f r- st K---- r - IVILE- ncit- Teeerver- any offence which disqualification/suspension served on me I have/have not also received a notice from the Registrar of Motor Vehicles containing particulars of my licence disqualification/suspension. Applicants signature I understand that if I rive w i st isqualified/suspended I

ge. WARNING: Additional fees will be imposed if you miss a payment. Your driver's licence may be suspended, you may not be able to do business with the Registrar of Motor Vehicles, and your goods may be taken and sold. If you cannot pay on time, you must let us know so that you can avoid additional fees and further actio • en