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 |
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1 |
FIRST NAME |
IVAN |
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2 |
LAST NAME |
IVANOV |
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3 |
DOB: |
dd.мм.yy. 19.07.1970 |
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4 |
COUNTRY OF BIRTH |
RUSSIA - VORONEZH |
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5 |
ADDRESS |
BARO ATALAYA 12, VILLANUEVA, MALAGA |
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6 |
Zip Code |
23456 |
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7 |
COUNTRY |
SPAIN |
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8 |
SEX |
M |
F |
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9 |
EYES |
Blue |
Green |
Brown |
Gray |
Black |
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10 |
HT |
1 – 76 |
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11 |
NATIONAL DRIVERS LICENCE |
MOS № 123456 Date of receipt 16.11.2002 - 16.11.2032 |
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12 |
KATEGORY |
A1 |
A |
B |
BE |
C1 |
C |
C1E |
CE |
D1 |
D |
D1E |
DE |
T |
T/S |
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13 |
IDENTIFICATION CODE: |
№ 1234567890 |
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14 |
BLOOD TYPE |
O (I) Rh + O(I)Rh+; A(II)Rh+; B(III)Rh+; AB(IV)Rh+. |
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15 |
ALLERGIC |
Yes |
No |
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16 |
DIABETIC |
Yes |
No |
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17 |
PASSPORT |
PC № 234567 |
issued 24.05.2005 |
expires 24.05.2015 |
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18 |
Yrs |
1 YRS |
3 YRS |
5 YRS |
10 YRS |
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19 |
DELIVERY TO |
BARO ATALAYA 12, VILLANUEVA, MALAGA, 23456, SPAIN |
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20 |
URGENT SERVICE |
12-21 DAYS - 10€ |
3-12 DAYS - 20€ |
INTERNATIONAL MAIL EXPRESS - 40€ |
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