Application Form for

a Driving Licence D401

Please read accompanying guidance notes before
completing this form. Please complete this form in
block capitals using a black ballpoint pen. Please place
an X in the appropriate boxes e.g. Please do not
photocopy this form as it may reduce its quality and
result in your application being delayed or rejected.

Part 1: Personal Details (See Part 1 of accompanying guidance notes) *Mandatory field

1. Have you previously held a learner permit and/or driving licence in Ireland?* Yes No

If yes, which one? Learner Permit Driving Licence

Driver number* (if known)

(You

will find this on Field 5 of the paper licence or Field 4d on a plastic card licence.)

Other
2. Title Mr
Mrs Miss Ms (please specify)

Name to appear on the licence. Acceptable photo ID must be provided in this name. Refer to list 1 on page 2 of the accompanying guidance notes.

3. First name(s)*

4. Surname *
As it appears on your birth certificate

5. Full name

6. If your surname has changed since your last licence issued please indicate the reason

Marriage/Civil partnership Deed Poll Use of Irish name Divorce/Separation

Previous names
Proof of address provided must match exactly the address given below. Please refer to list 2 on page 2 of the guidance notes.

7. Address line 1*

Address line 2

Town*
Official
Use
County/City* Eircode
If aged 70 or over or if your current licence expires on the eve
8. Date of birth* of your 70th Birthday a valid medical report will be required.

Day Month Year

9. Gender* Male Female

10. PPSN* Original proof of PPSN must also be provided. See list 3 on page 2 of the guidance notes

If born in Republic of Ireland, please state County. If born outside of the Republic of Ireland, please state country

11. Place of birth*

12. Mobile no.* Landline

Email address*

The NDLS will use these contact details to contact you in the event of issues with your application, dispatch of your licence and future renewal reminders.

October 2016
 GROUP 1 GROUP 2
GROUP 1 GROUP
Part 2: Licence Details (See Part 2 of accompanying
Licenceguidance notes) Description of Licence*Mandatory field
Description o
Licence
Category Description of
Vehicle Licence
Category Description
Vehicle
13. Application Renewal of driving licence. Category Vehicle
First time driving licence. Add/remove a category. Vehicle
Category

GROUP 1option 2 of checklist
GROUP

type*: Please see option 1 of checklist M Please see50c.c. see option 32of checklist
PleaseC1
45KmH Moped Small Truck
7,500kg

Personal detail change. MGROUP 1 45KmH

Replace
50c.c.
Moped GROUP 2
C1a damaged Small Truck
Description of or stolen licence.
a lost Replace licence.
7,500kg
Licence Licence Description of

Please see option 4 of checklist A1
Category Please see
Vehicle option 5Motorcycle
125c.c. of checklist
up toCategory
125cc PleaseCsee option 6 of checklist
Vehicle Large Truck
A1GROUP 1 125c.c. GROUP 2 of
11KW
Licence Description of Licence Description
Motorcycle up to 125cc C Large Truck
Exchange GROUP of foreign 1Category
licence. 50c.c. Other(Reason):
Vehicle GROUP
11KW 1 Category GROUP 2 7,500kgVehicle GROUP
Small
2
M Moped GROUP
1 C1 Small Truck less than 7,500 kg Truck a
GROUP

Please see GROUP
option 7 of 1Licence
checklist 45KmH
Description25KW
of GROUP
Licence 2 EC1
Description of 12,000kg
Small
more Truck
than 12
Licence GROUP 1 Description M Category 45KmH 50c.c.
ALicence
of categories
Vehicle
Moped 0.16KW/Kg
Licence GROUP
Description
25KW Motorcycle
C1
overof 2125cc 7,500kgof Vehicle
Category
Description Small EC1
Truck less than 7,500
Licence
12,000kg
kgDescription
more than 1
14. *Please indicate here the category A1 or 125c.c.
that you
Motorcycle wish
up
0.16KW/Kg to to
125ccapply for. C Large Truck over 3,500 kg
GROUP 1 Vehicle GROUP 2 125cc 7,500kg of EC
11KW
For a Category
Licence
definition of the categories Description
please refer to of4 of125c.c.
page theLicence
A
Category guidance Category
note Licence Description
Vehicle
Motorcycle of
Vehicle
over Description Licence
Category Large
Vehicle Truck a
Description
A1 M 50c.c.
Moped up to 125cc
Motorcycle CC1 Small
Large Truck less
TruckTruckover than
3,5007,500kg kgnoLarge
Licence Category DescriptionVehicle of Category
45KmH
11KW Licence Category Vehicle
Description of
Vehicle EC
Small
Category and Trailer Vehicle Truck
EC1 12,000kg

Category Vehicle 25KW

Category Vehicle more than 12,000 kg
Group
Licence M 1 GROUP
Required 50c.c. 1 Notes
Description Mopedof A1
A Group 1 M11KW
0.16KW/Kg
Required
Licence
125c.c.
C1
Motorcycle 50c.c. Group
up to 125cc
45KmHoverVehicle
Motorcycle GROUP
Moped
125cc 2
Description
up toEC1
7,500kg 2
Required
C 3,500
Smallof kg.Truck12,000kgNotes
less
Small
LargeD1 C1
than
Truck
Truck and
Group
over
7,500
Trailer
2
kgkg3,500 kg
1+16
no
7,500kg Small
Required Bus
Small Truck m
Categories
45KmH
Categories B25KW 3,500kg
50c.c.Categories EC moreLarge thanCategories
D1 12,000
Truck and Trailer Small Bus
Category M please tick
Vehicle M please tick Moped please tick C1 please tick
Small Truck
B Category C1 Max Vehicle
Vehicle up to 3,500
8 passengers Smallkg.
50c.c. 1+8 7,500kg
45KmH MopedA 0.16KW/Kg
Motorcycle3,500kg
over
45KmH125cc 7,500kg Truck less Smallthan Truck7,500 kg no
and Trailer
1+16

M 50c.c.
Moped C1 1+87,500kg
Max Small
8 EC1
Truck
passengers
EC less than 7,500
12,000kg
LargeD kg Truck and Trailer Large Bus m
Licence A1 45KmH Description
125c.c. of
Motorcycle up to 125cc A1Licence C 11KW
25KW 125c.c. Description
Motorcycle upLarge
to of
125ccTruck over more Cthan 12,000
3,500 kg kg Large Truck
11KW
A
0.16KW/Kg
Motorcycle
Vehicle up over 125cckg.
to 3,500 D1 1+16 note. AllD Small Bus max. 16 Large
passengers
passengers Bus
Category GROUP Vehicle 1 Motorcycle Category Vehicle
Car GROUP up2Large
M A145KmH
50c.c.
Moped 125c.c. B up to 125cc EB A1 C1 C 7,500kg Motorcycle
125c.c.
Small Truck to 125cc
less
Please
Truck
than over
7,500 kgC
3,500 kg Trailer Large Truck
GROUP 1 GROUP 2and
3,500kg
11KW 1+8
Max up 11KW
8 passengers and TrailerEC
D1Small applications Largefor Truck and passengers
Small
A1 125c.c.
Motorcycle up to 125cc C Vehicle to 3,500 kg. Large Truck Truck
over 3,500 kg
Small
Trailer
ED1
Bus max. 16 passengers
no SmallBus an
Truck
GROUP 1 DGROUP 2 Large Bus more than 8
1+16
11KW B 3,500kg EB EC1 Car and Trailer
12,000kg group 2 EC1 12,000kg
12,000kg

M
AM 50c.c.
25KW B 1+8
Max 8 passengers
C1 Vehicle0.16KW/Kg
25KW C more
Small than
D1 less 1+16 Truck12,000 and
categories kg
Trailer
LargeED1
Small EC1
Bus
passengers
Busmax.
D
no
more16 passengers
than 8 12,000kg
Small
than
more Bus
12,000Truck
than ka
12
A1
Licence 125c.c. Moped
Description
Motorcycle
0.16KW/Kg
upofto to
125cc
EB A C
Licence upEC1to 7,500kg kg. Small 12,000kg
3,500 Description
Large Truck
D ofover than
3,500 7,500
kgbe kg
12,000kg
than
more 12,000
than 1
A
Licence
45KmH
11KW 25KW Description
Motorcycle
Please refer B over
of 125cc 3,500kg Car and Trailer
Licence25KW Tractors Small
Motorcycle and Truck
over
Work and
125cc Trailer
Description
more than
must
of no
12,000 kg
Small
passengers Bus and Trailer no more
Category Category Vehicle W Category
EC1Max 8 passengers
1+8
EC
0.16KW/Kg 12,000kg
Vehicle ED1 Truck accompanied12,000kg ED
byEC Large
Large Bus
Truckan
ALicence
0.16KW/Kg
Description
Vehicle
accompanying EB of
Motorcycle over 125cc A Car and Licence
Category
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Tractors
more
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than Large
over
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12,000125cc
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Large Bus more than 8
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W Small D and Trailer and Trailer
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A
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Category Motorcycleguidance upVehicle
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and 12,000kg ED1 Large
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12,000kg
medical kg
and passengersEC
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report
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M
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Moped notes in D1 Small Small Bus
C1Work Vehicle upTruckED1 less
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12,000kg
max. 16 kgpassengers
0.16KW/Kg 7,500kg
A M 45KmH Motorcycle
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B 45KmH
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M 25KW 1+850c.c.
45KmH Max Moped
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3,500
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Vehicle up
W to 3,500 kg. B D1 Tractors and
1+16
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A1 125c.c.
3,500kg
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to
up 3,500
to125cckg.
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8 Bus
passengers
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kgrefer D
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A
B A13,500kg Motorcycle 1+8
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over 8
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up to 125cc
1+16
Pleasealso
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than 8kgD1
125c.c.
A2 A11+8
11KW
application C1 Large passengers
Large Bus to more Large Bus
passengers
EB3,500kg
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8 passengers
125c.c.
up to Motorcycle
3,500 kg. upW to 125cc
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EC
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accompanyingno passengers
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D
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ED1 no
no more
EB 25KW1+8
Max 8 passengers Car and Trailer EB EC1 Car
12,000kg
and
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than 12,000 kg guidance 12,000kg

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moremore
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and
12,000
notesand Trailer
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in kg ED1
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than 12,000 no tomore
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Large Truck and Trailerrequirements ED D1E Large Bus an
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B 15*. On receipt
3,500kg of thisVehicle
Tractors up
driving and to Work
3,500up
licence,
Vehicle kg.to
will youkg.
3,500 hold a licence D11+16 issued by another
Small
1+16 Bus and country?
Small Bus max.
Trailer noYes 16 passengers
more No
W B 1+8 Max3,500kg
8 passengers ED1
ED D1 12,000kg
Large Bus and Small Bus
Trailer max. 16 passengers
If Yes,Bplease provide Vehicles3,500kg details
1+8
MaxVehicle up to 3,500 kg.
8 below:
passengers than1+1612,000
Large Bus Large kg
moreBus than
D 8 more than 8
Tractors and Max Work8 passengers
1+8
D passengerspassengers
W ED Large Bus and Large
TrailerBus more than 8
EB Vehicles
Car and Trailer D
Issuing EB country Car and Trailer Small Bus and passengers
Trailer noTrailer
more no more
EB ED1 ED1
12,000kg Small Bus and
Car and Trailer than12,000kg
12,000than kg
Small
ED1 12,000 kg Trailer no more
Bus and
Driving licence Tractors no. and Work 12,000kg
than 12,000 kg
W W Tractors and Work ED Large Bus Large and Trailer
Vehicles Vehicles Tractors and Work ED Bus and Trailer
16. If yourW licence was lost or stolen Vehiclesplease sign the declaration ED below and get the declaration
Large Bus and Trailer witnessed
and stamped at your local Garda Station. Please note if you find or get your old licence back after applying
for a replacement, the old licence will no longer be valid.
I declare my licence lost/stolen (circle as appropriate)

Signature of Applicant

I certify that the applicant has declared his/her licence lost/stolen.

Name of Garda

Signature of Garda
Part 3: Exchanging a Licence (See Part 3 of accompanying guidance notes)
17. Did you obtain your current full foreign licence
by exchanging a licence from another country? Yes No

If Yes, please state the country where the original licence was obtained:

18. Is the licence you are exchanging, suspended, withdrawn, cancelled or are you disqualified?
(If yes, refer to Q18 on page 1 of guidance notes and www.ndls.ie for further information) Yes No

19. I took up normal residence in Ireland on

Day guidanceMonth
Part 4: Organ Donation (See Part 4 of accompanying


notes) Year

20. Place an X in the box provided if you would like code 115 to appear on your driving licence indicating
your wish to become an organ donor.
October 2016 Page 2
 Part 5: Driver Fitness (See Part 5 of accompanying guidance notes) *Mandatory field
If you answer Yes to any of the questions below 22 to 42 or 43(c), you will also be required to submit a medical report dated within one month of application date

21.* Do you need to wear glasses 31.* A serious problem with memory
or lenses for driving? Yes No or periods of confusion3 Yes No
(If yes Code 01 will be added to your licence) 32.*Persistent alcohol misuse
If in the past you answered Yes to this question or dependency Yes No
and are now answering No you must provide a 33.* Persistent drug misuse
current eyesight report with your application. or dependency Yes No
Health and Fitness 34. *Serious psychiatric illness or mental
health problems3 Yes No
Have you ever had, or do you currently suffer from,
any of the following conditions? 35.* Parkinsons disease Yes No
22.* Diabetes treated by insulin or managed by tablets
which carry a risk of inducing hypoglycaemia eg. 36.* Sleep Apnoea syndrome Yes No
sulphonylureas. (Ask your doctor whether you are on
sulphonylureas or other medications which carry a risk 37.* Narcolepsy Yes No
of inducing hypoglycaemia.) No need to tell us if 38.* Any condition affecting your
managed by diet alone or only by peripheral vision Yes No
medications which do not carry
a risk of inducing hypoglycaemia. Yes No
39.* Total loss of sight in one eye Yes No
23.* Epilepsy Yes No 40.* Any condition affecting both eyes, or the remaining eye
24.* Stroke or TIAs with any associated
1 if you only have one eye (not including
symptoms lasting longer colour blindness or short
than one month Yes No or long sight) Yes No
41. *A serious hearing deficiency which
25.* Fits or blackouts Yes No has worsened since your last
application/renewal Yes No
26.* Any type of brain surgery, brain abscess or severe head
injury involving in-patient treatment
or brain tumour or spinal injury 42. *Severe learning disability3 Yes No
or spinal tumour Yes No
43. *(a) Any persistent problems with
27.* An implanted cardiac pacemaker Yes No arms or legs which restricts your
driving to an automatic vehicle Yes No
28.* An implanted cardiac
defibrillator (ICD)2 Yes No 43.* (b) Any persistent problems with
arms or legs which restricts your
29.* Repeated attacks of sudden driving to an adapted vehicle Yes No
disabling dizziness Yes No
43. *(c) If you have ticked yes
30.* Any other chronic neurological condition such to 43(a) or 43(b) has your condition
as multiple sclerosis, motor neurone deteriorated since your last
disease or huntingtons disease Yes No application/renewal. Yes No
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).
While TIAs generally do not cause permanent brain damage,they are a serious warning sign of stroke.
2
An Implantable Cardioverter Defibrillator (ICD) is an electronic device which monitors your heart continuously. The ICD is programmed to detect abnormally fast or slow
heart rhythms.
3
If in doubt, please consult your family doctor.
A numeric code on your licence may indicate certain restrictions or conditions that affects your licence- including those related to a disability or illness. Information about
codes will be on the explanatory letter issued with your licence and on our website www.ndls.ie. Where you need an adaption to your vehicle on medical/disability grounds,
or an existing adaption is being modified, you should contact the NDLS as a new code may be needed on your licence.

Part 6: Declaration by Applicant (See Part 6 of accompanying guidance notes) *Mandatory field

44.* I hereby declare that: Ireland is my normal place of residence. I am not currently disqualified (with the exception of a
penalty point disqualification) from holding a learner permit or driving licence in Ireland, the E.U. or a recognised state.
The address given is my normal residence. The accompanying supporting documents relate to me. The information
I have given in this application is correct.
THIS DECLARATION MUST BE SIGNED BY THE PERSON TO WHOM THE DRIVING LICENCE IS TO BE ISSUED

Applicants signature

(Please keep signature within the box)
Day Month Year

Information contained in this form may be subject to disclosure under Section 60 of the Finance Act, 1993 (No. 13 of 1993) as amended by Section 86 of the Finance Act, 1994 (No. 13 of 1994) and
regulations made thereunder. List of disclosees is registered with the Data Protection Commissioner. An electronic version of all information contained in this application may be retained for a period
of at least 20 years.
Public Service Identity data collected on this form/provided by you may be used to maintain/authenticate your Public Service Identity, under Section 262(5) of the Social Welfare Consolidation Act
2005 (as amended). Only your Public Service Identity data may be shared with other public bodies under this provision.

Page 3
October 2016

Application Checklist for Driving Licence
You must apply in person at any NDLS centre. You may book an appointment at www.ndls.ie
Option 1 - For all applications for driving licences you must supply;

Application form for Driving licence D401 (Fully completed)

Current/ most recent driving licence / Learner permit
If you do not have your most recent licence you must present
a completed lost licence declaration (question 16 on D401)
NDLS medical form (dated within 1 month) if required (see page 3 of guidance notes)
Evidence of IBT if required (see page 3 of guidance notes)
Evidence of CPC if required (see page 3 of guidance notes)
Evidence of PPSN (list 3 on page 2 of guidance notes)
If the address has changed since your last learner permit/ driving licence
was issued, you must provide evidence of new address (see list 2 on page 2 of guidance notes, must be dated within 6 months)
Photographic ID (see list 1 on page 2 of guidance notes)
Evidence of residency entitlement (see list 4 on page 2 of guidance notes)
Relevant fee (see page 1 of guidance notes)
Your Photograph and signature will be captured at the NDLS office

The following additional information is required when applying for;

Option 2 - Applying for your first driving licence Option 7 - Exchange a foreign licence from EU/EEA or a
recognised state
Cert of Competency (dated within 2 years)
Current Learner Permit Evidence of residency entitlement
(see list 4 on page 2 of guidance notes)
Option 3 - Adding a Category Your current full licence (please note, if your licence
does not have a category start date you will need to
Cert of Competency (dated within 2 years) provide an original letter of entitlement /
Current Learner Permit driver statement from your relevant authority)
Current Full licence If you do not have your licence you will need to
present an original letter of entitlement/ statement
Option 4 - Change of personal details
from the appropriate licencing authority and
Evidence of name change if name complete the lost licence declaration
is changing (page 1, Q6 of guidance notes) (see question 16 on application form)
Evidence of new address (dated within 6 months) if If your licence is from an EU/EEA member state
address is changing (see list 2 on guidance notes) and is expired for less than 10 years, it must be
A completed NDLS medical form (dated within one accompanied by an original letter of entitlement/
month) if your medical details have changed driver statement from your relevant authority
(see page 3 of guidance notes) If your licence is from a recognised state and is
expired for less than one year, it must be
Option 5 - Replace a lost or stolen licence
accompanied by an original of entitlement/
A completed lost licence declaration driver statement from your relevant authority
(see question 16 of application form) If your licence is from a recognised state you
must present an eyesight report form D502
Option 6 Replace a damaged licence Certified translations are required for all Letter of
Entitlement/Driver statements which are not
Photographic ID (see list 1 on page 2 of guidance notes)
in English or Irish
Damaged Driving licence

THE NDLS CENTRES ARE OPEN MONDAY TO FRIDAY 9.00AM 5.00PM

(INCLUDING LUNCHTIME) AND SATURDAY FROM 9.00AM 2.00PM.
VISIT WWW.NDLS.IE FOR THE MAP AND ADDRESS OF YOUR NEAREST
CENTRE OR DOWNLOAD OUR NDLS CENTRE APP: