[별지 제28호의2서식]<개정 1999.12.31, 2002.7.3>
Issue No. : Certificate of Driver's License
Name in Full										Date of Birth					-
Address
License No.
License	Class		1st Class											2nd Class
	Date of Issue		Large		Ordinary				Small				Special	Ordinary			Small		Motorized Bicyle
Period																Sun of Penalty Score
Traffic Accident													Violation of Road Traffic Law(For the last 1 year)
Date of Accident	Police Station Concerned	Classification of Damage				Degree of human damage							Date of Violation	Police Station Concerned				Penalty Point		Applicable Article(Road Traffic Law)
						①	②	③				④
		Property· Injuries																		Art.
Date of Punishment																		Usage
※ 1. Injuries ①Death ②Serious injury Under the Article 32 of the Road Traffic Law ③light injury the above-mentioned statement is certified as true and correct. ④bruise 2. Property The chief of Police Station or The chief of Driver's License Examination Office, Official Seal Republic of Korea
21026-45511일 99.3.18승인											268㎜×190㎜ (신문용지 54g/㎡)