12. The applicant must submit the following information in the authorization application:(1) his or her name and contact information;
(2) where applicable, the grounds on which the applicant considers that his or her judicial record entries, other than those referred to in paragraphs 1 and 2 of section 11, are unrelated to the aptitudes required and appropriate conduct to be a driver of an automobile for the purpose of offering passenger transportation; and
(3) any other information that may be determined by government regulation.