PRITABLE APPLICATIONS
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Use Block Capital letters only
PERSONAL INFORMATION
First name: |___|___|___|___|___|___|___|___|___|___|___|___|___|___| Last name: |___|___|___|___|___|___|___|___|___|___|___|___|___|___| Address: |___|___|___|___|___|___|___|___|___|___|___|___|___|___|___| |___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___| City: |___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___| County: |___|___|___|___|___|___|___|___|___|___|___|___|___| Country: |___|___|___|___|___|___|___|___|___|___|___|___|___|___|
CONTACT INFORMATION
E-Mail: |___|___|___|___|___|___|___|___|___|___|___|___|___|____|___| Phone: |___|___|___|___|___|___|___|___|___|___|___|___| ID LICENSE FOR: |___| 1 YEAR VALIDITY - €70 |___| 3 YEARS VALIDITY - €85 |___| 5 YEARS VALIDITY - €100 |___| 10 YEARS VALIDITY - €120 |___| 20 YEARS VALIDITY - €165
NATIVE DRIVERS LICENSE INFORMATION
NATIVE DRIVER’S LICENSE No. |___|___|___|___|___|___|___|___|___| Date of Birth: _____|_____DD______|_____MM______|_______YY Country of Birth: |___|___|___|___|___|___|___|___|___|___|___|___|___| City of Birth: |___|___|___|___|___|___|___|___|___|___|___|___|___| Gender(male, female) : __F___|___M____| (CIRCLE) Eye color: |___|___|___|___|___|___|___|___|___|___|___|___|___| Height: |___|___|___| CM
|___| THEFT/ LOST/ STOLEN INSURANCE FOR ALL OF ITDL’s - €14.99
|_X__| REGISTERED POST DELIVERY(€5.OO)- INC
Native Driving License : |_A_| MOTORCYCLES
|_B_| PASSENGER CARS |_C_| VEHICLES OVER 3.500 kg |_D_| VEHICLES OVER 8 SEATS |_E_| TRUCK WITH TRAILER
Payment method
|___| Post money order #__________________________________ |___| Bank Draft # ___________________________________
Please make a payment to: ITDL, Mita Ireland Limited, Unit 72, Penrose Wharf, Cork, Ireland Note: Applications without payments cannot be processed Please read carefully before signing this application. I acknowledge that I may not drive, anywhere without a valid native Driver's License, and that my International Translation of Driver's License is not a standalone document. It has to be accompanied by native valid driver's license all the time. I admit not to use any of those documents for purpose of breaking or violating the Law.
Be sure you have met all requirements for International Driver License: 1. Signed Application 2. One Photo (any sizes) 3. Copy of Native Driver License 4. Payment |___| |___| |___| |___|
ATTACH ONE COLOR PHOTO (ANY SIZE)
SIGNATURE HERE (write clearly into white box below using black ink )
Printable ITDL form UN – 256/54-03