Los Santos Licensing Center 4005.Rodeo St. Piloting Application Form

Section I - Personal Information

I.1 Full Name(Surname, firstname):

I.2 Age:

I.3 Gender:

I.4 Residence:

I.5 Contact Number:

Section II - Medical Background

II.1 Do you suffer from any physical illness?: (Yes/No) If yes, what?:

II.2 Do you suffer from any mental illness?: (Yes/No) If yes, what?:

II.3 Have you ever had a health issue in the past?: (Yes/No) If yes, what and when?:

Section III - Criminal Background

III.1 Have you ever been convicted of a crime?: (Yes/No) If yes, what and when?:

III.2 Have you ever been arrested?: (Yes/No) If yes, what for and when?:

Section IV - Miscellaneous

IV.1 Why do you desire to obtain a fishing license?:

IV.2 Why should we give you a fishing license?:

IV.3 Do you have any past experiences with ships and boats?: (Yes/No) If yes, what?:

IV.4 Are you going to need a fishing course before the interview?: (Yes/No) (Note that the course costs $5,000)

IV.5 Have you got a naval license?: (Yes/No)

By submitting thisapplication, you agree that all the

information given is correct. If any information is false, you

confirm thatthis application will be terminated. You also

accept that theLSLC staff mayterminate your application

without reason. As well asagreeing to our no refunds policy.

The LSLC department isnotentitled to reimburseyour

licenses should you lose them.

Applicant's signature: [Your name here]