Certificate of Identity form For the purpose of applying for a driving licence/learner permit only Section 1: Declaration by applicant (Please see full explanatory notes before completing this form) Name: ________________________________________________ Address: ________________________________________________ ________________________________________________ Please affix ________________________________________________ photo here Date of Birth: ________________________________________________ PPSN: ________________________________________________ I hereby declare that: • I was born in the Republic of Ireland or the UK • The particulars supplied in this form, including the photograph, and in my application for a driving licence and/or learner permit are correct and relate to me • I do not hold an Irish/UK passport or any other official photographic identity document e.g. Public Services Card, that would verify my identity • I further certify that I understand that it is an offence to provide false or misleading information in respect of the associated application Signed: ___________________________________ Date: ___________________________________ (To be signed in the presence of a witness) Section 2: Declaration by witness (Please see full explanatory notes before completing this form) I personally know ____________________________ who has signed Section 1 above in my presence. I also certify that the affixed photograph is a true likeness of ____________________________. I further certify that I understand that it is an offence to provide false or misleading information in respect of the associated application. Signature of Witness: ___________________________________ Date: ___________________________________ Name (in block capitals): ___________________________________ Tel No: ___________________________________ Address: ________________________________________________________________________________ ________________________________________________________________________________ Profession: ___________________________________ This form is for use by customers born in the Republic of Ireland or the United Kingdom only. Certificate of Identity form Explanatory Notes This Certificate of Identity form can only be used for the purpose of providing supporting documentation as part of an application for a driving licence or learner permit and should not be used for any other purpose. This Certificate of Identity form should only be used in the following circumstances: ✓ You do not have an Irish driving licence or learner permit to submit with your application (because either you are a first time applicant or because having held an Irish licence or learner permit, it has been lost, stolen or destroyed and declared as such) AND ✓ You hold an Irish or UK birth/adoption certificate AND ✓ You do not have a Public Services Card AND ✓ You have never held a passport OR ✓ Your Irish passport has expired by more than 12 months OR ✓ You have lost your passport OR ✓ You do not have a valid UK photo licence. When completing the form, please write clearly using a black ballpoint pen. This form should be signed in the presence of, and witnessed by, a Medical Doctor, Solicitor, Commissioner of Oaths, Bank Manager, School Principal or Elected Public Representative. The witness must have known you personally for at least the last 2 years and must not be related to you in any way. The witness must complete section 2 of the form in full. The photograph should be attached in the box provided using staples or gum/glue before calling to the Doctor, Solicitor, Commissioner of Oaths, Bank Manager, School Principal or Elected Representative (please do not obstruct the face with a staple when attaching the photograph)..