PERSONAL INFORMATION个人信息(将显示在驾照上)

First name(名): |___|___|___|___|___|___|___|___|___|___|___|___|___|___|

Last name(姓): |___|___|___|___|___|___|___|___|___|___|___|___|___|___|

Date of Birth(生日): ___|___MM___|___DD____|_____YY

Gender(male男, female女) : __F___|___M____|   (CIRCLE)
 

Eye color(眼睛颜色):gray灰色,green绿色,blue蓝色,black黑色,brown褐色

|___|___|___|___|___|___|___|___|___|___|___|___|___|

Address(地址): |___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|

 |___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|

City(市): |___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|

Country(国家): |___|___|___|___|___|___|___|___|___|___|___|___|___|___|

ZIP/Post Code(邮编): |___|___|___|___|___|___|___|___|___|___|___|___|

MAILING ADDRESS (AVOID P.O. BOXES)邮寄地址

First name(名): |___|___|___|___|___|___|___|___|___|___|___|___|___|___|

Last name(姓): |___|___|___|___|___|___|___|___|___|___|___|___|___|___|

Address(地址): |___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|

 |___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|

City(市): |___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|

State/Province(省): |___|___|___|___|___|___|___|___|___|___|___|___|___|

ZIP/Post Code(邮编): |___|___|___|___|___|___|___|___|___|___|___|___|

Country(国家): |___|___|___|___|___|___|___|___|___|___|___|___|___|___|

 DRIVERS  LICENSE INFORMATION(驾照信息)

DRIVER’S LICENSE(中国驾照号码) 

|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|

Original Driver License Country(发照国家)

:|___|___|___|___|___|___|___|___ |___|

Original Driver License Expiration Date(驾照有效期)

|___|___|MM___|___|___|___|_YY

Height(身高): |___|___|____| CM  |

Category(国际驾照类别): 参考”申请国际驾照所需材料”

                  |_A_|  MOTORCYCLES

                  |_B_|  PASSENGER CARS

                  |_C_|  VEHICLES OVER 7,700  Lbs

                  |_D_|  VEHICLES OVER 8 SEATS

                  |_E_|  TRUCK WITH TRAILER

                  |___|   NON GOVERNMENTAL ID CARD

CONTACT INFORMATION(联系信息)

E-Mail: |___|___|___|___|___|___|___|___|___|___|___|___|___|____|___|

Phone: |___|___|___|___|___|___|___|___|___|___|___|___|

|___|  三年期– 1600元

|___|  五年期– 1800元

|___|  十年期–  2200元

SHIPPING(邮寄):

|___|  UPS GROUND(15天加快)–380元

|___| USPS EXPRESS(10天特快)–550元

SIGNATURE HERE (WRITE CLEARLY BELOW)

本人签名（请清晰书写）