tho applicant experienced Yeo No hours wae ane? ssoclatvernen-epleptc'seinres?” _—) (©) Does the applicant Keep fast-acting (@) Yes, please give | carole ery rah date of most recent is00e- ee en hi fprininp le Cm el (0 (intend taboo to ocour whist drving? necessary precautions for safe cing? 8. Stroke or TIA? YesyNo’ ata) Se ahypogtyemic episode ee eee aay ay (©) If Yes, is there full awareness (@) Has there been a ful recovery? Oo ‘of hypoglcaemia? Oo (©) Has aca urasound been undertaken? (| [_] (6) IF Yes, was the carotid artery stenosis {Feiner 25096 in ether cart artery? assistance of ancther person? OO (GIs there history of multiple strokes/TIAS? 4. Sudden and dsabiing diziness or vertigo, ‘within the last year with a liability to recur? It Yes, please give details and dates below. SSS, 1% Witete wicerce Yes No © Sinticant hea uy within he e Yes wine oo {@) Lose of visul itd? ui (©) Severe peripheral neuropathy, suiclent to impair limb function for safe driving? (_) O 7. Any form of brain tumour? 8. Other intracranial pathology? ry IWY¥es, please give detaits in section 9, page 7. 8. Chronic neurological disorder(s)? (J) (1 @ Has there been taser treatment or ‘Yes a Pas teateamen taney 10, Parkinson's disease? oOo Soe a moaicont one TLL Graverehess win ewstioyean? CC] or eaten L Ti pentane racane CEE eve H | Date of bith |) JA [o|} [6 [0] o ok Ceoteinrnerer est ie Scere auleecserce creek Is there a history or evidence of Yes ‘coronary artery disease? O No, go to section 3b, Cardiac arrhythmia Yes, please answer all questions below ‘aortic aneurysm or dissection? Is there a history or evidence of peripheral arterial disease (excluding Buerger's disease), ‘and enclose relevant hospital note. eae rns 1s Hast aeeientoverhed arepiode Yee. No of angina? [1] [+ Peripheral arterial disease? Yes fete (ekndeg Buerert ae a eee 1 TT _ 2 Acute coronary syndrome including ‘Yes No 2. Does the applicant have claudication? oO Pare oO er wes oan tao TT] T eee 8 coronary ansiolsy PO? -~ Yes Ploeee sees: ” 3. Aortic aneurysm? ry intervention. t it Yes: tet pr illtemcer aera ‘4. Coronary artery bypass att surgery? E ae ‘Abdominal (0) Has Itbeen repalred successtuly? [_| sven possegie dae! | | | | I | ee anata eke Sores cai! 6, Yes to any ofthe above, are there any Yes No Lang ROE tae oteee ‘physical heatth problems or disablities, OO eee (6.9. mobility artes or COPD) that would make —! lee) Idapptea' unaietotndetae s niues ce [Jon standard Bruce Protocol ETT? Please gia details below, 4. Dissection ofthe aorta repaired successfully? Yes If Yes, please provide copies ofall reports including those dealing wih any surgeal treatment 6: isthe ahistry of Martane dase? Yes Lik cenhecteteesbble bid IFY¥es, please provide relevant hospital notes, |_| Is thre a istry or evcence of Yer No carga arya? s cr rt disease HtNo, goto ection 2, Peripheral arterial cbease 11s, please answer all questions below and enclose 1s ea REESE A Le = relevant hospital notes, ee ee Ly HN, goto section Se, Cardiac other 1. Has nee bean a soritcant turbance te, answer questons blow and prod Ofeariae rte? eg. aoa ease, teevet noel ete, Sinan atlovertcdar conduction defect, Yop No sil utero fsiaten, row or road ves complex tachyearda) mine atSyears? (| |_] 4. Inthe ahistry of congenital heart cseaser |" 2. Has the arrhythmia been controlled Yeo N a Salton for atest Senin? C11 a tema attr ofan vive unser 2. Hasan CD Onplnted CaracOstbitn Crtiverticl pacemaker wth certo, yj, & Inthe ahistry of arte steno? Yes cardiac resynchronisation therapy defibrillator = If Yes, please provide relevant reports: (CRED type) been implanted? OU (including echocardiogram), 4 Hana paar of a hnticar pacer = ‘ares eeyntreruaton ery poco hak ay ineaiioks asked (CRIP type) been implanted? a Yes: ee 5. Does the applicant cent have we eee | | Sninant symptoms’ (0) fe the appar oe ofthe spon that ‘ceaeemeee eeeneaey CC] Kiel ola aiepeinniditr ae () Does the applicant attend a pacemaker Clinically or on scans etc) since the last poasin coe a founoe epplenton? O olH|a|m|m|a fp | ‘Applicant’ tulname | |i |/ | Date of bith |/ INo, go to section 34, Valvular/congenital heart disease No ls Ue Lie le He No Alel i IeTo) Noe ew gator 2 eee dein mone aorecmrengns paiement sn N72 ies oxercee EG been undetkon er age Lylolzie{s) Is there a history or evidence of heart failure? No, go to section of, Cardiac channelopathies | ItYes, please answer all questions and enclose relevant hospital notes. ‘3. Has an echocardiogram been undertaken Yes. No 11. Please provide the NYHA cass, (or planned? it known, (@) undertaken, is oF was tha ft sjecton No - [-]& Has a oop recorder been implanted * (er planneay? r ‘2. Established cardiomyopathy? = fraction greater than or equal to 40%? (1 ies, please ave detals mn secton®, page 7. [| [ ] sa coronary angiogram been undertaken Yes 3. Has a left ventricular assist device (LVAD) or Yes No (or planned)? | 2) {J Sai LO L \ ee wanna cm Kite caine Si, Seas emer ve 4 65. Untreated aia myxoma? eens Has @ myocardial petusion scan, stress ass nearore a meee I No, go to section 3g, Blood pressure | Yes No 4. Brugada syndrome? MEME 4 Psychiatric illness Is there a history or evidence of the Of Of §F Ne Ns OF Os 2 Long QT syndrome? Yes No Isthere a history or evidence of peychiatie Yes No ifs to ether, please give detals in section 9, [_] ilivess within the last 3 years? ra page 7 and encioee relevant hosp notes No, goto section 6, Substance misuse 7 If Yes, please answer al questions below. eee 11 Signfcant psychiatric dsorder within the Yes ‘past 6 monthe? If Yes, please confirn condtion |] ‘All questions must be answered j Testing blood prose e180 (gaya or more {___ z tinder !Comm/ig castle or more pasos ake afurher 2, Poychossorryporariamania whinthe Yes No Zeacing et ans Smuts apart and record the beet Pact t2 months, holudng peyote depressor? |] [| {tthe 9 Teadngs the box provided. ou 1, Peasorecoiodaysbes, | S79) 44 (@) Dementia o cognitive impainent? 5 No pee SE 7 sees 2. ts the anplcantonant-typertensve treatment? Yos 46 Preabe diagnoson? OO ese provide tee previous reecings [> win cates vamos MEME 5 Substance misuse isthe aso of upacanot miewse Nes No Lig / 4% | [ifelo cooeoat Cie I No, go to section 6, Sleep disorders if Yes, please answer all questions below. 1. Is there a history of aleohol dependence in the past 6 years? (177 7 36 | [i [slo [tz 7 &F_| [iso ee a ae oo IFYes, pease gve detain section 9, page 7 |_| [~~ Has the sppcant undergone an alcohol =) (inetudhg date of agnosis and any treatment etc). L : ‘Applicant’ name an pate ot btn |} [4/0] 1 [6] 64 real Is thee a history or evidence of Obstructive Yes No ‘Sloop Apnoaa Syndrome or any other medical) Condition causing excessive sleepiness? — No, go to section 7, Other medical conditions. It Yes, please give diagnosis and answer all questions below. Ee 8) Obstructive Sleep Apnoea Syndrome, please indicate the seventy: Mild (ABI <15) Moderate (AHI 15 - 29) ‘Severe (AHI >@9) Not known another measurement other than AH! i used, must be one that is recognised in cinical practice as equivalent to AHI. OVLA does not prescribe different measurements as this isa cinical Issue. Pease give detain section 9 page 7, Further deta, ) Piease answer questions (10 (for al sleep ‘conattions,, es (0 Date of lagnes: is ie (1s t controlled sucessstaly? LT) oO (IF es, please stato treatment {6 Does the applicant have a history ‘of lver disease of any origin? Ite, s this the result ‘of alcohol misuse? If Yes, please give details In section 9, page 7. Lg 7. Is there a history of renal failure? Yes It Yes, please give detail in section 9, De age 7. 8. Does the applicant have severe symptomatic Y°S Sryecdang race |e 8. Does any medication currently taken cause Yes No tenoplont estates) C2 sicShet "pln in sc 8, Maden suigheapieors necro me? 410, Does the applicant have any other medical ‘condition that could affect safe diving? ITs, please provide detals in section 9, page 7 Please provide deals of all curent medication including eye drops (continue on a separate sheet If necessary ASP AUN SM. 2 OD Reason for taking: £72 fi} heen on a baci ene 5 o Approximate date started (tinown):| |_| [free |e Le Net | aaa) (a Datootistvevew.[ | |] METIOSMIN | 14 BI Reason fer taking: _(y ARETE C—O = 4. there ahistory or evidence of narcolepoy? [~) (7~ 2 Is there curently any functional impaiment Yes No ats Ikly to afect contra of the vehicle?) 2 Is there a history of bronchogenic carcinoma Yes. No or other malignant tumour with a signicant > Taty to metatasiee cretraly? OM ‘4 Is there any illness that may cause significant Y¢S or fatigue or cacheia that afets safe diving? 5. Is the applicant profoundly deat? It Yes, i the applicant able to communicate Inthe event ofan emergency by speech for by using a device, eg. a texiphone? Dé Dé [ Hehe f OV ASTAT IN, 60. Reason for taking: (/DUEFEPEO L- I ‘Approximate date started i known Tay AM eet Reason fortaking:_ B7 poproninata ate stared ener] ] l a Reason for taking ‘Approximate date stated (f known} v olH\almimia ‘Applicant's full name |\/| A) NI) | pate orbitn| 7 [G4] 0] [8 Please send us copies of relevant hospital notes. Do not ‘send any notes not related to fness to ive. Use the ‘space below to provide any addtional information. Never had wis OF Chath pin» dave tracshig 40-9 dork 9 frecattins jahiallg in Fo ZoZ! jhan in VE* Hed Err dare 4 feb 2o2p HS GP, no issue ported, £CG Bette no conend hoe Sean fy of Cacdaoliy (Me aypladrin poked i fil for wore - tore no Cone Please provide detals of type of specialists or consultants, Including address. (Consultant In Reason for attendance | ‘Address Date of last appointment: CConsutant Reason for attendance Name ‘Address a ern 111 Os SR A reer loch cecu Prec ‘To be'fled in by the doctor carying out the examination. lease make sur al sactons of the form have been filed in. “The form wil be retured to you if you do not do this. | confi that his report was filed in by me at examination ‘and have taken the applicant's history into account. also Confirm that | ar curerily GMC registered and licensed. to practise inthe UK or lam a doctor who is medically registred within the EU, if the report was filed in outside the UK. ‘Signature of examining doctor jeveees gop ets) Doctor's stamp | Motor Medicals Ltd International House 5 /o Applicant's fll name | Date ot bith || | 4] O} | |6 The applicant must fill in this page Applicant’s declaration ‘You must fl in this section and must net alter itin any way. lease read the following important information carefully then sign to confirm the statements below. Important information about fitness to drive ‘As part of the investigation into your fitness to drive, we (DVLA may require you to have a ‘medical examination and/or some form of practical assessment. If we do, the individuals involved in these will need your background medical details to carry out an appropriate assessment, ‘These individuals may include doctors, orthoptists, at eye clinics or paramedical staff at a driving ‘assessment centre. We will only share information relevant to the medical assessment of your fitness. to drive, ‘Also, where the circumstances of your case appear ‘to suggest the need for this, the relevant medical information may need to be considered by one or ‘more of the members of the Secretary of State's. Honorary Medical Advisory Panels. The membership Of these Panels conforms strictly to the principle of confidentiality. For information about how we process your data, your rights and who to contact, see our privacy Notice at [Link]/dvia/privacy-policy Declaration | authorise my doctor, specialist or appropriate healthcare professional to disclose medical information or reports about my health condition to the DVLA, on behalf of the Secretary of State for Transport, that is relevant to my fitness to drive, |'understand that the doctor that | authorise, may pass this authorisation to another registered healthcare professional, who will be able to provide information about my medical condition that is relevant to my fitness to drive. | understand that the Secretary of State may disclose ‘such relevant medical information as is necessary to the investigation of my fitness to drive to doctors and other healthcare professionals such as orthoptists, aramedical staff and the Secretary of State for ‘Transport's Honorary Medical Advisory panel members. | declare that | have checked the details | have given ‘on the enclosed questionnaire and that, to the best ‘of my knowledge and belief they are correct. | understand that it is a criminal offence i | make a false declaration to obtain a driving licence and can lead to prosecution. Name [MoHAMmMan YASIN — | Signature authorise the Secretary of State to correspond with medical professionals via electronic channels (fax and/or email) Yes No Checklist * Have you signed and dated the declaration? ‘* Have you checked that the optician, optometrist or doctor has filled in all parts of the report and all relevant hospital notes have been enclosed? Yes Yes - Important This report is valid for 4 months from the date the doctor, optician or optometrist signs it. Please return it together with your application form. e207 10 69rd dq eoue0n sequn 8Nia uiseA PeWwWeYoW JW eo) fe hire drivers licence Medical report for a combined hackney carriage/pri THE APPLICANT TITLE @orsivisss DATE oF BIRTH TT) ] SURNAME YAsin CBw) J FORENAME(S) MoHAMMAD es] ADDRESS z 5 Kear 1°36 ConreaL. AVENUE q| | | NEw BAsroRy 2 Norn Net Am CURRENT OCCUPATION Slanature of Applicant OCCUPATIONAL PHYSICIAN ONLY (To be signed in the presence of a 2 Please give the name and address of thes Doctor (or Group Practice) that you have been registered with over the Past 12 months NAME OR FR Lo | ADDRESS Ca. | Sherwood Rise Medical Centre 31 Nottingham Road Sherwood Rise Nottingham NG7 7AD Tel: 0115 962 2582 -0115 962 3080 Fax: 0115 962 2969 OCCUPATIONAL PHYSICIAN ONLY THIS SECTION TO BE COMPLETED BY THE Recommendation:, | certiy that | have, examined the applicant, who has signed this form in my Presence, and in*my opinion MEETS, the medical requirements of bee for Group 2 licences by the DVLA. Signature ..... Date

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