Form 2 of the Schedule BEFORE re-enacted by BC Reg 343/2012, effective November 23, 2012.

Form 2

Certificate of Medical Practitioner

I, ..................................................................., medical practitioner, observed a person identified to me as ................................................................... at ............................................................[place] on ........................................[day, month, year] at ..............................[time] at which time I formed the opinion that .................................................. was incapable, due to

of comprehending the nature of a demand under section 225 (1) of the Motor Vehicle Act, R.S.B.C. 1996.

DATED ........................................[day, month, year] at ...................................................... in the Province of British Columbia.

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Medical Practitioner