driving license application form download

Driving Application Form Software Is Provided

This software is provided free of charge and you may download the latest version by clicking on the Get Acrobat Reader button.

Please note: PennDOT will charge a fee of 30 or more for each check returned to the Department as uncollectible.

All forms may be printed and mailed to PennDOT using the address listed at the top of the form, unless otherwise noted on the form.

Your changes will not take effect until PennDOT has received and processed your form.

I also understand it is an of fence to fail to provide information which can lead to prosecution with a ne of up to 1000.

The correct fee (See leaet INS1 15 for fees and details on how to pay.) Amount Cheque or postal order number Identity documents (if this applies) Y our last licence (and counterpart if this applies) Y our test pass certicate (if t h is applies) Y ou may wish to use a secur e delivery service to send your identit y documents to us.

Y ou must ll 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 af fect your tness 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 suf fer from any of the following conditions No Ye s If you have answer ed Y es, please tick all the appropriate boxes.

Epilepsy 2 Fits or blackouts 3 Repeated attacks of sudden disabling giddiness 4D iabetes controlled by insulin 5D iabetes controlled by tablets 6 An implanted cardiac pacemaker 7 An implanted cardiac debrillator (ICD) 8 Angina (heart pain) which is easily br ought 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 T otal loss of sight in one eye 20 Any condition af fecting both eyes, or the remaining eye if you only have one eye (not including colour blindness or short or long sight) 21 Any condition af fecting your visual eld 22 Any persisting limb problem which needs driving to be restricted to certain types of vehicle or those with adapted controls Keep your signatur e within the white box Keep your signatur e within the white box Y our signatur e 8 We no longer issue paper licences.

Y our new licence will be a plastic photocard, a paper counterpart will accompany it.

Y ou must pr oduce both if the police or a court ask for them.

Other organisations such as vehicle - hire rms and insurance companies could ask to see both.

Y our health 5 Part B Only ll in this part if you have told us about a medical condition befor e.

What is the condition Has it got worse since you told us about it.

No Ye s Have you had any special controls tted to your vehicle since your last licence was issued.

No Ye s Post Of ce date stamp T ick the documents you are providing to prove your identity see pages 6, 7 and 8 of INF1D for more details.

T ick the documents you are also providing to show a clear link to your current name if different from that shown on your passport, birth certicate or adoption certicate.

Marriage certicate Divorce certicate Y our 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.) Wa r ning: This person must have known you personally for at least two years, and must not be a r elative or a member of the Post Of ce staf f pr ocessing the application, if you choose to use the Pr emium Checking Service see page 13 of INF1D for mor e details.

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.

Driving Application Form Code Full Daytime

Signature Date Full name Signing your photograph 7 Business or home address Postcode Full daytime phone number Profession Qualications Wa r ning: W e will make random checks on those who sign photographs for driving licence applications.

Conrming your identity 6 PLACE PHOTOGRAPH F ACE UP See page 9 and 10 of INF1D Peel her e Peel her e Y ou must r ead pages 6 to 10 of the INF1D before lling in section 6 and 7.

Do not ll in sections 6 and 7 or supply a new photograph if you have a photocar d licence, unless you ar e r egistering a change of name, photograph or signatur e.

UK birthadoption certicates ar e not acceptable as sole pr oof of identity and we may ask for further evidence.

W e are unable to verify details on non-UK birth certicates and they cannot be accepted as pr oof of identity.

I understand that it is a criminal of fence if I make, or anyone else makes, a false declaration to get a licence and to do so can lead to prosecution and a ne of up to 2500.

Driving License Application Form Download