1 - Surname of the holder

2 - Other name(s) of the holder

3 - Date and place of birth

4a - Date of issue of the licence

4c - Name of the issuing authority

5 - Number of licence

6 - Photograph of the holder

7 - Signature of the holder

8 - Permanent place of residence

10 - Date of first issue of each category

11 - Date of expiry of each category

12 - Additional information / restrictions