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

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)

SCHOOLING

3 PROFESSIONAL

2 LICENSED PRIVATE

4 CONDUCTOR

2 ELEMENTARY

PERSON

AUTOMATIC CLUTCH ONLY UP TO 4500 KGS. GVW

4 VOCATIONAL

AUTOMATIC CLUTCH ONLY ABOVE 4500 KGS. GVW

5 COLLEGE

ARTICULATED 1600 GVW AND BELOW

ARTICULATED 1601 UP TO 4500 GVW

ARTICULATED 4501 GVW AND ABOVE (TRUCK - TRAILER)

6 POST GRADUATE

3 HIGH SCHOOL

YES

ORGAN DONOR

BLOOD TYPE

VEHICLES ABOVE 4500 KGS. GVW

EDUCATIONAL ATTAINMENT (EA)

1 INFORMAL

2 NON-PROFESSIONAL

VEHICLES UP TO 4500 KGS. GVW

(MANUAL AND AUTOMATIC CLUTCH)

CHANGE ADDRESS

TYPE OF LICENSE APPLIED

(TLA)
FOR

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

OTHERS

H REVISION OF RECORDS

NON-PROF TO PROF

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

HAIR

EYES
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

1. BLACK

5. OTHERS (Specify)

CONDITIONS

COMPLEXION

BUILT

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

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

COMPUTER FEE
TOTAL

EMPLOYER'S BUSINESS NAME

TEL NO.

EMPLOYER'S BUSINESS ADDRESS

AMOUNT

COMPUTATION OF FEES

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

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

THIS IS TO CERTIFY THAT I HAVE CAREFULLY EVALUATED THIS

APPLICATION INCLUDING THE SUPPORTING DOCUMENTS

SIGNATURE OF APPLICANT

PRINT NAME/SIGNATURE