The image displays a document with printed text on it. The document appears to be an official or legal form, possibly an application, as suggested by the presence of blank spaces and checkboxes. There are instructions written in a formal tone that provide guidance on how to complete the document. The document is numbered at the bottom left corner, indicating it's part of a series or step within a process. The text is too small to read clearly, but it includes words like "instructions," "checkboxes," and phrases that typically appear in official forms instructing on required actions or information. The style of the image is straightforward and functional, with no decorative elements or images, focusing entirely on conveying information through text.