UPON HEARING AN APPLICATION duly made to the Court on the day of 19 by the Applicant, of ............................. for the removal of the consequential disqualification made by order of the day of 19 at a sitting of the Court at ........................... in court area and district aforesaid whereby the Applicant was declared disqualified for holding a driving licence for a period of from the day of 19 which became effective on the day of 19 ,

AND THE COURT BEING SATISFIED that at least fourteen days' notice of the making of the Application was given to the Superintendent of the Garda Síochána for the district in which the Applicant ordinarily resides and that a period of *three*nine *twenty-one* months has now elapsed from the beginning of the period of disqualification,

THE COURT ORDERED that the said disqualification be removed with effect on and from the day of 19 , (being a date not earlier than *six months *one year*two years after the beginning of the period of disqualification)

Dated this day of 19 .

Signed .............................

Judge of the District Court