Name of Bearer– Your character name.
Race– Human, elf (and elven Court), dwarf, fetchling, tiefling.
Birthdate– When your character was born.
Pictograph of Bearer– Paste a character picture there, silly.
Career (First/Second)– Your character’s classes. The m20 variant this is for lets you multiclass once (so make it count!)
Age/Ht/Wt– As they appear.
Eyes/Hair/Gender– As they appear.
Signature of Bearer– We can’t _all_ sign with an X.
I haven’t quite thought of something to do with that blank space up top; perhaps a logo for the Istorian Empire’s Bureau of Travel and Transit? Information for your character’s spouse and/or children?