d1-form-provisional-driving-licence-uk-1.pdf

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 DVLAlocal 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 1a • •

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 ■ ■ 4 Diabetes controlled by insulin ■ ■ 5 Diabetes 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

d1-form-provisional-driving-licence-uk-1.pdf

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