XLS《2申请表正面》

"初次申领" "机动车驾驶证申请表" 受理岗签字签章"档案编号" "申请人信息","姓名","贾铭"性别",,

"男/女",,

"出生日期",,

,"XXXX年XX月XX日",,

,,

,,

"国籍",,

"中国" ,"身份证明名称","居民身份证/护照号码",,

"号码",,

"X","X","X","X","X","X","X","X","X","X","X","X","X","X","X","X","X","X","照片" ,,

"居住/暂住证号",,

"号码",,

"X","X","X","X","X","X","X","X","X","X","X","X","X","X","X","X","X","X" ,"邮寄地址","XXX省XXX市(县)XX区XX街(路)XX号" ,"固定电话","座机号码"电子信箱",,

,,

"XXX@qq.

com" ,"移动电话","移动号码"邮政编码",,

,,

"XXXXXX" "申请业务种类","初次申领",,

,"申请的准驾车型代号"驾校培训有驾驶经历自学直考" ,"增加准驾车型"驾校培训全日制驾驶职业教育学生最高准驾车型被注销" ,"持军警驾驶证申领"军队驾驶证武警驾驶证" ,"持境外驾驶证申领"香港驾驶证澳门驾驶证台湾驾驶证外国驾驶证" ,"证件损毁换证转入换证有效期满换证" ,"达到规定年龄换证自愿降低准驾车型换证"申请的准驾车型代号" ,"因身体条件变化降低准驾车型换证" ,"信息变化换证",,

,"变更事项"变更内容" ,"信息备案",,

,"从业单位" ,"补证",,

,,

,"原因","丢失其他" ,"注销",,

,,

,,

"本人申请死亡身体条件不适合丧失民事行为能力其他" ,"注销最高准驾车型",,

,,

,,

"发生交通事故造成人员死亡,承担同等以上责任连续三个记分周期不参加审验记满12分延长的实习期内再次记6分以上但未达到12分" ,"注销实习准驾车型" ,"恢复驾驶资格",,

"准驾车型代号",,

,,

"超过有效期一年以上未换证被注销未满两年未按规定提交体检证明被注销且机动车驾驶证在有效期内或超过有效期不满一年" ,"延期换证延期审验延期提交身体条件证明",,

,,

,,

"服兵役出国(境)其他" "申请方式",,

,"本人申请监护人申请委托代理申请" "委托代理人监护人信息",,

,"代理人/监护人姓名",,

,,

,,

"身份证明名称"身份证明号码" ,,

,"联系地址"联系电话" "申告的义务和内容","机动车驾驶证申请人应当如实申告是否具有下列不准申请的情形:申请人及代理人对申请材料的真实有效性负责. ,"

一、器质性心脏病、癫痫病、美尼尔氏症、眩晕症、癔病、震颤麻痹、精神病、痴呆以及影响" ,"肢体活动的神经系统疾病等妨碍安全驾驶疾病;

申请人签字:贾铭" ,"

二、三年内有吸食、注射毒品行为或者解除强制隔离戒毒措施未满三年,或者长期服用依赖性" ,"精神药品成瘾尚未戒除;

,"

三、提供虚假申请材料,以欺骗等不正当手段申领机动车驾驶证;

,"

四、造成交通事故后逃逸构成犯罪;

,"

五、饮酒后或者醉酒驾驶机动车发生重大交通事故构成犯罪;

XXXX年X月X日" ,"

六、醉酒驾驶机动车或者饮酒后驾驶营运机动车依法被吊销机动车驾驶证未满五年;

代理人/监护人签字: ,"

七、醉酒驾驶营运机动车依法被吊销机动车驾驶证未满十年;

,"

八、因其他情形依法被吊销机动车驾驶证未满二年" ,"

九、驾驶许可依法被撤销未满三年" ,"