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Fillable Printable Application for A Driving Licence
Fillable Printable Application for A Driving Licence
Application for A Driving Licence
Official use only
Passport
■■
B/cert ■■
M/cert ■■
Other
No ID ■■
Back of photograph
Start date
Your licence starts on the day we issue it. You can
ask for your licence to start from a later date but this cannot be
more than two months after the day you apply.
Day Month Year
■■■■ ■■■■ ■■■■■■■■
Please tick the licence you want.
•
Provisional ■■
If you are 16 and getting Disability Living Allowance
(mobility component) at the higher rate, and want to drive a car ■■
•
Replacement
Replace my licence due to a change of name or address
(or both). I am enclosing my current driving licence.
■■
•
Duplicate
My licence has been:
lost or stolen
■■ defaced ■■ destroyed ■■
•
Exchange
Change my licence following a test pass.
■■
Enter categories in the box.
Remove expired endorsements or suspension details. ■■
Add provisional motorcycle entitlement. ■■
Exchange my paper licence for a photocard licence. ■■
Change my photograph. ■■
Exchange my Northern Ireland licence. ■■
Exchange my foreign licence for a British one. ■■
Which country issued it?
Did you pass your test in that Country? Yes
■■ No ■■
If ‘No’, which country?
If you passed your test in Canada, was it
in a vehicle with manual transmission? Yes
■■ No ■■
If ‘Yes’, you must enclose evidence of this (if not shown on your
licence). See INF1D page 12 – licences from other countries.
•
Renew
At age 70 or over ■■
For medical reasons ■■
Revoked under the Road Traffic (New Drivers) Act 1995
■■
After disqualification ■■
Previous licence details
4
I want to donate an organ to help someone else after my death.
Please register me on the NHS Organ Donor register as someone whose
organs can be used for a transplant. Tick the appropriate box or boxes.
Any part of my body
■■
Kidneys
■■
Corneas
■■
Heart
■■
Lungs
■■
Liver
■■
Pancreas
■■
Organ donation
D1
Application for a driving licence
You must read booklet INF1D when filling in this form.
Information about the Premium Service available at selected Post Office
™
branches and
DVLA local offices is also in this booklet. See leaflet INS115 for information on fees.
An executive agency of the
Department for Transport
Was your last licence a: photocard licence?
■■
paper licence?
■■
If you have given up driving because you were disqualified in Great Britain,
please give the date and say which court dealt with it (if known).
Day Month Year
Court name
■■■■■■■■■■■■■■■■
Are you currently disqualified in any other country? No
■■
Yes
■■
If ‘Yes’, which country were you disqualified in?
What is the expiry date shown on the
Day Month Year
licence or entitlement you are renewing?
■■■■ ■■■■ ■■■■■■■■
Your details
1
Surname
First names
Mr
■■
Mrs
■■
Miss
■■
Ms
■■
Other title Male
■■
Female
■■
(for example, Rev)
Day Month Year
Date of birth
■■■■ ■■■■ ■■■■■■■■
What is your UK driver number (if you know it)?
■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■
Current address
Post town Postcode
Place of birth (country)
Full daytime phone number
E-mail address
Has your name or address (or both) changed
since your last licence was issued? No
■■
Yes
■■
If ‘Yes’, write the previous details below.
Have you lived in another EC or EEA country in the last 12 months?
No
■■
Yes
■■
If ‘Yes’, which country?
live in the UK?
Day Month Year
What date did you come to
■■■■ ■■■■ ■■■■■■■■
You must fill in both questions 2a and 2b
a Can you read a car number-plate (with glasses
or corrective lenses if necessary) from 20.5 metres
(67 feet) or 20 metres (65 feet) where narrower
characters (50mm wide) are displayed? Yes
■■
No
■■
b Do you need to wear glasses or corrective
lenses when driving? Yes
■■
No
■■
Your eyesight
2
The licence you want
3
Please use BLOCK CAPITALS and fill in this form in black ink. If you want
to apply for a LGV or PCV licence, you need to fill in a D2 application
form. See page 12 of the INF1D for details of where to get this form.
12/03
Residency
1
a
•
•
Document checklist
Make sure you have enclosed the following
where they apply.
Tick the appropriate boxes.
The correct fee
■■
(See leaflet INS115 for fees
and details on how to pay.)
Amount
Cheque or postal
order number
Identity documents (if this applies) ■■
Your last licence (and counterpart
if this applies)
■■
Your test pass certificate
(if this applies)
■■
You may wish to use a secure delivery
service to send your identity documents
to us. Enclose a pre-paid secure envelope
for us to send these back to you.
You must fill in either part A or part B or we will send your
application back to you.
If you have already told us about a medical condition that could
affect your fitness to drive – and you have no new medical condition
– miss out part A and go on to part B of this section.
Part A
Have you ever had, or do you currently suffer from
any of the following conditions? No
■■
Yes
■■
If you have answered ‘Yes’, please tick all the appropriate boxes.
1 Epilepsy
■■
2 Fits or blackouts
■■
3 Repeated attacks of sudden disabling giddiness
■■
4Diabetes controlled by insulin
■■
5Diabetes controlled by tablets
■■
6 An implanted cardiac pacemaker
■■
7 An implanted cardiac defibrillator (ICD)
■■
8 Angina (heart pain) which is easily brought on by driving
■■
9 Persistent alcohol misuse or dependency
■■
10 Persistent drug misuse or dependency
■■
11 Parkinson’s disease
■■
12 Narcolepsy or sleep apnoea syndrome
■■
13 Stroke, with any symptoms lasting longer than
one month, recurrent “mini-strokes” or TIAs
■■
14 Any type of brain surgery, severe head injury
involving inpatient treatment, or brain tumour
■■
15 Any other chronic neurological condition
■■
16 A serious problem with memory or periods of confusion
■■
17 Severe learning disability
■■
18 Serious psychiatric illness or mental ill health
■■
19 Total loss of sight in one eye
■■
20 Any condition affecting both eyes, or the remaining eye
if you only have one eye
(not including colour blindness or short or long sight)
■■
21 Any condition affecting your visual field
■■
22 Any persisting limb problem which needs
driving to be restricted to certain types
of vehicle or those with adapted controls
■■
•
Keep your signature within the white box
•
•
Keep your signature within the white box
•
Your signature
8
We no longer issue paper licences. Your new licence will be a plastic photocard, a paper counterpart will accompany it. You must produce
both if the police or a court ask for them. You should also present both when taking a driving test. Other organisations such as vehicle-hire firms
and insurance companies could ask to see both.
Your health
5
Part B
Only fill in this part if you have told us about
a medical condition before.
What is the condition?
Has it got worse since you told us about it?..............No
■■
Yes
■■
Have you had any special controls fitted to your
vehicle since your last licence was issued?...............No
■■
Yes
■■
Post Office
™
date stamp
Tick the documents you are providing to prove your
identity – see pages 6, 7 and 8 of INF1D for more details.
Photocopies are not acceptable.
Passport ■■Your UK birth or adoption certificate ■■
EC or EEA identity card
■■
Travel Document
■■
Evidence of SRP (State Retirement Pension)
■■
Also, please write the identity number of the document you are providing.
Tick the documents you are also providing to show a clear link to
your current name if different from that shown on your passport,
birth certificate or adoption certificate.
Marriage certificate
■■
Divorce certificate
■■
Your deed poll or statutory declaration ■■
Also, please write the identity numbers of the documents you are providing.
If you are providing identity documents other than an up-to-date UK, EC or
EEA passport, someone reliable must sign the back of your photograph.
(See page 8 and 9 of INF1D for more details.)
Warning: This person must have known you personally for at least two
years, and must not be a relative or a member of the Post Office
™
staff processing the application, if you choose to use the Premium
Checking Service – see page 13 of INF1D for more details.
TO BE FILLED IN BY THE PERSON SIGNING YOUR PHOTOGRAPH.
State how many years you have known the applicant:
■■
years
This MUST be at least 2 years.
I have signed the back of the photograph which is a true likeness
of the applicant.
Signature Date
Full name
Signing your photograph
7
Business or home address
Postcode
Full daytime phone number
Profession Qualifications
Warning: We will make random checks on those who sign
photographs for driving licence applications.
Confirming your identity
6
PLACE PHOTOGRAPH
FACE UP
See page 9 and 10
of INF1D
➦
➦
➦
➦
Peel here
Peel here
You must read pages 6 to 10 of the INF1D before filling in
section 6 and 7. Do not fill in sections 6 and 7 or supply a new
photograph if you have a photocard licence, unless you are
registering a change of name, photograph or signature. UK
birth/adoption certificates are not acceptable as sole proof of
identity and we may ask for further evidence. We are unable to
verify details on non-UK birth certificates and they cannot be
accepted as proof of identity.
I understand that it is a criminal offence if I make, or anyone else makes, a
false declaration to get a licence and to do so can lead to prosecution and
a fine of up to £2500. I also understand it is an offence to fail to provide
information which can lead to prosecution with a fine of up to £1000.
See page 11 of INF1D.
We will not accept this application unless you sign below in
black ink and your signature is completely within the white box.
Date
If you have answered YES to one of the above questions you may be
required to complete a medical questionnaire. Questionnaires are
available on the DVLA website http://www.dvla.gov.uk to be sent in with
your application.
Important
