FORM 4-A
[See Rule 14(2)]
Form of Application for Issue of International Driving Permit to
Drive a Motor Vehicle in Other Countries

To
Automobile Association of Upper India,
New Delhi

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


Name
Father's or Husband's Name
Place of Birth and Country
Mobile Number and Address
Email ID and Date of birth
Education Qualification
Identification marks
Blood Group / RH factor
Have you previously held international Driving
permit ? is so give details
My Indian driving license No, dated, issued by & valid up to
Particulars & date of every Conviction. which has been ordered on be enclosed on any driving license held by the applicant.
Have you been disqualified for obtaining a driving license to drive? If so, for what reason ?
Have you been subjected to a driving test as to your fitness or ability to drive a vehicle in respect of which a driving license is applied for? If so, give the following details

Date of Test ..................................................Testing Authority................................................ Result of Test.........................................
(1)
(2)
(3)
(4)

I enclose the copy of Passport (First and Last Page) and Visa.

I enclose three copies of my recent passport size photograph.

I enclose the copy of Driving Licence.

I enclose a medical certificate in Form 1-A (Download Form 1-A)

I hereby declare that the particulars given above are true to the best of my knowledge and belief.

Date: ……………………………….
* Strike out whichever is inapplicable ................................................................................................Signature / Thumb impression of Applicant