Driver

ML **R

Application Id 271*********** Application Date (dd/mm/yyyy) 27/10/2023

Application Type Reissue DL Application Validity Period 3-Years Class of Licence Applied for B Do you want to recapture? No Reason for Reissue Lost but not expired Comments Reissue D/L Number ABC87826AD38 First State of Issuance FCT First Issued Date

(dd/mm/yyyy)

15/10/2021 Expiry Date (dd/mm/yyyy) 12/03/2026

Personal Details

Applicant's Name Henry Chinedu Ibe Mother's Maiden Name IBE Gender Male Height (In Meters) 1.81

Date of Birth (dd/mm/yyyy) 12/03/1991 Blood Group O+ Tax Identification Number

(TIN)

NA State of Origin Imo

LGA of Origin Owerri West Nationality Nigeria

Facial Mark No Do you require glasses for

driving?

No

NIN Number NA Any Form of Disability No

Contact Details

Mobile Number 081******** Next of Kin Phone Number 070******** Email Address NA

Residential Address

Address Line1 NO 3 ANAMBRA CRESCENT SUNCITY Address Line2 NA City ABUJA State FCT

Local Government Area (LGA) Municipal Area Council Postal Code NA Mailing Address

Address Line1 NO 3 ANAMBRA CRESCENT SUNCITY Address Line2 NA City ABUJA State FCT

Local Government Area (LGA) Municipal Area Council Postal Code NA Payment Details

Payment Status Payment Confirmed Validation Number 169************ Payment Gateway TeasyPay Payment Date (dd/mm/yyyy) 27/10/2023 Processing Details

State FCT Local Government Area (LGA) Municipal Area Council Capture Center Mabushi_II

I declare that the information provided in this document is true and binding on me. I will notify the appropriate authorities of any changes therein.

Applicant Signature / Date

For Official Use only: Processing State Board of Internal Revenue Officer's Details Signature / Date

Have you checked payment status? (Fill in 'Yes' or 'No' ): I hereby declare that the applicant has made payment for this transaction and affirm here that this information is true to the best of my knowledge. State BIR Officer's Name

For Official Use only: Road Traffic Officer's Details Date of Test: If yes, indicate Class(es): Authorizing Officer's Name

Signature / Date

Vision Test Result: Does applicant require glasses to drive? (Fill in 'Yes' or 'No') Have you checked all the details given by the applicant? (Fill in 'Yes' or 'No') Do you recommend issuing licence? (Fill in 'Yes' or 'No') Ref: No Road Traffic Officer I hereby declare and affirm that all the information stated on this form are true to the best of my knowledge. Test Officer's Name

Signature / Date

Application Details

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