APPLICATION
FORM: TO BE COMPLETED IN BLOCK CAPITALS
Please read the information relevant to your application. If the application form is
incorrectly completed and/or not accompanied by the correct payment and/or the appropriate
supporting documentary evidence, delay will occur in the issue of your IDP.
|
| Surname
: Mr/Mrs/Miss
....................................................................................................... |
| Other Name(s) :
..................................................................................................................... |
| Date of
birth
....................................................................................................................... |
| Country
and town of birth:
.................................................................................................... |
| Address in
Republic of Ireland:
.............................................................................................
.......................................................................................................................................... |
| Address to which permit should be sent:
................................................................................
.......................................................................................................................................... |
| Contact
tel no (inc STD code):
............................................................................................. |
| Republic
of Ireland driving licence no:
..................................................................................... |
| Issuing
Authority:
.................................................................................................................. |
| Groups:
................................................................................................................................ |
| Expiry
Date:
.......................................................................................................................... |
| Vehicle
Types:
........................................................................................................................ |
I declare
that the information I have given on this form is correct and that I hold a valid Republic
Of Ireland Driving Licence covering the type(s) of vehicle(s) that I wish to drive. I am
over 18 years of age. I understand that it is my duty to comply with the relevant
laws of the countries in which I wish to drive a motor vehicle.
SIGNATURE
..........................................................................................................................................
DATE ........................................................
DEPARTURE
DATE.......................................... |
| IDP
Statutory Fee (IR £4.00  5.08 each permit)
.............................................................................. |
| *Airmail
Postal Charge
...........................................................................................................
(* Postal Fee: Permits will be dispatched by ordinary mail unless the cost of additional
postage such as airmail is included in your remittance) |
| Total Remittance Postal
Order / Cheque
............................................................................................................. |