CPC Driver Qualification Card Declaration Form

Foirm Dhearbhúcháin maidir le Cárta Cáilíochta Tiománaí CPC

FOR OFFICE
PPS Number: USE ONLY
Uimhir PPSN:
Please enclose
Date and Country of Birth: photo but do
Dáta agus Tír Bhreithe: not attach it
here

Irish Driver Number:

Uimhir Tiomána na hÉireann:

First Name:
Ainm:

Surname:
Sloinne:

Mobile Number:
Uimhir Fón Póca: 0 8
Email:
Ríomhphost:

Address:
Seoladh:

I confirm that I am legally residing and/or working in Ireland.

Deimhním go bhfuil cónaí orm agus/nó go bhfuilim ag obair in Éirinn de réir an dlí.
I have read and agreed to the terms as set out in the CPC Driver Declaration Information leaflet
Tá na téarmaí mar atá leagtha amach sa bhileog eolais - Eolas maidir le Dearbhú CPC Tiománaí - léite agus comhaontaithe agam

Note: Only complete this section if you were not employed as a Professional Driver in Ireland or any EU Member State.
Tabhair faoi deara: Ná comhlánaigh an chuid seo ach amháin mura raibh tú fostaithe mar Thiománaí Gairmiúil in Éirinn nó in aon Bhallstát AE.
I declare that I have not been engaged in /or received payment I now wish to return to driving professionally from
in respect of any professional driving activity (bus/truck) since Ba mhaith liom filleadh ar an tiomáint ghairmiúil ón
Dearbhaím nach raibh mé fostaithe in aon ghníomhaíocht
tiomána gairmiúla (bus/trucail) / nach bhfuair mé aon íocaíocht
ar ghníomhaíocht tiomána gairmiúla (bus/trucail) ó
and I have completed 5/6 days of driver CPC periodic training
as required within the last 5 years.
agus tá 5/6 lá d’oiliúint thréimhsiúil CPC Tiománaí tugtha chun
críche agam, de réir mar atá de dhíth, le 5 bliana anuas.

Signature: Date:
Síniú: Dáta:
Please keep your signature within the box
Please do not return this form until the Licence Category has been added to the full licence

Údarás Um Shábháilteacht Ar Bhóithre An Rannóg Oideachas do Thiománaithe, Páirc Ghnó Ghleann na Muaidhe,
Road Safety Authority Cnoc an tSabhaircín, Bóthar Bhaile Átha Cliath, Béal an Átha, Co. Mhaigh Eo
Driver Education Section, Moy Valley Business Park, Primrose Hill, Dublin Road, Ballina, Co. Mayo
email: cpc@rsa.ie web: www.rsa.ie
Dear Driver,

I refer to correspondence which was issued to you from the Driver Testing Section prior to you taking your practical
driving test. This letter referred to the Driver Certificate of Professional Competence (Driver CPC) which came into
effect on the 10th of September 2008 for bus drivers and the 10th of September 2009 for truck drivers.

I am pleased to inform you that as you have passed all four stages of the CPC test process, you now have
entitlement to the Driver CPC. If you wish to drive professionally (for a living) you are required to maintain this
qualification and you must carry a Driver CPC card. It is illegal to drive professionally without a Driver CPC card
and there are penalties for non-compliance.

Please Note: in order to maintain your ‘Drivers CPC’ you are required to complete one days Driver CPC Periodic
Refresher Training per year, from the anniversary of the date on which you passed your fourth and final CPC
qualifying test. This training must be completed at an RSA approved CPC training centre. Details are available
from http://www.rsa.ie/en/RSA/Professional-Drivers/Driver-Hours/Find-a-CPC-Trainer/

In order to receive your Driver CPC Card, you are required to sign and return the declaration overleaf and include a
recent passport-sized photograph. Please sign your name on the back of the photograph.

If you do not wish to drive professionally you do not require a Driver CPC card.

Should you have any queries, please contact the CPC Unit by email - cpc@rsa.ie

Yours sincerely,

The Manager
Driver Education Section

Údarás Um Shábháilteacht Ar Bhóithre An Rannóg Oideachas do Thiománaithe, Páirc Ghnó Ghleann na Muaidhe,
Road Safety Authority Cnoc an tSabhaircín, Bóthar Bhaile Átha Cliath, Béal an Átha, Co. Mhaigh Eo
Driver Education Section, Moy Valley Business Park, Primrose Hill, Dublin Road, Ballina, Co. Mayo
email: cpc@rsa.ie web: www.rsa.ie