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1. RSA DTT Application Form 2013:RSA Application Form 15/01/2013 14:56 Page 1 Application for a Driver Theory Test Car (B), Motorcycle (A, A2, A1), Moped (AM), Tractor/Work Vehicle (W), Truck (including Step 1 of Driver CPC) (C), Bus (including Step 1 of the Driver CPC) (D), Truck & Bus (including Step 1 of Driver CPC) (CD), Bus Module (BMT) or Truck Module (TMT) You can now book online at www.theorytest.ie The fee for category AM, BW, BMT & TMT is €45; for category C & D is €72 and for CD is €84 TO BOOK PHONE 1890 606 106 (Lo–call rate) Lín Áirithinte trí Ghaeilge 1890 606 806 Application for a Driver Theory Test Car (B)/Motorcycle (A, A1)/Moped (AM), Tractor/Work Vehicle (W), Truck (C) or Bus (D) – Note 6. Our operators are available from Monday to Friday 8.00am to 6:00pm to book your test and immediately confirm your appointment. Please have your Credit/Debit card, PPSN and PSC Card to hand. Application for a Driver CPC Bus or Truck Theory Test(Certificate of Professional Competence – Note 1) You can now book online at www.theorytest.ie The fee for a Driver CPC Bus or Truck Theory Test is The fee for both a Bus & Truck combined Test is TO BOOK PHONE 1890 606 106 (Lo-call Rate) Text Phone 1890 616 216 Líne Áirithinte trí Ghaeilge 1890 606 806 Our operators are available from Monday to Friday 8.00am to 6.00pm to book your test and immediately confirm your appointment. Please have your Credit Card and PPSN to hand. MANDATORY Please Note: A separate form is required for CPC Case Study –Step 2 Applications. You can now book online at www.theorytest.ie The fee for a Category AM, BW, C or D Theory Test is Please read both sides of this form and complete the form in BLOCK CAPITALS Please Note: A separate form is required for CPC 45.00 144.00. (Part 1: 216.00. 72.00 Part 2: Applications. 72.00) Personal public service number (PPS Number) Driver number (in BLACK PRINT on paper licence or 4d on card) To Book PHONE 1890 606 106 (Lo-call Rate) or TEXT PHONE 1890 616 216 nó Líne Áirithinte trí Ghaeilge 1890 606 806 Our operators are available from Monday to Friday 8.00am to 6.00pm to book your test and immediately confirm your appointment. Please have your Credit/Debit Card, PPSN, Learner Permit or Driving Licence to hand. (Note 5) Please read both sides of this form and complete the form in BLOCK CAPITALS CATEGORY OF TEST (TICK ONE ONLY) Cars, Tractors and Work Vehicles MANDATORY FOR C, D, CD, BMT & TMT Please read both sides of this form and complete the form in BLOCK CAPITALS CATEGORY BW Driver number (in BLACK PRINT–item 5 on your Learner Permit) Driver number (in BLACK PRINT – 9 numbers – on your licence) Personal public service number Personal public service number (PPS No.) CATEGORY AM Motorcycles & Mopeds CATEGORY D CATEGORY CD Truck & Bus Theory Test MANDATORY Bus Theory Test MANDATORY FOR CATEGORY C & D APPLICATION MANDATORY Stock number (in RED PRINT–1 Letter + 7 numerals–on your Learner Permit) CATEGORY TMT Truck Module Test CATEGORY C Truck Theory Test CATEGORY BMT Bus Module Test MANDATORY CATEGORY OF TEST (TICK ONE ONLY) CATEGORY AM Irish CATEGORY BW Russian Please tick if you would like to listen to the test through headphones in one of the following languages. Motorcycles & Mopeds English Polish Lithuanian Arabic Cars, Work Vehicles & Land Tractors Irish / English / Polish (All categories) CATEGORY OF TEST (Please Tick) *Multiple Choice Questions (MCQ) Note: This option will not be available on the day of testing unless selected in advance Trucks YOUR DETAILS Arabic (Category AM/BW only) Russian / Lithuanian CATEGORY D (Category BW Only) (Note 9) CATEGORY C BUS & TRUCK (*MCQ) (Part 1) €72 Bus & Truck Case Studies (Parts 2 combined) €144 Buses (*MCQ) (Part 1) €72 Bus Case Studies (Part 2) €72 (*MCQ) (Part 1) €72 Truck Case Studies (Part 2)€72 BUS TRUCK PLEASE NOTE – Your First Name(s) and Surname(s) Must match exactly the name and surname on the form of Identification that will be presented at the test PLEASE NOTE the date that you post your application. If after 14 days you have NOT received an appointment confirmation, please Center. Please note the date that you post your application. If after 14 days you have NOT received an appointment confirmation, please contact 1890 606 106 YOUR DETAILS PLEASE NOTE the date that you post your application. If after 14 days you have NOT received an appointment confirmation, please contact 1890 606 106 IMMEDIATELY. Failure to do so could result in LOSS of fee or missed appointment. (Note 3) contact 1890 606 106 IMMEDIATELY. Failure to do so could result in LOSS of fee or missed appointment (Note 2). IMMEDIATELY. Failure to do so could result in LOSS of fee or missed appointment (Note 2). YOUR DETAILS Title Ms/Miss/Mrs/Mr TitleMs/Miss/Mrs/Mr Title Ms/Miss/Mrs/Mr First Names First Names First Names Surname Surname Surname Gender M/F Gender M/F Gender M/F Bi Date of Birth Date of Birth Address Address Day Month Year Day Month Year Country of Birth Daytime Tel. No.Bi Daytime Tel. No.Bi Mobile Tel. No.Bi County County Mobile Tel. No.Bi IF PROVIDED, CONFIRMATION WILL BE BY EMAIL ONLY IF PROVIDED, CONFIRMATION WILL BE BY EMAIL ONLY Country Email Country Email CONFIRMATION TEXT PROVIDED TELEPHONE NUMBER IS MANDATORY CONFIRMATION TEXT PROVIDED 24 HOURS PRIOR TO TEST DATE Where would you like to take your test? (Note 2) Where would you like to take your test? (See locations overleaf (Note 1) Where would you like to take your test?(see locations overleaf (Note 1) What is the earliest date you would be able to take your test? Please allow 10 days for postal application.(Note 7 & 10) What is the earliest date you would be able to take your test? Please allow 10 days for postal application (Note 6) What is the earliest date you would be able to take your test? Please allow 10 days for postal application (Note 6 & 10) Day Day Month Month Year Year Day Month Year If the above date is not possible, a test will be booked for you on the closest possible date. To allow us to book a date and time that is best for you, we recommend you book on-line at www.theorytest.ie or alternatively by telephone using the number at the top of this form. recommend you book on-line at www.theorytest.ie or alternatively by telephone using the number at the top of this form. Do you have a special need or disability that may require special arrangements to take your test e.g. dyslexia, other reading, hearing or language difficulties etc.? Note 9 Please note if you require additional support, you will need to send medical evidence from a school, doctor or employer on headed paper together with this completed application form. Upon receipt we will contact you to make the If the above date is not possible, a test will be booked for you on the closest possible date. To allow us to book a date and time that is best for you, we If the above date is not possible, a test will be booked for you on the closest possible date. To allow us to book a date and time that is best for you, we recommend you book on-line at www.theorytest.ie or alternatively by telephone using the number at the top of this form. If you have a special need or disability that may require special arrangements to take your test e.g. dyslexia, or other reading or hearing difficulties, additional support can be provided, e.g. extended time. You will need to send medical evidence from a school, doctor or employer on headed paper together with this completed application form. Upon receipt we will contact you to make the arrangements or for further information you may Email theorytesthelp@prometric.com See note 10 for Language Support Services. arrangements or for further information you may Email theorytesthelp@prometric.com Do you have a special need or disability that may require special arrangements to take your test eg. Dyslexia, reading or writing difficulties or hearing issues? PLEASE NOTE - If you require additional support, you will need to provide medical evidence from a school, doctor or employer on headed paper together with this application form. Upon receipt we will contact you to make the arrangements for your test. (Please Tick) (Please Tick) (Please Tick) Please tick if you would like to listen to the test CREDIT/DEBIT CARD DETAILS I wish to pay by Mastercard/Visa. Please charge my account. My card number is: (Note 8) Irish English Polish Russian Lithuanian Please charge to my account Please tick if you would like to listen to the test through headphones in one of the following languages. through headphones in one of the following languages. CREDIT/DEBIT CARD DETAILS I wish to pay by Mastercard/Visa. Please charge my account. My card number is: Remember, with a Credit Card or Voucher you can book online immediately at www.theorytest.ie Irish English (Note 9) Irish / English / Polish (All categories) Russian / Lithuanian (Category BW ONLY) Expiry Date € CREDIT/DEBIT CARD DETAILS I wish to pay by Mastercard/Visa. Please charge my account. My card number is: Expiry Date Title Please charge to my account Name of card holder Signature of card holder Date Expiry Date Please charge to my account Remember, with a Credit Card or Voucher you can book online immediately at www.theorytest.ie Day € Month Year Remember, with a Credit Card you can book online immediately at www. theorytest.ie Date Day Expiry Date € Title PAYZONE VOUCHER DETAILS (Note 6) Name of card holder Signature of card holder Voucher Number Month Year Title Name of card holder Signature of card holder Date Day Month Year Day Month Year PAYZONE VOUCHER DETAILS (Note 6) Expiry Date Voucher Number Day Month Year

2. You can now book online at www.theorytest.ie Driver Theory Test Centres Test may be taken at the following centres: 1. Abbeyfeale Athlone Ballina Cahirciveen Carlow Carrick-on-Shannon Castlerea Cavan Charleville Clifden Clonmel Cork Derrybeg Donegal Drogheda Dublin IFSC Dublin North Dublin South (Dun Laoghaire) Dublin West Dundalk Ennis Galway Kilkenny Killarney Letterkenny Limerick Longford Macroom Monaghan Mullingar Naas Navan Nenagh Portlaoise Skibbereen Sligo Tralee Tullamore Waterford Westport Wexford Wicklow Youghal 2. 3. 4. 5. 6. 7. 8. 9. 10. Language Support Services: Translator support tests are available by special arrangement at the following test centes; Dublin Central, Dublin North (Santry), Sligo, Waterford, Cork, Galway, Limerick. This support is for candidates who do not speak or understand English. Evidence of a candidate’s requirement of this service must be provided. For further information please email; drivertheorytest@prometric.com or call the booking line on 1890 606 106 (lo-call rate). 11. Cancellation/Reschedules: If you wish to cancel or reschedule your Theory Test appointment, you must give us at least 5 working days notice or you will lose your fee. For example, to reschedule or cancel a test booked for a Friday you must let us know on the previous Monday. 12. Test preparation: The test questions are taken from the question bank in The Official Driver Theory Test Questions and Answers, Cars, Motorcycles and Work Vehicles June 2017 Edition book or CD-ROM and The Official Driver Theory Test Questions and Answers, Truck and Buses June 2017 Edition book or CD-ROM. We have now launched an online learning portal please see dttsore.promtric.com for more details! Make a note of the date you post your application and if after 14 days you have not received an appointment notification, please contact 1890 606 106 (Lo–call rate) immediately. If you don’t, you may miss your appointment and lose your fee. Web Bookings: www.theorytest.ie Phone Bookings: Call 1890 606 106 (Lo–call rate)and have your PPS number and Credit/Debit Card details or Payzone Voucher to hand and Driving Licence if you have one. If you are not the card holder, the card holder must be present to authorise the use of the card. Fax Bookings: Faxthis completed application to 042 9368899. Postal Bookings: Send this completed application form with your postal order or cheque to the following address: Driver Theory Test, PO Box 15, Dundalk, Co. Louth. Postal orders and cheques must be made payable to Driver Theory Test. Payment note –in addition to paying with a Credit/Debit Card, postal order or cheque you may also pay for your AM & BW test with a voucher obtainable from any outlet displaying the Payzone Sign. Required Documents:When you arrive to take the Driver Theory Test, you will need to have a valid Form of ID. a. A full list of acceptable I.D. are listed in our website www.theorytest.ie and the email/letter confirmation you will receive. Only valid ( in date) and original documents in good condition will be accepted. The name(s) and surname(s) must match exactly with the details on this application form or you will not be able to test and will lose your fee. Please note: For a category C, D or CD theory test you must present a valid, full Irish category B, C or D driving licence (or one from another EU/EEA member state or Switzerland). For a Truck Module Theory test you must also present a current category D learner permit or full Irish category D driving licence or one from another EU/EEA member state or Switzerland. For a Bus Module Theory test you must present a current category C learner permit or full Irish category C driving licence (or one from another EU/EEA member state or Switzerland). Certification: This form covers applications for Driver Theory Test Categories AM, BW, C, D and CD, which once passed will allow you to obtain a Learner Permit in these categories. Categories C, D and CD also provide candidates with the first step of the Certificate of Profession Competence (CPC). The form also covers the applications for the Bus or Truck Module Theory Tests for drivers who have already passed the full Bus or Truck Theory Test. For example, when a driver sits and passes the full Bus Theory Test, this provides them with a Driver Theory Test Certificate in driving a bus, plus the first step of the Certificate of Professional Competence (CPC). If within two years of passing the full Bus Theory Test the candidate decides they would like to drive a truck also, they can sit the Truck Module Theory Test, meaning that they do not need to sit the full Truck Theory Test. However, if you have not passed this module theory test within two years, you will then be required to sit the full Truck Theory Test. Irish Language: An Irish language version of this form is available. If you complete a form in Irish, an Irish language version of the Theory Test will be provided on the day of your test.