Application Form for a Driving Licence D401 - NDLS

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.)

2. Title

Other

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 4 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

7. Address line 1* Address line 2 Town* County/City*

Proof of address provided must match exactly the address given below. Please refer to list 2 on page 4 of the guidance notes.

Eircode

Official Use

8. Date of birth* 9. Gender*

Day

Male

Month

Year

Female

10. PPS number* 11. Place of birth*

Original proof of PPS number must also be provided. See list 3 on page 4 of the guidance notes. If born in Ireland, please state County. If born outside of Ireland, please state Country.

12. Mobile no.* Email address*

Landline

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.

ndls.ie

Page 1

March 2020

GROUP 1 GROUP 1

GROUP 2 GROUP

Part 2: Licence Details (See Part 2 of accompLaincyeinngceguidance notes)Description of

Licence*Mandatory fieDldescription o

CaLtiecgeonrcye

VeDheicslceription of

CaLtiecgeonrcye

VeDheicslceription

13. Application Renewal of driving licence. CategFoirrsyt time drivinVgehliiccelence.

type*:

Please see option 1 of checklistM

GPRleOasUe sPee510oc.pc.tion

45KmH

2Moof cpheedcklist

Personal detail chanLgicee.nce MGRORUeDpPelsa1ccreip4ta55ioK0cmln.coH.osft oMr osptoelden licenLicceen. ce

Add/rCeamteogvoeray category. Vehicle PleaseCGs1eRe oOptUioPn 32of ch7e,5c0k0lkigst Small Truck ? ReGpRlaODcCeeU1saPcrdi2patimonagofed l7i,c50e0kng ce.Small Truck

LCLCLCLCMAABEWMABEWMAABEWMAABEWiiiiaaaa1111B1B1B1Bcccctttt456eeeeCeeee.*.ccrIIIDFAoooo*efAofsAoeeeeOAgrMrrrrPsur1y`2iyyyyouYpanlvoreeLCiidiMAABEW1uLCnenarMAABEWesia1BesrLCcisfgagMAABEW'1BcLCi,tMAABEWc0000een3333itlae1B....ec,,,,i11114444e1111aicepli55551Bnc66665555ttg1111c22225555i0000nieKKKK2222og1111tiKKKKei555500001111cl0000cneoeWWWW5555KKKKoepcccccmcmcmcm++++enkkkkcguoKKKKep........nWWWWeg8g8g8g8n////dccccccccHHHHnKKKKgRrtGGGGWWWWeac........lonrggggnycoeeiocesyocrfaceqtRRRReeEPPryatsfreuyllhxeeeytwiptOOOOMMMVMCMMVMCMMVMCMMMVMCTVTVTVTVDVDVDVDVeraacneth0e3rrrrrsseeeeeeeeeeeeichaaaaeeee0.a3oooaooaooaoooa,1aaaa4ocee1doUUUU5i.ah,hhhhhhhhhhhh164511rrrrssss255ks00aspttxptxpttxpttx36ccccK.5t211K25v501ss0.00oooooooiiiiiiii3,K1iiii24eW1Ke5ccccK1501aaaa5ccm+0.eeeecccccccceenkttttPPPP,cccc6W1455dK1Kil1258888ccm+..50Wrrrrrrrooookg8g/Kcc6eeH2rrrrr15KKKd1nnnnllllllllo25..501WddddGW0g80ccccccc/llllgcc..KHeeeeeeeeW25Ko1KKrgiiii501eGWccm+rrrr0keeee..Wpdpdpdpd5KooKgyyyyyyyppppe..sWccm+g8sssskir/1111sssscceHKK..GWWg8vi/ppauuuu..PccRcccccccaaaatHKgrttttteGWTTTT..RcaaaatteldgiiiiialllllllpppphsssssoerciieeeeeeeooooonqgrrrreRpoonnnnOaMMMVMCTVDVneossssNIpaaaaRufeOulMMMVMCTVDVpBttttnnnnrnnsgmoddddauouououoeeeerleeetooooiieaeoliiiiTeroooaOrfttMMMVMCTVDVdeeeaillllaUea47scepooopvpvpvpvnnnnceOihhheeeeMMMVMCTVDVaotaoooorsUraWWWWlaopttxhhhr3333cameeeasetrseaeaeeeeiioopttxsggggnoooaooiinrrrrcrniaeeecrfffftUaaenlfecoocctttttPoii,,,,oooaeshhhiciaccersiff8aderrrrUtrrecceooooeeeeoooootPnspttx5555ccyhhhortnl8lrseedrroooccrpttxliilecccireerocinllandi1111rrrrrrrrreicccctP0000ooelieinceeeitdphhcbt8yynpi1111arrrogsssskkkkecsctPe1gscsrdponllyyp22228gfdLC0000rrsocc1leenusMAABEWeeccare2222nlleitrdcccneulTccaoeedpi5555accyyptiraisrllp1Be1Tssc5555dpaeyykkkkpleeoikksllpCu1rssLCccaptccccrnMAABEWMAABEWteeotoesrlluTlaeccccccggggana,toiytsniillpccccasaTaid1Bn1Blauoecsseeootnwigccccllpri....sCdcneuoetoeetowttslwiceranpvneoeoetnol aseWGdapvnauoe3eneo:otnWgiewdrggtr3uoeirolfrneictgypvn,rseeoloflrWoooeotw5,pvn3BeeolWrWeeoceocgg5rrB3ruf 1rret.0gy,rEafyyore11rrnoeosk0t5,p21rssk0oeo5rdot22.1rr0003i5i2111rrsk.l0e,14eg551u25k1s0AABEWsk651c25502LCk20K.0sg2MAABEW1K3501ccg05n2.iW05K,3c1B14ccm+cgk155LCe5AABEWki.hK6MAABEW..,5Wcac118g4o25/.101Bccc55HKcKk21KW6c505110.25..c0gcigW5KKt2ccm+1B1Katkoc5011Br0LCLCLCLCEEEEEEEEDDDDDDDDCCEECCEECECCEEcgKce..WW5g8K/ccm+cccecHkh.KGWKit....Wg8c/iiiiHenKDDDDDDDDCCCCCCCeaaaaW11111111eg..dccccegpnRcMMMVMCTVDVttttsgo11111111ReeeePOeeeelreeeacedaeeeoOoooaMMMVMCTVDVlnnnnratggggehhhtrseayqpttxreMMMVMCTVVeeechaerccccaoooaooliiaihooooUcsaecctuhhhryeeecirsca8spttxrrocaoooaeeeeearcnlloodiirrrrccieeilhhhceeareccltPirpttxcerc8tdpryyyyoyypesaootriinllsidreccaslecceetucii0ccar38etrropdne(yypTcrys.danllLC1s0EECCEEDDdi,ccll1p3ls1ee5uRLCeeoccrakeEECCEEDD.aer6t,n11pd4o20Tyyc10s3as50iias3KllpDDCC2a1s611.5tn511250ee.oLC,eciu0dtEECCEEDD1ccaoruoe,DDCC1aW1n5K4o115Ke211Kuc+i5s501TkcLC601111EECCEEDDaa1t6l2K5i0Wtnllp15.K25psW11pvng8e0dcacm+/Keik2++++ouoe1ceetKDDCCoWae512K11o1rK0iK11nW5013e..0cWig8W.s5/le1111KtDDCCegaccWica+5H11rKgkKpvnnccm+efwGsWtocktWKtg6666i,d...sWK3nuoeg8n/11..orgeW7777g8ooeceo/i5gKgtccreHWKof1111l11cGWetC.,,,,,spvn..oge1111e55551rrrn0oeogn2222cW5i3g1oksR22220000aeennu,,,,gbsGr21rr0g00000r,,,,t0000ec,2510000sktrRor0000oeoCh5MMVMCTV5kkkk2ryc0)ee0000eo500002CkggggeyOMMMVMCTVDVo1rrCo0c:50000rkkkkr1ee1l5dskgcgaCkkkkkMMVMCTVooargggguOc2EfacMMMVMCtTVDVy0reeeo1ggggaec2cg.hhoooaEoyarco5Ucttxrpeecreehhehca.5bwareskooaooriiaoooapttxhGGGGaccaUDVDVDVDVccLLLLSLSmLLpSSLSmLLpSSLSmLLpSSLSmLLpSSSSSttttthh1ooicghhiihr2i8rscttxrrehhhhyoaacc1pttxecectP+cnlloocaaaaaaaaaaaaaaaaaaaa8.iieeeeccoorro+mmmmmmmmmmmmmmmmiic1eeeeeiacrcctasooooaaaaranllRRRRpecdctP1cc16cl8pdkeerryyorrrrrrrsrrrsrrrsrrrs8ahhhhsrri7or1+sssss6enllrrrrrnnnnnlpdl1ccnggggggggggggggggldyyp7aaaaaaaaaaaaaaaa,pcceesu+l1cca1sssees1r5i1neeee2iriiii,ccccOOOOeTpd16usyy15a2pdcca0seeeeeeeeeeeeeeee2yypcccc,llllllllllllllllt7dssllpeeeels1s60T11112t0,llllllllllllllll01aee,urrrr7o,icca0ryllup0nccas015,tttt 0llll1k2tsnnnneeTo,00iiiiTTTTTTTTaaTBBBBBBBB2222r0TTTTTTT102hhhhBBBBBBBB50UUUUaneeeekg2llp,tistgllps0pppp0ds00a2eek,uoe0g0opgggg,eeorftn0in0rrrrrrrr,,,,rk0aaaarrrrrrr0hnkdguuuuuuuu,LCRs0kEEDDCCEEuuuuuuuuuoelsoa000000ekogttttuuuuuuuuai0gl0pvnuuuuuuuLCtEECCEEDDgeeeeekPPPPtndWl0g0nnnneiuoedeiiiissssssss0koDDCC3ssssssssauoepvnge11oei0000oceticccccccc0ikWoooorgcccccccDDCCgark11rrrrGla3clqtDVgpvnLSmLSLpSSLttkee.,gpvngG11ersssserWkkkkkkkk0000otraaaa????kkkkkkk1111feDVWohLSmLSLpSSLeotgaaaa????3s11nnnn5ettC3,uEECCEEDDee2222gaaaaahnerergoeommmmr5Geeg nnnnn2222ftho1caaaaaarrnnnnRDVe,LSmLSLpSSLt0tgimmmm?a?a?a?a,eDDCCGa?a?aa?akkkkr11mmmmcoeorrrsro1ammmmRh5hDVksLSmLSLpSSLtro1eorrooooo50scdddd,,,,otr2nrrrsrddddohaaaaagggg0he1etaaaannnngggekssmmmmennnne11s00001rrr2no0aieeggggrRaaaaa12rrieeaaaallll00cOffffoooommmmesraaaa15coooouksrrrsreeeeedeeeeoa1h2ciRyllllddddkscOeddddsTTTT0000y2TTTT51gr0nlllleeeekrrrsr25cgggghllllk0draaaaevvvvsxxxx2sc1rrrrtllllssssrn25leggggnikrnaaaacOrrrr0000iTTo5BBc2grrrrsTThBBteeeeU5celeeeeTTTTeeeecllllTTTTin....eeccOpiTT5BB2ssssaaaaTTk1hBBaaaaU5cgelllleeeekcgllrcrtepcrr,.carr1ctuurrrrrrrrllllluug1111rrrrnrkkkkccgyrr0,iiiiiTTctBB2uuarrttttiiiic1TTg.hBBruuuuUteleuu1aaaaPcttttllllaaaan0llllcptiTTnuu+hhhhBB2issTTuuhBBU+esse6666eeee3333ggggPlaPcghhhheeeey.0carr,pccnP1.oiarrccss1ruurssmiiiauuoiiiiga0c60lccaaaarr,ttouu6rccllllarreuuprrrrrllll,,,,uu7lesdaaaarrrruu?P7ekka0c?akk1eeee0fhe1ncta?eeeeeuuin1ss,pppp5555uusss,elkkPre01p5021?akk1cnnnn52aacca?c2noncciossaqraannnn????ssrg2012c02n2,rrrr0,ndarrrrccamlonaaaa0000occ0tsa?0ger,s0,?a+k0tmkk0mn2Nupsi?akk10omn0ua?0n0oea?ttekik?a1kcsimod,me8888kk00r02dme?????akk1t00cssss0000a?ogpgnngooi7777nnnnmeu6id0d,00aon2d2opkk7rntdlngafa?onaik?akka10lngggmmossssn2,espnPmenetudl,,,,oooo1of5gadotgia?T2oa0ap?atklTwd,Yolnnnnmdetkkkkmicdo25555m0ngovdahso,Tlnx0seeeeTp0rnode,ts0ndolr,0leavGngfoxr0n0reaobnrrinoooogggg0eDVLSLSmLpSLSto0toeseVDLLSmSLSLpSteTeek0000mmmmnTidi.ltdfsr0nc0nnnnoeTih0tsaraaT0h2eeanogeTeeetT.yedpaaaaavh0edaaaaaxTsaise0mmmmeksrreTanmmmmsCetrr0000eoa1rR.sdokoakggggvigr0isxertiorirrrsrerrhwoooohsTea1rrrrrsgnTh.stalktPedflisnr0rnsaAhtnEECEEDDirggggarneaaaafT6e3agggggeraaaashTtoealeee.sbsleshgisaecLCCOerrrrkkkkaEECCEEDDirri6e3glc1rt.hieeeeekclllliaeseeeerVtLLSSmLSLpSticlylllll1ilr,eiDDCCeeeerrllllraari1rrr1r1talrkllllEECEEDDleahggggihLCreltieEECCDDtip5lr,lt6e3garnaDDCCthealsssstalaaaaaiTT11BB2eenTTnlhBBUemmmmehiTTcBB2p5TTihBBn?6e3gepoaiehenrn11aprglDDCCia0rr,1lr,rrrrsn?ihDDCCarrgaratiuu11ruurr,erarra110eceuua0rntluuuup5gggglr,uuaaaaear0Pet8uuson?uuenees0ieessi7nssp5n?tn110i8ssccr?ossncceeee1rencs0rllll0a07neccCpon?cce1grllllsrsrskk0,oa0a?1kka?ntsl8nkks0n??ak1knkt2aa?s0c5,oTTnBB27nTTGhBBegeosn8n2k?ni5s0N?a7n?akegn2mongtmosrr,?aoarrce0m?auuk,ormuud,enDmdoog0onruungesnuuk0md,0e5d,ononDDenlgnfonssna0oess0koye50dgldccfdDgoccTe0aogrTro1o0e0mudvgdxTn0rT6ssog1okk0Ey?akk1v0m0ra?oexrrenTseT.rkpE0r0saerageTeTn2.rknooersa0rr?ara1r?akgkmgimtieoarrrital1erd,sl2kdgfhi1ting63egrknheea0tlaselhliio+6e3grka1eheaocrle,lrdargdisT0ieT1e+ep5arlsvhr,l1xnargr1se6n?e1p5rr0srr+a0enTe+T.en?6sa1arr17a08?11s07n2rrc11r6k,i86ti2?1s0a5,s7ntal27lk,oh016e3g,nhe2k105,,0se1i0l,oi2105,a20nlkoglr,05i2ar00m0e,2e00npe,kp5s00,0n0ogkR,000m0gn?0nt00rgklr0g0a0okk0eg00e0k0ggeg8?0os0kr7nk0gkaqkeergkgsgkr,ogsLSmLSLpSLtsgnkeu5rGeghDVLSmLSLpSLStesogaaaaa0mihmmmnGLLSmLSLpStoarDVmLSLSLpStaaaaaemmmmet0hrrrsrgohaeRoaaaaarniggggaaaarrrsrmmmaaaehmmmsesceoadeoranRrkggggaaaarrrrsseeeerrrsklllheereiscOgrn1gggglllrnaaagggeeeescaaallllseset1ellllnicrOTBB2TTeeeehBBllleeetecllllen1llliTTBB12TTlllhBBUgerr,tarrpuutnuulTngBB20TThBBuiTTBBrr2,uuTThBBarrUeeuuuunp0sstuugssuuger,0Parrcrr,uuccarrnuuriuussuuss0u00uutuucceouuccserk0Pn?a1kkss?anssissss0ckk00cccc?a1kkrocc?anrn2n2sak0a?ks?a1kkmk0a?m?a1kkn2a?nn

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

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 ndls.ie for further information) Yes

19. I took up normal residence in Ireland on

Par t 4: O rgan Donation (See Part 4 of accompanyDinagy guidanceMnoontthes)

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.

March 2020

Page 2

No No

ndls.ie

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 three months of application date

21.* Do you need to wear glasses

or lenses for driving?

Yes

No

(If yes Code 01 will be added to your licence)

If in the past you answered `Yes' to this question and are now answering `No' you must provide a current eyesight report with your application.

31.* A serious problem with memory

or periods of confusion3

Yes

No

32.*Persistent alcohol misuse or dependency

Yes

No

33.* Persistent drug misuse 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.* Parkinson's disease

Yes

No

22.* Diabetes treated by insulin or managed by tablets

which carry a risk of inducing hypoglycaemia eg.

sulphonylureas. (Ask your doctor whether you are on

sulphonylureas or other medications which carry a risk

of inducing hypoglycaemia.) No need to tell us if

managed by diet alone or only by

medications which do not carry

a risk of inducing hypoglycaemia. Yes

No

36.* Sleep Apnoea syndrome

37.* Narcolepsy 38.* Any condition affecting your peripheral vision

39.* Total loss of sight in one eye

Yes

No

Yes

No

Yes

No

Yes

No

23.* Epilepsy

Yes

No

24.* Stroke or TIAs1 with any associated

symptoms lasting longer

than one month

Yes

No

25.* Fits or blackouts

Yes

No

26.* Any type of brain surgery, brain abscess or severe head

injury involving in-patient treatment

or brain tumour or spinal injury

or spinal tumour

Yes

No

27.* An implanted cardiac pacemaker Yes

No

28.* An implanted cardiac defibrillator (ICD)2

Yes

No

29.* Repeated attacks of sudden disabling dizziness

Yes

No

30.* Any other chronic neurological condition such

as multiple sclerosis, motor neurone

disease or huntington's disease Yes

No

40.* Any condition affecting both eyes, or the remaining eye if

you only have one eye (not including

colour blindness or short

or long sight)

Yes

No

41. *A serious hearing deficiency which

has worsened since your last

application/renewal

Yes

No

42. *Severe learning disability3

Yes

No

43. *(a) Any persistent problems with

arms or legs which restricts your

driving to an automatic vehicle Yes

No

43.* (b) Any persistent problems with

arms or legs which restricts your

driving to an adapted vehicle

Yes

No

43. *(c) If you have ticked yes

to 43(a) or 43(b) has your condition

deteriorated since your last

application/renewal.

Yes

No

1A 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.

2An 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.

3If in doubt, please consult your family doctor.

Certain additional information, restrictions or conditions to be fulfilled by the driver relating to the holding of a driving licence may be noted on a licence in coded format. Further information regarding the codes is set out in the explanatory letter issued with your licence and at ndls.ie

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

*Mandatory field

44.* I understand that (i) in accordance with section 22A of the Road Traffic Act 1961, as amended, a person cannot apply for a driving licence whilst disqualified in Ireland, the EU/EEA or a recognised state, (with the exception of a penalty point disqualification in Ireland) and (ii) it is an offence under section 115 of the Road Traffic Act 1961, as amended, to knowingly provide false or misleading information in support of my application. I declare that (i) Ireland is my normal place of residence, and that (ii) I am not currently disqualified (with the exception of a penalty point disqualification in Ireland) in Ireland, the EU/

EEA or a recognised state.

THIS DECLARATION MUST BE SIGNED BY THE PERSON TO WHOM THE DRIVING LICENCE IS TO BE ISSUED

Applicant's signature

(P lease keep sign ature within the box)

Day

Month

Year

ndls.ie

Page 3

March 2020

Application Checklist for Driving Licence

You must apply in person at any NDLS centre. You may book an appointment at 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 three months) 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 PPS number (list 3 on page 4 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 4 of guidance notes, must be dated within 6 months) ? Photographic ID (see list 1 on page 4 of guidance notes) ? Evidence of residency entitlement (see page 2 of guidance notes and also see list 4 on page 4 of guidance notes) ? Relevant fee (see page 2 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

? Cert of competency (dated within 2 years) ? Current learner permit

Option 3 - Adding a category

? Cert of Competency (dated within 2 years) ? Current learner permit ? Current driving licence

Option 4 - Change of personal details ? Evidence of name change if name

is changing (page 1, Q6 of guidance notes) ? Evidence of new address (dated within 6 months) if

address is changing (see list 2 on guidance notes) ? A completed NDLS medical form (dated within three

months) if your medical details have changed (see page 3 of guidance notes)

Option 5 - Replace a lost or stolen licence ? A completed lost licence declaration

(see question 16 of application form)

Option 6 ? Replace a damaged licence

? Photographic ID (see list 1 on page 4 of guidance notes) ? Damaged driving licence

Option 7 - Exchange a foreign licence from EU/EEA or a recognised state

? Evidence of residency entitlement (see list 4 on page 4 of guidance notes)

? Your current driving licence (please note, if your licence does not have a category start date you will need to provide an original Letter of Entitlement / Driver Statement from your relevant authority)

? If you do not have your licence you will need to present an original Letter of Entitlement/ Driver Statement from the appropriate licencing authority and complete the lost licence declaration (see question 16 on application form)

? If your licence is from an EU/EEA member state and is expired for less than 10 years, it must be accompanied by an original Letter of Entitlement/ Driver Statement from your relevant authority

? If your licence is from a recognised state and is expired for less than one year, it must be accompanied by an original Letter of Entitlement/ Driver Statement from your relevant authority

? If your licence is from a recognised state you must present an eyesight report form D502

? Certified translations are required for all Letter of Entitlement/Driver Statements which are not in English or Irish

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.

Data Protection

The RSA will treat all information and personal data you supply as confidential. The information requested on this form is necessary for the purposes of processing your application for a learner permit/driving licence. The information provided in your application will be processed by the RSA and/or its agents solely for the purposes of processing your application, carrying out our obligations, providing services to you and managing our relationship with you.

The RSA may disclose personal data internally and to its agents, contractors and service providers to the extent reasonably required for the purposes described above. Such data may also be shared with other entities but only as permitted by law. Personal data 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. Public Service Identity data 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). Public Service Identity data may only be shared with other public bodies under this provision.

The RSA will process your details in accordance with its obligations under the Data Protection Acts and Regulation (EU) 2016/679 General Data Protection Regulation (GDPR). This includes taking all reasonable steps (including appropriate technical and organisational security measures) to protect personal data. An electronic version of all information contained in this application may be retained for a period of at least 20 years

You have the following rights, in certain circumstances and subject to certain restrictions, in relation to your Personal Data: The right to access your Personal Data; The right to request the rectification and/or erasure of your Personal Data; The right to restrict the use of your Personal Data; The right to object to the processing of your Personal Data; The right to be forgotten in certain circumstances; and The right to receive your Personal Data, which you have provided to us, in a structured, commonly used and machine-readable format or to require us to transmit that data to another controller.

If you wish to avail of any of these rights, please contact the Data Protection Officer at Road Safety Authority, Moy Valley Business Park, Primrose Hill, Ballina, Co. Mayo F26 V6E4 or via email to dataprotection@rsa.ie. Your request will be dealt with without undue delay and in any event within one month of receipt of the request.

March 2020

Page 4

ndls.ie

 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download