Please complete this form in block capitals using a black ballpoint pen. Please place an X in the appropriate boxes Please do not photocopy this form as it may reduce its quality and result in your Application being delayed or Please complete this form in. Link to this page:. Acceptable photo ID must be provided in this name.
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Please complete this form in lock Capitals using a lack allpoint pen. Part 1. Personal etails see note 2 1. First name s 3. Surname If you are known by a name other than above please complete below 4. Known as If your name has changed since the last licence issued please complete below 5. If abroad please state country above 7. Gender Male Female 8. Contact number mobile preferred 9. On receipt of this driving licence will you also hold a driving licence from any other country?
Yes No If Yes, which Country? Have you previously held a learner permit or driving licence in Ireland? Yes No If Yes, which one? Exchanging a river s see note 5 Has the licence you are exchanging for an Irish licence previously been exchanged for a licence in another country?
Yes No If Yes, please state the country where licence was previously exchanged Organ onation see note 6 Tick here if you would like a code on your licence indicating your wish to become an organ donor.
Part 5. Yes No If in the past you answered Yes to this question and are now answering No you must provide an eyesight report with your application Health and Fitness Have you ever had, or do you currently suffer from, any of the following conditions? Ask your doctor whether you are on these or not.
Yes No No need to tell us if managed by other tablets and or diet. Epilepsy Yes No Fits or blackouts Yes No Any type of brain surgery, brain abscess or severe head injury involving in-patient treatment or brain tumour Yes No or spinal injury or spinal tumour An implanted cardiac pacemaker Yes No An implanted cardiac defibrillator IC 2 Yes No Repeated attacks of sudden disabling dizziness Yes No Page 2 of Any other chronic neurological condition such as multiple sclerosis, motor neurone disease, Yes No Parkinson s disease and Huntington s disease A serious problem with memory or periods of confusion Yes No Persistent alcohol misuse or dependency Yes No Persistent drug misuse or dependency Yes No Serious psychiatric illness or mental health problems Yes No Parkinson s disease Yes No Sleep Apnoea syndrome Yes No Narcolepsy Yes No Any condition affecting your peripheral vision Yes No Total loss of sight in one eye Yes No Any condition affecting both eyes, or the remaining eye if you only have one eye Yes No not including colour blindness or short or long sight A serious hearing deficiency Yes No Any persisting problem with arm s or leg s which needs driving to be restricted to certain types of vehicle Yes No or those with adapted controls Is your vehicle adapted because of a physical disability to enable you to drive?
Yes No Severe learning disability 3 Yes No If you have answered yes to any of the above, a medical report will be required 1 A transient ischemic attack TIA is an event, with stroke symptoms that lasts less than 24 hours before disappearing sometimes called a mini-stroke.
The IC is programmed to detect abnormally fast or slow heart rhythms. Please turn over leaf and complete Section 6. Page 3 of Millennium Centre, undalk Fair Street, rogheda Mayo 1. I hereby declare that Ireland is my normal place of residence see note 2 I am not currently disqualified from holding a learner permit or driving licence The address given is my normal place of residence The accompanying photographs and supporting documents relate to me This form is for a driving licence and lets you: Apply for a first time licence or renew an existing licence complete all parts of the form.
Replace a lost, stolen or damaged licence complete parts, 1,2, 4, 5 and 6 of the form. Add on new licence categories after you pass a driving test complete all parts of the form.
If the new categories are Group 2 vehicles e. Advise of a change to your health that affects your driving complete all parts of the form. Advise of a change of personal details, e. Exchange a licence from another country for an Irish one complete all parts of the form. See note 7 to see if you need to complete part 5 in your case. In accordance with rules on data protection your data may be shared with other State Agencies to enable your identity and entitlement to a licence to be verified.
To apply for a licence you must be normally resident in Ireland; this generally means that you live here at least days each calendar year because of work or personal ties. If you are studying or working abroad you may still be considered normally resident in Ireland provided you return here regularly.
Your address should be the place at which you are normally resident; for a student this generally means a family home. If you are applying for a personal details change on an existing licence please see note 3.
If you do not have a number or are unable to trace it please contact the epartment of Social Protection and they will give you the necessary information. PPSN is mandatory and must be completed. Acceptable evidence of address includes utility bills e. Evidence of age must be provided by submitting your original birth certificate or current passport. It will mean in some cases you will have to give us some supporting documents. The licence type required is for the vehicle you want to drive.
The table in this note will give you the vehicle category description for each vehicle. If you are applying for a first time driving licence you have to enclose your learner permit and your pass driving test certificate Certificate of Competency , or in some cases for motorcycles a Certificate of Satisfactory Completion Initial asic Training Motor Cycles.
If you do not have your learner permit you must get the Garda declaration in part 6 stamped at your local Garda station. If you are renewing your licence you must include your most recently issued driving licence.
If you do not have your licence you must get the Garda declaration in part 6 stamped at your local Garda station. If you are adding extra licence categories to your existing licence please enclose your pass driving test certificate Certificate of Competency , or in some cases for motorcycles a Certificate of Satisfactory Completion Initial asic Training Motor Cycles.
You may also need a medical report form see note 7. If you are replacing a damaged licence please enclose the damaged licence; if unable to do so you must have the Garda declaration in part 6 of the form stamped at your local Garda station. Page 6 of Original documents are needed in each case. In the case of an address change please supply copy of a utility bill copy of online bill will be accepted with your name and new address. If a medical condition affects your driving you will need a medical report completed by your octor see note 7.
If you are exchanging your licence for an Irish one you must enclose the licence being exchanged. This licence will be sent to the country of issue by us when your Irish licence issues.
It is against the law to hold another EU licence at the same time as the licence for which you are now applying.
Question 15 asks you to confirm that you do not hold two licences at the same time. The Table below describes each vehicle in a licence category. This will help you identify the licence that you want to apply for. A1 M c. Motorcycle Moped up to cc Light quadricycles. Small Truck less over than 3,, kg kg 11K escription of escription of A1 c. Trailer M 11K escription of escription Truck of over 16 3, kg 3,kg c.
M M Moped more 8 up to 3, kg. AE M M A1 c. Motor tricycles. Motorcycle Tractors and up ork to cc C 11K than 12, kg A1 c. Motorcycle s Tractors and up ork to cc C 11K s 25K 0. Small us Truck and over Trailer 3, no kg more combined does not exceed 12, kg.
Motor tricycles with a power rating not exceeding 15 k. A2 Motorcycles with a power rating not exceeding 35 k, 18 with a power to weight ratio not exceeding 0. A Motorcycles.
application Form D401 Driving Licence
Application Form for a Driving Licence D401 - NDLS