Fillable Printable Application for A Driving Licence

Application for A Driving Licence

Ofﬁcial use only

Passport

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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.

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•

Duplicate

My licence has been:

lost or stolen

■■ defaced ■■ destroyed ■■

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Exchange

Change my licence following a test pass.

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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

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

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Kidneys

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Corneas

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Heart

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Lungs

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Liver

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Pancreas

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Organ donation

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?

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paper licence?

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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

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Are you currently disqualiﬁed in any other country? No

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Yes

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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

Surname

First names

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Mrs

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Miss

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Other title Male

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Female

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(for example, Rev)

Day Month Year

Date of birth

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What is your UK driver number (if you know it)?

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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

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Yes

■■

If ‘Yes’, write the previous details below.

Have you lived in another EC or EEA country in the last 12 months?

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Yes

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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

■■

b Do you need to wear glasses or corrective

lenses when driving? Yes

■■

Your eyesight

The licence you want

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

•

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)

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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

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Yes

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If you have answered ‘Yes’, please tick all the appropriate boxes.

1 Epilepsy

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2 Fits or blackouts

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3 Repeated attacks of sudden disabling giddiness

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4Diabetes controlled by insulin

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5Diabetes controlled by tablets

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6 An implanted cardiac pacemaker

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7 An implanted cardiac deﬁbrillator (ICD)

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8 Angina (heart pain) which is easily brought on by driving

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9 Persistent alcohol misuse or dependency

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10 Persistent drug misuse or dependency

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11 Parkinson’s disease

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12 Narcolepsy or sleep apnoea syndrome

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13 Stroke, with any symptoms lasting longer than

one month, recurrent “mini-strokes” or TIAs

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14 Any type of brain surgery, severe head injury

involving inpatient treatment, or brain tumour

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15 Any other chronic neurological condition

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16 A serious problem with memory or periods of confusion

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17 Severe learning disability

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18 Serious psychiatric illness or mental ill health

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19 Total loss of sight in one eye

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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)

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21 Any condition affecting your visual ﬁeld

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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

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

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

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Yes

■■

Have you had any special controls ﬁtted to your

vehicle since your last licence was issued?...............No

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Yes

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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

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

PLACE PHOTOGRAPH

FACE UP

See page 9 and 10

of INF1D

➦

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