FORM 4A FORM 4A

[Refer rule 14(2)]

FORM OF APPLICATION FOR ISSUE OF INTERNATIONAL DRIVING PERMIT
TO DRIVE A MOTOR VEHICLE IN OTHER COUNTRIES
To
The Licensing Authority, Space for Passport size
............................................ photograph
...........................................
I apply for an International Driving Permit to enable me to drive vehicles of the
following categories:
CATEGORIES OF VEHICLES FOR WHICH THE PERMIT IS APPLIED FOR
(A) Motor Cycles Category L1 and Category L2;
(B) Motor vehicles, other than those in category (A) above, having a permissible
maximum mass/weight not exceeding 3,500 kg (7700 lb) and not more than eight seats
in addition to the driver’s seat in Category M1;
(C) Motor vehicles used for the carriage of goods and whose permissible maximum
mass/weight exceeds 3,500 kg (7700 lb);
(D) Motor vehicles used for the carriage of passengers and having more than eight
seats in addition to the driver’s seat;
(E) Combination of vehicles of which the driving vehicle is in a category or
categories for which the driver is licensed (B and/or C and/or D), but which are not
themselves in that category or categories.
PARTICULARS TO BE FURNISHED BY APPLICANT
1. Name .....................................................................
(Surname) (Middle Name) (First Name)
2. Father’s or Husband’s name ..........................................................................
3. Place of Birth and Country (proof to be ..........................................................................
enclosed)
4. Address : .........................................................................
(a) Present ..........................................................................
(b) Permanent ..........................................................................
(c) Mobile
(d) Email Id
5. Date of birth (proof to be enclosed) ..........................................................................
6. Educational Qualification ..........................................................................
7. Identification marks (1)....................................................................
(2)....................................................................
8. Blood group/RH factor ..........................................................................
9. Have you previously held International ..........................................................................
Driving Permit? If so, give details
10. Particulars and date of every conviction ..........................................................................
which has been ordered to be endorsed on
any driving licence held by the applicant
 11. (a) Have you been disqualified for obtaining ..........................................................................
a driving licence to drive? If so, for what
reason?
(b) Have you been barred by the current
country to drive in that country? If so, for
what reason?
12. Have you been subjected to a driving test as ..........................................................................
to your fitness or ability to drive a vehicle in
respect of which a driving licence is applied
for? If so, give the following details:

Date of test Testing authority Result of test

(1)
(2)
(3)
(4)
13. I enclose three copies of my recent passport size photograph.
14. I enclose the copy of driving licence No. .... dated ... Issued by .... Valid up to ....
15. Present address where I wish to collect my IDP, (applicable only in case if applicant
is applying from a Foreign Country after expiry of IDP issued during his current
stay)....................................
16. I have paid the fee of Rs. .........................
I hereby declare that the particulars given above are true to the best of my
knowledge and belief.

Date :............... Signature/Thumb impression of Applicant.

*Strike out whichever is inapplicable.]