Application For Driver'S License & Conductor/student Permit
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1Republic of the Philippines
Department of Transportation & Communications
LAND TRANSPORTATION OFFICE
East Avenue, Quezon City
Field Office: ______________________
Date: ______________________
MM – DD – YYYY
APPLICATION FOR DRIVER’S LICENSE & CONDUCTOR/STUDENT PERMIT
INSTRUCTIONS:
1. Accomplish this form correctly.
2. Print data legibly.
3. Submit this form to receiving personnel together with the required supporting documents.
NAME (Family Name, First Name, Middle Name)
___________________________________________________________________________________________________________
ADDRESS (No., Street, City / Municipality, Province)
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
CITIZENSHIP
SEX
TEL. NO.
PAGER/EMAIL:
______________________________ _______
___________________
____________________________________
BIRTHPLACE
BIRTH DATE (MM/DD/YY)
HEIGHT (cm)
WEIGHT (kg)
_______________________________
_____________________
___________
___________
CIVIL STATUS
Single
Married
Widow/er
Others
ORGAN DONOR
Yes
No
TYPE OF APPLICATION (TOA)
REVISION OF RECORDS (PREVIOUS)
A. NEW
NAME (Family Name, First Name, Middle Name)
Student
Professional
Non-Prof
Conductor's Permit
_____________________________________________________________
B. 2 YRS. DELINQUENT OR MORE
C. CHANGE TYPE
ADDRESS (No., Street, City/Municipality, Province)
NON-PROF TO PROF
PROF TO NON-PROF
_____________________________________________________________
FOREIGN LIC. TO NON-PRO
FOREIGN LIC. TO PROF
_____________________________________________________________
D. RENEWAL
E. ADDITIONAL RESTRICTION CODE
BIRTHDATE ___________________________
F. DUPLICATE
MM
DD
YY
G. REVISION OF RECORDS
CIVIL STATUS
(EX. Address, Name, Civil Status, Birth, etc.)
Single
Married
Widow/er
Others
H. OTHERS
SPOUSE NAME (Last Name, First Name, M.I.)
__________________________________________________________________________________________________________
MOTHER’S MAIDEN NAME (Family Name, First Name, M.I.) Indicate even if deceased
__________________________________________________________________________________________________________
FATHER’S NAME (Family Name, First Name, M.I.) Indicate even if deceased
__________________________________________________________________________________________________________
EMPLOYER’S BUSINESS NAME
TEL NO.
_________________________________________________________________
_____________________________________
EMPLOYER’S BUSINESS ADDRESS
__________________________________________________________________________________________________________
OTHER CONTACTS
TEL NO.
_________________________________________________________________
_____________________________________
Any false statement in this application or misrepresentation of facts relative thereto shall render the license
null and void and shall serve as ground to bar applicant from acquiring any license/permit.
THIS IS TO CERTIFY THAT THE INFORMATION
SUBSCRIBED under oath before me
I HAVE GIVEN IS TRUE AND CORRECT.
______________________________________
______________________________________
CHIEF
SIGNATURE OF APPLICANT
Transportation District Office
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Parent category: Business