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ITU

Questionnaire

For the receipt of International drivers license you must fill a next questionnaire in Latin a letter as in Your passport or confirmative documents.

Title

These club members

1

FIRST NAME

IVAN

2

LAST NAME

IVANOV

3

DOB:

dd.мм.yy. 19.07.1970

4

COUNTRY OF BIRTH

RUSSIA - VORONEZH

5

ADDRESS

BARO ATALAYA 12, VILLANUEVA, MALAGA

6

Zip Code

23456

7

COUNTRY

SPAIN

8

SEX

M

F

9

EYES

Blue

Green

Brown

Gray

Black

10

HT

1 – 76

11

NATIONAL DRIVERS LICENCE

MOS № 123456        Date of receipt 16.11.2002 - 16.11.2032

12

KATEGORY

A1

A

B

BE

C1

C

C1E

CE

D1

D

D1E

DE

T

T/S

13

IDENTIFICATION CODE:

№ 1234567890

14

BLOOD TYPE

O (I) Rh +                    O(I)Rh+; A(II)Rh+; B(III)Rh+; AB(IV)Rh+.

15

ALLERGIC

Yes

No

16

DIABETIC

Yes

No

17

PASSPORT

PC № 234567

issued   24.05.2005

expires   24.05.2015

18

Yrs

1 YRS

3 YRS

5 YRS

10 YRS

19

DELIVERY TO

BARO ATALAYA 12, VILLANUEVA, MALAGA, 23456, SPAIN

20

URGENT SERVICE

12-21 DAYS - 6€

3-12 DAYS - 18€

INTERNATIONAL MAIL EXPRESS - 36€

To fill a questionnaire, select in a group necessary, to affix signature in a necessary square, to fasten photo and to deport by mail or e-mail

Category:

A1  Motor cycle easy
A Motor cycle of
B Passenger car of
ВЕ Passenger car with the trailer of
C A freight transport vehicle is more than 3500 kg (7700 pound) of
C1 A freight transport vehicle is to 3500 kg (7700 pound) THIS  Freight transport vehicle more than 3500 kg (7700 pound) with the trailer of
C1Е Freight transport vehicle to 3500 kg (7700 pound) with the trailer of
D A transport vehicle is more than 8 passenger places of
D1  A transport vehicle is less than 8 passenger places  of
DE A transport vehicle more than 8 passenger places with the trailer of
D1E A transport vehicle less than 8 passenger places with the trailer of
Т Tractor of
T/S Trolleybus

Postal destination address:

(any citizen can get documents to address which specify in a questionnaire)

Mark a postal address and name of recipient here.

Name:

Last name:

Address / street / house / apartment:

City/Village:

Area / State / Edge:

Index:

Country:

 

Photo, Signature

(A picture can be prescanned in the coloured image with permission in 300 dpi, signature – 600 dpi in a black and white image a size 550 pixels and to save in JPEG.)

 

Urgent service (additionally 20 €)

Download Questionnaire


CODICE FISCALE 93115560422
PREFETTURA-UFFICIO TERRITORIALE DEL GOVERNO DI ANCONA
SCRIMA, 132 ANCONA AN ITALIA
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