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International Driving Permit Slip (Indian Union ) IDPNo — HROGIOPIT 12016 Validity Unni 18/08/2017 "Name and Designation of Issuing Authority DSP GUHA Place of Isve ‘SUB DIVISIONAL OFFICER (CIVIL), GULHA Date of issue 9104/2016 12:44:56 PM Diving License NO. HR-os20140080271 ‘OLD Driving License NO, ‘A PARTICULARS CONCERNING THE DRIVER (1) Name of the Applicant PREETPAL SINGH (@) Fathers or husband's Name YADWINDER SINGH (8) Place of Bith & County INDIA (4) Date of BithvApproximate age 05/10/1885 (5) Adress (@) Permanent Address VPO KANGTHALI TEH. GUHLA DISTT KAITHAL 136034 (©) Present Adcress \VPO KANGTHALI TEH, GUHLA DISTT. KAITHAL 196034 (©) Blood Group Factor =O B. CATEGORIES OF VEHICLES FOR WHICH THE PERMITS IDP Vehicle class Motor Cycles Category L1 and L2 Motor Vehices, other than those inthe Categor(A) above, having permissible maximum massiveight not exceeding 3,500 KG(T700 Ib) ‘nd not more than eight seats in addition tothe drivers seat in Category Mt Passport No. 7 Ureri708 a Visa Details 1060112482660K AUSTARLIA Foe Details 9¢-4478--18104/2016 Rs 500 Lic idysthencityy AS), —, GULHA Nt, i eot.edu.au FORMB0001 Se" Express Online Training UCAT3 nu wee di lcs of STD265460 Statutory Declaration: Commonwealth Statutory Declaration Act 1959 Section 1: Applicant | prectpa singh, of 1/2 Baten treet st Albans in the tate of VC, 3021 mke te folowing declaton under the Comnenweath StatoryDedrationAet 955 and wo soery and ncerely dear thats 1 The work submited for the White ard course wa my own ork "have rected no asstance fom anyone (course ane excluded) othe completion othe Wh ‘hae ented mse tly for he Wht Card course undertaken Thetine, date place, and the number ofthe hours ake by me to clete the enine course ane assessments a. Time takentocomplete course: ¢ 3a hours 5. Datecoursewas completed: 14 = ld lace courte was completed adres r pylon) TREET «ST ALBANS Pe ar an ec ere eT Sg irtntonly makes fale statement ina statutory declaration guilty of an otence unde section 1 of Statutory Declaration Aet 1959, ANDI beleve that the statements nti dai eee ‘Signature of Appleant (SIGN IN FRONT OF AN AUTHORISED PERSON] Section 2: Authorised Person For deals please see the “ind an Authorised Person ta Cert Your Decumerts section on Page 2. Talon antdedardbetrenet_ Pee ae Pande this pF sy of ter WA as mlb (ame) Fs | __-ABDUL HARUUN KHAN JP agers | SSI = ‘CAIRNLEA 3023, JUSTICE OF THE PEACE FOR VICTORIA Eee #80 naz (uatcation) sramo Hece Section 3: Observer (Any person who witnessed you undertaking the online assessment) (Name, of pia Bante, (psn ncn nm ot ST Ab aoncsoe P89 cnc emir BUCCI 2.9242. De selemnly and sincerely deciare that Lam over the age of 18 years a tha: 1. have observed the course participant undertaking the course assessment and the mo 2. confi thatthe course parpants one andthe same perso 2 the zerson wo unde sid time, date and place stated in the Applicant's declaration above 3. know thatit isan offence to make the declaration should tbe fale in any material particule anc | bolieve thatthe statements rade inthis decoration are true in every patil ( a S talshe ‘Sijsture of declarant /deponent the Observer) Date Section 4: Certified Copy of Identification roves ceed cop of photo ldenifation~ Seepage 2fo deta "TRIGA REPUBLIC OF INDIA | ‘ada pe waa Vesa eas ease 17671709 me] _1.07/08/2014 06/03/2024 PIND<

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