Certificate Of Identity Form printable pdf download

Certificate of Identity form

For the purpose of applying for a driving

licence/learner permit only

Section 1: Declaration by applicant

(Please see full explanatory notes before completing this form)

Name:

________________________________________________

Address:

________________________________________________

Please

________________________________________________

affix

photo

________________________________________________

here

Date of Birth:

________________________________________________

PPSN:

________________________________________________

I hereby declare that:

• I was born in the Republic of Ireland or the UK

• The particulars supplied in this form, including the photograph, and in my application for a driving licence

and/or learner permit are correct and relate to me

• I do not hold an Irish/UK passport or any other official photographic identity document e.g. Public Services Card,

that would verify my identity

• I further certify that I understand that it is an offence to provide false or misleading information in respect of the

associated application

Signed: ___________________________________

Date: ___________________________________

(To be signed in the presence of a witness)

Section 2: Declaration by witness

(Please see full explanatory notes before completing this form)

I personally know ____________________________ who has signed Section 1 above in my presence. I also certify that

the affixed photograph is a true likeness of ____________________________. I further certify that I understand that it

is an offence to provide false or misleading information in respect of the associated application.

Signature of Witness: ___________________________________

Date: ___________________________________

Name

: ___________________________________

Tel No: ___________________________________

(in block capitals)

Address:

________________________________________________________________________________

Profession:

___________________________________

This form is for use by customers born in the Republic of Ireland or the United Kingdom only.

Certificate Of Identity Form

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