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PHILIPPINE INTERNATIONAL DRIVING PERMIT (PIDP)APPLICATION FORM

MAIN OFFICE683 Aurora Boulevard Quezon City 1112 Philippines Tel: (63.2) 723.0808 Fax: (63.2) 726.5878

MAKATI SATELLITE OFFICEC-6 Arcadia Bldg., JP Rizal Ext., Guadalupe Cembo, Makati City Tel: (63.2) 882.6039 Telefax: (63.2) 882.5985

ALABANG SATELLITE OFFICE#1, MotorTown II, Alabang Town Center Tel: (63.2) 850.9831 Fax: (63.2) 850.6903

PIDP FORM NO.: A____________________

PERSONAL INFORMATIONast name First Name Middle name

rth Date (MM/DD/YYYY) Birth Place Age Sex (M / F) Civil Status (S / M)

ationality: Filipino Other ACR No. (if foreigner) Occupation: Employed Own Business Student

ome Address

p Code Tel. No. Fax No.

ell Phone No. E-mail Address Destination

ompany Name

ompany Address

p Code Tel. No. Fax No.

uthorized Representative Contact No.

ddress

OFFICE USE ONLY

AAP Membership No. O.R. No. PIDP Released By

Type: Regular Member PIDP Validity: 1 yr. 2 yrs. 3 yrs. New Renewal Reinstatement

Expiry Date (MM/DD/YYYY) Issued By Remarks

PIDP No. (License)

Validity: 1 yr. 2 yrs. 3 yrs.

Date Paid (MM/DD/YYYY) Encoded By

Insurance No. Amount Paid Printed By

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - AP Membership Number NAME: Last name First Name Middle name

ar Details: Car Make Car Model Color Year Model Plate No.

Car Make Car Model Color Year Model Plate No.

owing can be availed after 7 days

Requirements: 1. Membership in AAP or any FIA accredited motoring club or association2. Original Philippine Drivers License with photocopy3. Latest 2X2 ID Photo colored with white background (2pcs.)4. Original ACR / Passport for foreigners

5.Accomplish form at the back if applicable

LICENSE DETAILScense No.

ate Issued (MM/DD/YYYY) Expiry Date (MM/DD/YYYY)

suing Country (for Foreign License)

R / DLR No. (for Philippine License)

cense Type: Non-Professional Professional Card Type: Non-Card Card

estrictions 87654321

PIDP Received by

Drivers License Received by

Applicant Signature

Date (MM/DD/YYYY)

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AUTHORITY

I hereby authorize M_____________________________________ torepresent me at the Automobile Association Philippines (AAP) for thepurpose of obtaining an international drivers permit, to submit allrequirements thereof, and to receive in my behalf, the permit when issued.

I also authorize above representative to sign in my behalf, the AAP proxy

form, and I designate M_____________________________________, or inhis absence, the President of AAP, or the presiding officer, in any and allgeneral assemblies or meetings which AAP may call while my membershipremains valid. It is understood the said proxy is automatically invalidated bymy actual presence in such assemblies or meetings.

________________________

Applicant DateSignature over printed name