Application for an International Driving Permit Photo The Secretary, ‘The Automobile Association of Bangladesh Mobile :01711-819958, 01611-819959 3B, Outer Circular Road, Maghbezar, Dhako-1217 01979-29786 Opposite of Agora Shopping Center 19361054, 934 4 Copy Stamp Size 1 Copy Passport Size Dear Sir, [wish to apply for an International Driving Permit, enclose herewith in original valid Bangladesh Driving Licence No. sonoee date Valid, Place of Issue together with my Photographs. If place of issue out of Dhaka District, photocopy of attested local driving licence by the B.R-T.A. and Photocopy of passport data page with a sum of Taka 2500/= (Two thousand five hundred) onl} fitness declaration form on reverse has been completed 1 confiem that fee authority will not be responsible, ifthe delivery of licence isnot taken within one month, The physical IDP No. {ri nt /20. 1. NAME IN FULL 2. PLACE OF BIRTH (Only District) 3. DATE OF BIRTH 4, ADDRESS (in short) 5. BLOOD GROUP. « 6, OCCUPATION 7. PASSPORT NO. DATE OF ISSUE. sense VALID UPTO. 8, PHONE : OFFICE MOBILE Yours faithfully oun ‘Applicant's signature PORTO ONT “The application is required to ans ‘or No" in the space provided opposite to each question, (a) Bo-you suffer from epilepsy or from sudden attack of disabling giddiness of fainting? ves) No (©) Are you able to distinguish with each eye ata distance of 25 yards in good! day-light (ith glasses, if wor) a motorcar number plate containing seven letters and figures? O¥es/NoO (6) Have you lost ether hand or foot and of ate you suffering from any defeet in ‘movement control of muscular power of either arm or leg? Oves/NoO (@)_ Can you readily distinguish the pigmentary colour red and green? Dyes No O (€) Do.you suffer from night blindness? Oves/NoO (Do you suffer from a defect of hearing? Ores /NoO (g) Do you suffer from any other disease or disability likely to cause your driving of a motor vehicle to be source of danger to the public? D¥es/No For office use only for Automobile Association of Bangladesh Secretary/Asstt, Secretary8118 This Licence is not valid in Bangladesh, ‘THE AUTOMOBILE ASSOCIATION OF BANGLADESH INTERNATIONAL DRIVING PERMIT. Valid for one year from the date of issue. 18 APR 2018 IDP No, 15085/18 DL No.(DK/04106, 12e10006/@B) Issued at Haan S Josh Secretan}Presidgnt