I declare hereby:
(1) My physical condition:
(i) Suffering from any physical handicap such as a missing or defective limb
(ii) Suffering from any disease or physical disability as specified in the First Schedule to the Road Traffic (Driving Licences) Regulations
(iii) Need to wear glasses or corrective lenses when driving
(iv) Need to wear hearing aids when driving
(2) Whether the Commissioner has at any time, because of the disease or physical disability as specified in (1)(ii) above or any other disease or physical disability, refused to issue me a driving licence or renew my driving licence:
(3) I hereby declare that I do not hold more than one test form for the same vehicle class(es) under application.
(4) I hereby declare that the class of licence that I am applying for has not been suspended or cancelled and I am not disqualified from holding or obtaining a driving licence.
(5) I have read through the content of this application form and understand the “NOTES FOR ATTENTION”.
(6) My declarations above are true and correct. I understand that, if I knowingly make any statement or provide any information in this application form which is false in any material particular, I shall be liable under Section 111(3) of Road Traffic Ordinance (Cap. 374) to a fine of $5,000 and imprisonment for 6 months.