21 Application for Driver's License

LTO application form for driver's license

Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: REPUBLIC OF THE PHILIPPINES
DEPARTMENT OF TRANSPORTATION & COMMUNICATIONS
LAND TRANSPORTATION OFFICE

LTO FORM NO. 21

East Avenue, Quezon City

No.

FIELD OFFICE

1 ACCOMPLISH THE FORM CORRECTLY

INSTRUCTIONS
2 PRINT DATA LEGIBLY IN CAPITAL LETTERS

3 SUBMIT THIS FORM TO THE
CSR/EVALUATOR TOGETHER WITH
THE REQUIRED SUPPORTING
DOCUMENTS

APPLICATION FOR
DRIVER'S LICENSE

NAME (Family Name, First Name, Middle Name)

PRESENT ADDRESS (No., Street, City/Municipality, Province)

TEL NO. / CP NO.

TIN

TO BE ACCOMPLISHED BY LTO PERSONNEL ONLY
NATIONALITY

GENDER (F/M)

HEIGHT(cm) WEIGHT(kg)

BIRTH DATE (MM/DD/YY)

LICENSE
NUMBER

RESTRICTION CODE

TYPE OF APPLICATION (TOA)
A. A. NEW

D. FOREIGN LIC. CONVERSION

CHANGE CIVIL STATUS

B. B. DELINQUENT/DORMANT

E RENEWAL

CHANGE NAME

F

CHANGE DATE OF BIRTH

LICENSE
C. CHANGE CLASSIFICATION
PROF TO NON-PROF

ADDITIONAL RESTRICTION CODE

G DUPLICATE

DRIVING SKILL ACQUIRED OR
WILL BE ACQUIRED THRU

1 STUDENT PERMIT

1 DRIVING SCHOOL

(DSA)

(MANUAL AND AUTOMATIC CLUTCH)

2 LICENSED PRIVATE

4 CONDUCTOR

5

AUTOMATIC CLUTCH ONLY ABOVE 4500 KGS. GVW

5 COLLEGE

6

ARTICULATED 1600 GVW AND BELOW

6 POST GRADUATE

7

ARTICULATED 1601 UP TO 4500 GVW

8

2 ELEMENTARY

PERSON

AUTOMATIC CLUTCH ONLY UP TO 4500 KGS. GVW

4 VOCATIONAL

SCHOOLING

3 PROFESSIONAL

ARTICULATED 4501 GVW AND ABOVE (TRUCK - TRAILER)

3 HIGH SCHOOL

YES

ORGAN DONOR

BLOOD TYPE

VEHICLES ABOVE 4500 KGS. GVW

4

EDUCATIONAL ATTAINMENT (EA)
1 INFORMAL

2 NON-PROFESSIONAL

VEHICLES UP TO 4500 KGS. GVW
(MANUAL AND AUTOMATIC CLUTCH)

3

CHANGE ADDRESS

TYPE OF LICENSE APPLIED
(TLA)
FOR

MOTORCYCLE/MOTORIZED TRICYCLES /
E- BIKES (LSV) TRIKES (A-1)

2

OTHERS

H REVISION OF RECORDS

NON-PROF TO PROF

1

NO
CIVIL STATUS (CS)
1.SINGLE
2.MARRIED
3.WIDOW/ER
4.SEPARATED

HAIR

EYES

BUILT

CONDITIONS

COMPLEXION

1. BLACK

1. BLACK

1. LIGHT

1. LIGHT

2. BROWN

2. BROWN

3. BLONDE

3. GRAY

2. MEDIUM
3. HEAVY

2. FAIR
3. DARK

4. GRAY

4. OTHERS

5. OTHERS (Specify)

A WEARING CORRECTIVE LENSES.
B DRIVE ONLY WITH CUSTOMIZED VEHICLE

(Specify )

C DRIVE ONLY W/ SPECIAL EQUIPMENT FOR UPPER

BIRTHPLACE (City/Municipality, Province)

OR LOWER LIMBS
FATHER'S NAME (Family Name, First Name, Middle Name) indicate even if deceased

D DAYLIGHT DRIVING ONLY
E WITH HEARING AID

MOTHER'S NAME (Family Name, First Name, Middle Name) indicate even if deceased

COMPUTATION OF FEES
APPLICATION FEE

SPOUSE NAME (Family Name, First Name, Middle Name) indicate even if deceased

P

COMPUTER FEE
TOTAL

EMPLOYER'S BUSINESS NAME

TEL NO.

EMPLOYER'S BUSINESS ADDRESS

AMOUNT

P

LICENSE FEE
ADDITIONAL RESTRICTION CODE
CHANGE CLASSIFICATION
REVISION OF RECORDS
COMPUTER FEE
OTHERS (SPECIFY)

FILL THIS UP ONLY IF YOUR
NAME ABOVE IS DIFFERENT
FROM YOUR NAME IN
PREVIOUS LICENSE

P

PREVIOUS NAME (Family Name, First Name, Middle Name)

THIS IS TO CERTIFY THAT
THE INFORMATION I HAVE
GIVEN IS TRUE AND
CORRECT.

QR-OPD-ADL R-1 03/01/10

TOTAL

P

THIS IS TO CERTIFY THAT I HAVE CAREFULLY EVALUATED THIS
APPLICATION INCLUDING THE SUPPORTING DOCUMENTS

SIGNATURE OF APPLICANT

PRINT NAME/SIGNATURE

ROAD TEST SCORE SHEET
INSTRUCTIONS: AN APPLICANT HAS 100 POINTS AT THE START OF THIS TEST. A NUMBER OF POINTS IS
DEDUCTED FOR ERRORS COMMITTED. PASSING SCORE IS 70.
THE TEST WILL
IMMEDIATELY BE DISCONTINUED AND COUNTED AS FAILURE UNDER THE FOLLOWING
CONDITIONS.
1. STRIKING ANOTHER CAR
2. STRIKING A PEDESTRIAN
3. STRIKING ANY FIXED OBJECT

4. IMPROPER ACTION CAUSING
COLLISION OR NEAR
COLLISION OF OTHER
VEHICLE

1.

PRE DRIVING CHECK UP
1.1 CHECK TIRES AND BATTERIES
1.2 CHECK/CLEAN/ADJUST MIRRORS, LIGHT AND WINDSHIELD
WIPER
1.3 USE OF SEATBELT/ HELMET
1.4 CHECK HAND AND FOOT BRAKE
1.5 DISENGAGE CLUTCH WHEN STARTING ENGINE
2. DRIVING SKILLS
2.1 STEERING
2.1.1
POSITION OF HANDS
2.1.2
SMOOTHNESS
2.1.3
TWO HAND GRIP
2.1.4
OVERSTEERING
2.2 ENGINE CONTROL 2.2.1
USE OF GEAR
2.2.2
CHOOSE OF GEARS
2.2.3
USE OF CLUTCH
2.2.4
USE OF ACCELERATOR
2.3 USE OF BRAKES
2.3.1
APPLY BRAKES SMOOTHLY
2.3.2
REACTIONS TO HAZARDS
2.3.3
VEHICLE TURNING
2.4 SPEED CONTROL
2.4.1
OBSERVE SPEED LIMIT
2.4.2
NEEDLESS STOPS
2.4.3
OBSERVANCE TO TRAFFIC
RULES
2.5 TURNING LEFT,
2.5.1
TAKES PROPER LANE
TURNING RIGHT
AND U-TURN
2.5.2
SIGNAL INTENTION
2.5.3
USE OF HAND AND LIGHT SIGNAL
2.5.4
SWINGS TOO WIDE AND CUTS
TOO SHORT
2.6 BACKING
2.6.1
NUMBER OF ATTEMPTS
2.6.2
CONTROL OF VEHICLE/TRAILER
2.7 PARKING
2.7.1
NO. OF ATTEMPTS
3. OBSERVANCE TO TRAFFIC RULES
3.1 RIGHT OF WAY TO 3.1.1
WHILE APPROACHING
OTHER VEHICLES
INTERSECTION
3.1.2
IN CHANGING LANES
3.1.3
IN PASSING/BEING PASSED
3.2 STOP
3.2.1
OBEY TRAFFIC SIGNS
LIGHTS/SIGNALS
& OTHERS
3.2.2
POSITION AFTER STOPPING
3.2.3
MAKING FULL STOP WHEN
NECESSARY
3.2.4
ANTICIPATING BEFORE SIGNAL
CHANGES
3.2.5
EXERCISE DUE CARE FOR
PEDESTRIAN
3.3 RIGHT OF WAY
3.3.1
FOR OTHER VEHICLES
3.3.2
FOR PEDESTRIAN
3.3.3
FOR EMERGENCY
3.3.4
YIELDING OF RIGHT OF WAY
3.3.5
FOR BICYCLIST

TOTAL
DRIVING SKILLS RATER

DATE

PRINT NAME/SIGNATURE

COMMENTS / RECOMMENDATION

MAKE & TYPE OF MOTOR VEHICLE USED

TOTAL EQUIV.
DEMERIT
POINTS WEIGHT
10
2
2

TOTAL

DEMERIT

TOTAL

DEMERIT

TOTAL

2
2
2
50
2
2
2
2
2
2
2
2
3
3
3
3
2
4
2

2
2
4
2
2
2
40
5
3
3
4

4
2
3
3
3
3
3
2
2

100

100

CHIEF PRACTICAL EXAMINER

PLATE NO.

PLATE NO.

PLATE NO.

PRINT NAME/SIGNATURE

RECOMMENDED RC/S

APPROVED / DISAPPROVED
HEAD OF LICENSING CENTER

PRINT NAME/SIGNATURE