Drivinglicence.pdf

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.

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.

The licence you want

Ofﬁcial use only

Your details

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

Passport

■

Surname

First names

B/cert

■

M/cert

■

Mrs

Miss

Other

■

I f you are 16 and getting Disability Living Allowance

(mobility component) at the higher rate, and want to drive a car

Other title

Male

Female

(for example, Rev)

Day

Month

Year

• Replacement

Replace my licence due to a change of name or address

(or both). I am enclosing my current driving licence.

■■ ■■ ■■■■

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

■■■■■■■■■■■■■■■■

Current address

■

Date of birth

No ID

• Duplicate

My licence has been:

■

lost or stolen

defaced

destroyed

• Exchange

Change my licence following a test pass.

■

Post town

Postcode

Enter categories in the box.

■

Place of birth (country)

Remove expired endorsements or suspension details.

■

Full daytime phone number

Add provisional motorcycle entitlement.

■

E-mail address

Has your name or address (or both) changed

since your last licence was issued?

Exchange my paper licence for a photocard licence.

■

Yes

Change my photograph.

■

If ‘Yes’, write the previous details below.

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

1 a

Residency

■

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

■

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

■

Yes

■

Day

Month

Year

■

■■ ■■ ■■■■

What date did you come to

For medical reasons

live in the UK?

■

Revoked under the Road Trafﬁc (New Drivers) Act 1995

Your eyesight

■

After disqualiﬁcation

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?

Organ donation

Yes

■

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

■

b Do you need to wear glasses or corrective

lenses when driving?

■

Kidneys

Corneas

Yes

■

Heart

Lungs

Liver

Pancreas

Previous licence details

•

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?

■

Yes

■

If ‘Yes’, which country were you disqualiﬁed in?

What is the expiry date shown on the

■■ ■■ ■■■■

Day

Month

Year

Back of photograph

licence or entitlement you are renewing?

An executive agency of the

Department for Transport

12/03

If ‘No’, which country?

If you passed your test in Canada, was it

in a vehicle with manual transmission?

■

If ‘Yes’, which country?

Your health

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.

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?

Conﬁrming your identity

■

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

1 Epilepsy

■

Yes

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

2 Fits or blackouts

■

Also, please write the identity number of the document you are providing.

■

Evidence of SRP (State Retirement Pension)

3 Repeated attacks of sudden disabling giddiness

■

4Diabetes controlled by insulin

■

5Diabetes controlled by tablets

■

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

6 An implanted cardiac pacemaker

■

7 An implanted cardiac deﬁbrillator (ICD)

■

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

Divorce certiﬁcate

■

Also, please write the identity numbers of the documents you are providing.

9 Persistent alcohol misuse or dependency

■

Your deed poll or statutory declaration

10 Persistent drug misuse or dependency

■

11 Parkinson’s disease

■

12 Narcolepsy or sleep apnoea syndrome

Signing your photograph

13 Stroke, with any symptoms lasting longer than

one month, recurrent “mini-strokes” or TIAs

■

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:

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

years

■

19 Total loss of sight in one eye

This MUST be at least 2 years.

I have signed the back of the photograph which is a true likeness

of the applicant.

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

Signature

Date

22 Any persisting limb problem which needs

driving to be restricted to certain types

of vehicle or those with adapted controls

Full name

■

Business or home address

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.

Postcode

Full daytime phone number

Profession Qualiﬁcations

Warning: We will make random checks on those who sign

photographs for driving licence applications.

Part B

Only ﬁll in this part if you have told us about

a medical condition before.

What is the condition?

Post Ofﬁce ™ date stamp

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

Document checklist

Make sure you have enclosed the following

where they apply.

Tick the appropriate boxes.

The correct fee

Your signature

(See leaﬂet INS115 for fees

and details on how to pay.)

■

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.

Peel here

Important

Amount

Cheque or postal

order number

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

PLACE PHOTOGRAPH

FACE UP

Identity documents (if this applies)

■

• Keep your signature within the white box •

See page 9 and 10

of INF1D

Your last licence (and counterpart

if this applies)

■

Your test pass certiﬁcate

(if this applies)

■

Peel here

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.

• Keep your signature within the white box •

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.

■

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