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ROAD TRANSPORT DEPARTMENT MALAYSIA

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i)  ! "#$ #
ii) Use CAPITAL LETTERS

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1. No. NRIC / Passport /
Police / Military
2. Categories
3. Name
4. Address
5. Postcode
6. City
7. State
8. Sex (M / F)
9. Place of birth
(To PMA only)
10. Date of Birth
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1. Application for New License, or Add a Class only
Class
Date Passed
DL series 18 / 3 JPJL
i.
ii.
iii.
Day
Month
Year
2. To change license only
Code Country / Agency issuing the original license
If a foreign country, State
3. For Application copy, or an International Driving Permit only
No. Series License
Class License
Day Month
Year
4. Licence Expiry Date
(If applicable)
Day Month
Year
5. Application Period
(If applicable)
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 (For New Driving License Application, New or Change License
License Only)
Do you have things like the following? If yes, tick
in the appropriate box.
A
B
C
Court Sentence
Mad Pig Disease
Handicapped
D
E
F
Dizziness and Fainting
Difficulty reading the weather as far as 23m in the light of
Other Diseases, State
... ... ... ... ... ... ... ... ... ... ... ... ... ...
No. Vehicle Registration
(For disabled members only)
I declare that all information given above is true.
Date ... ... ... ... ... ... ... ... ... ... ... ... ... ..
... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
Signature
OFFICE USE
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(I) This form must be completed when: -
a. You apply for a new driving license / new licenses / license new / add class and a
copy of the license.
b. You apply for a foreign exchange license from the license / police / military to the
license or licenses Malaysia.
c. You apply for international driving permit.
(Ii) Use ONE form for each type of transaction only.
(Iii) Include a photograph of the applicant and make sure all documents are complete
when submitting applications.
(Iv) Write clearly, use BLOCK LETTERS.
(V) In the box provided, use one box for each letter or number and leave one box
blank between words.
Use a short spell if necessary.


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 Use the following code (Select one only)
06 - DRIVING LICENSE NEW LEARNING
15 - CHANGE OF LICENSE TRIAL
24 - ADDITIONAL CLASS LEARN DRIVING LICENCE
00 - NEW DRIVING LICENCE
38 - COPY OF DRIVING LICENSE STUDY
04 - International Driving Permit (PMA)
53 - ADDITIONAL CLASS & LEARN Driving Licence Renewal
05 - CHANGE OF LICENCE
54 - COPY & LEARN Driving License Renewal
20 - ADDITIONAL CLASS OF DRIVING LICENCE
55 - ADDITIONAL CLASS & STUDY COPY OF DRIVING LICENCE
30 - COPY OF DRIVING LICENCE
56 - ADDITIONAL CLASS & STUDY COPY OF DRIVING LICENSE renewal
50 - ADDITIONAL CLASS & Driving License Renewal
10 - NEW TRIAL LICENCE
60 - COPY & Driving License Renewal
11 - ADDITIONAL CLASS LICENSE TRIAL
64 - ADDITIONAL CLASS & COPY OF DRIVING LICENCE
12 - COPY OF LICENSE TRIAL
67 - ADDITIONAL CLASS & COPY & Renew Licenses
14 - ADDITIONAL CLASS & LICENSE TRIAL COPY
DRIVING

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1. NRIC / Passport / Police / Military
If you are serving in the police force or army, enter the number
police / military as the case may be. If you are not the people of Malaysia,
Enter your passport number. If you are a public person, fill in the identity card number.
For example: 123456-10-0956, fill
2. Categories
Use the following code:
0 - Permanent Resident
7 - Malaysia Birth Certificate
1 - The Malaysian Public
8 - Receipt Introduction Malaysia
2 - Police
9 - Non-Citizen Malaysia
3 - Members of the Army
3. Name
Enter your name as in identity card or passport.
4. Address
Enter your home address.
5. Postcode
Enter the postcode you live now.
6. City
Enter the city where you live now.
7. State
Enter the state you live now.
8. Gender
Enter L - Male, F - Female.
9. Place of Birth (For international permit applicant)
Enter the city where you are born.
10. Date of Birth
Enter your birth date. For example, 13 th February 1960, enter:
1
2
3
4
5
6
1
0
0
9
5
6
1
3
0
2
1
9
6
0

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1. To request a new license or just add a class.
Class
Enter your license class has graduated. If B1, complete
Date Passed
Enter the date of passing the class of license.
JPJL3
Fill JPJL3 serial number for each class you pass.
2. To change license only
Enter TEN if the original license issued by the Armed Forces.
Code Country / Agency
Enter POL if the original license issued by the Royal Malaysia Police.
Original License Issuing
Fill in the SIN if the original license issued by Singapore.
Fill in the LS where the application of non Diplomat Diplomat and approved by
Wisma Putra or the RTD Headquarters.
Fill in the NEB if the original license issued by a foreign country (except Singapore).
If Foreign Country, State
Specify the name of the country where the original license issued by a foreign country.
3. To request a copy or an international driving permit only
Series License
Enter the serial number of the Driving Licence / Licence Trial / Your Driving Licence.
Class License
Enter the Class Licence as stated in the Driving Licence / License Trial License
Your driving.
4. Licence Expiry Date
Enter the date of expiry learn / licenses / license now.
5. Application Period
Enter either 1, 2, 3, 5 or 10 years for driving license and 02 for Trial Licenses
(If you apply for 3 years, 03 Fill in the box).

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 (To request new driving license, new driving license or
exchange only)
Mark
in the appropriate box only
Signature
This form must be signed by the applicant.
B
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