Documente Academic
Documente Profesional
Documente Cultură
2 Your details
Your GB driver number (if you know it):
PRUTE812115V99RY
Title:Mr x Mrs x Miss x Ms x Other (for example,Dr) xxxxxxxxxxx
Surname : Vladislav
First names : Pruteanu
Date of birth :
11121985
Full current address
House No. 6 9 D D D
Postcode K T 9 1 P S
Full phone/mobile number: 07931265002
Email address : vlad.pruteanu@gmail.com
If any of your personal details above have changed since your last licence was issued please give the
previous details below.
Country you were born in:
If you have lived in another
EU/EEA country in the last
12 months, please tell us which:
What date did you
DDMMYYYY
come to live in the UK ?
To apply for a GB driving licence, you must be normally resident in
the UK for more than 185 days (see booklet INF1D).
3 Your eyesight
Please see note A over the page and refer to INF1D.
Can you meet the legal eyesight standard for driving? Yes x No x
Do you need to wear glasses or corrective lenses to meet this standard? Yes x No x
Organ donation
I want to register my details on the NHS Organ Donor Register to donate the following after my
death. Please put xin the box(es) that apply:
(A) Any of my organs and tissue x or
(B) Kidneys x Corneas x Heart x Lungs x Liver x Pancreas x
Duplicate
4 Your health
Please see note A on opposite page.
Have you ever had, or do you currently suffer from any of the following conditions?
Yes x No x
If you have answered 'Yes', please put x in all the appropriate boxes and send your application to
DVLA, Swansea, SA99 1TU
Diabetes controlled by insulin (no need to notify us if you have diabetes controlled by
1 tablets or other injections unless you experience hypoglycaemia requiring the
assistance of another person)
2 Epilepsy x
3
Any condition affecting both eyes, or the remaining eye if you only have one eye
x
Not including colour blindness or short or long sight
Any condition affecting your visual field or acuity (apart from wearing glasses or corrective
lenses)
8 Any type of brain surgery, severe head injury involving in-patient treatment, or a brain tumour x
9 An implanted cardiac pacemaker x
10 An implanted cardiac defibrillator (ICD) x
11 Repeated attacks of sudden disabling giddiness x
12
Any other chronic neurological condition including Multiple Sclerosis, Motor Neurone and
Huntington's Disease
Any persisting limb problem which needs driving to be restricted to certain types of vehicles or
x
those with adapted controls
Postcode :
Full daytime phone number:
Profession :
Signature:
Date : D D M M Y Y Y Y
Your checklist
Do not send cash.
I enclose:
The correct fee of:
Cheque or postal order number:
Your last licence (if applicable): x
7 Your declaration
I declare that I am resident in the UK and understand that it is a criminal offence to make a false
declaration to get a driving licence and that to do so can lead to prosecution and a maximum
penalty of up to two years imprisonment. I also understand that failing to provide information is an
offence that could lead to prosecution and a fine of up to 1000.
Important Date: D D M M Y Y Y Y
We will not accept this application unless you sign below in black ink and your signature
is completely within the white box.