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DOTC LTO Form 21 PDF
DOTC LTO Form 21 PDF
No.
FIELD OFFICE
INSTRUCTIONS
2 PRINT DATA LEGIBLY IN CAPITAL LETTERS
APPLICATION FOR
DRIVER'S LICENSE
TIN
GENDER (F/M)
HEIGHT(cm) WEIGHT(kg)
LICENSE
NUMBER
RESTRICTION CODE
B. B. DELINQUENT/DORMANT
E RENEWAL
CHANGE NAME
LICENSE
C. CHANGE CLASSIFICATION
PROF TO NON-PROF
G DUPLICATE
1 STUDENT PERMIT
1 DRIVING SCHOOL
(DSA)
SCHOOLING
3 PROFESSIONAL
2 LICENSED PRIVATE
4 CONDUCTOR
2 ELEMENTARY
PERSON
4 VOCATIONAL
5 COLLEGE
6 POST GRADUATE
3 HIGH SCHOOL
YES
ORGAN DONOR
BLOOD TYPE
2 NON-PROFESSIONAL
CHANGE ADDRESS
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
BUILT
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)
CONDITIONS
COMPLEXION
1. BLACK
(Specify )
OR LOWER LIMBS
FATHER'S NAME (Family Name, First Name, Middle Name) indicate even if deceased
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
COMPUTER FEE
TOTAL
TEL NO.
AMOUNT
LICENSE FEE
ADDITIONAL RESTRICTION CODE
CHANGE CLASSIFICATION
REVISION OF RECORDS
COMPUTER FEE
OTHERS (SPECIFY)
TOTAL
SIGNATURE OF APPLICANT
PRINT NAME/SIGNATURE
1.
TOTAL
DRIVING SKILLS RATER
DATE
PRINT NAME/SIGNATURE
COMMENTS / RECOMMENDATION
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
PLATE NO.
PLATE NO.
PLATE NO.
PRINT NAME/SIGNATURE
RECOMMENDED RC/S
APPROVED / DISAPPROVED
HEAD OF LICENSING CENTER
PRINT NAME/SIGNATURE