| | | | :--- | :--- | | | [ABC Medical Centre] | | Address | [Blk 123, #01-45, Singapore 123456] | | Contact Number | [6123 4567] | | Report Date | [DD/MM/YYYY] |
☐ – Reason: ________________________________________ medical checkup for pdvl
☐ – No medical condition that impairs safe driving. ☐ FIT WITH CONDITIONS – Required to: | | | | :--- | :--- |