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FOR OFFICE USE ONLY

Ref No: ITL/RM/DLC/2017/...

Receipt No:...

(This Application is issued free of charge)

Application to obtain the Certificate of Authenticity and Validity of the Sri Lankan Driving Licence
for conversion to an Italian driving licence under the Bilateral Agreement
between Italy and Sri Lanka of December 2016.

Data should be written according to the original Sri Lankan Driving Licence. All names appearing in the
driving licence should be included.

1. Name of the city of the relevant Italian Department of Motor Traffic :


Citt della competente motorizzazione Italiana

2. Sri Lankan Driving Licence No :

3. Date of Issue :
D D M M Y Y Y Y

4. Date of Expiry :
D D M M Y Y Y Y

5. Name :

6. Surname :

7. Date of Birth :
D D M M Y Y Y Y

8. Place of Birth (City) :

9. Country :

10. Date of First residency in Italy as per the :


D D M M Y Y Y Y
Certificato di Residenza Storico

Contd..2/
-2-

11. Address in Italy & City :

12. Telephone Number (Italy) :

13. Declaration by the Applicant:


I understand that the issuance of an Italian Driving Licence through conversion, under the said
bilateral agreement is at the discretion of the Government of Italy, who is the final authority, on
questions of eligibility, residency, and other provisions in relation to my application.

I declare that I am a citizen of Sri Lanka and hold residency in the Italian Republic.

I certify that the documents attached to this application were not subjected to alterations,
modifications, or falsifications to hide or deflect true facts.

I am aware that applicants:

Should have reached the minimum age of 18 years to drive a motor vehicle

Possess a valid and permanent (non-temporary) Sri Lankan Driving Licence

Should have obtained the Sri Lankan Driving Licence prior to the registration of residency in
Italy.

Should have obtained residency in Italy within a period of less than four (04) years from the date
of application.

Following Documents are attached.

1. Two Photocopies of the Driving Licence issued by the Government of Sri Lanka.
2. Photocopies of the following pages of the Passport. (Data Page & Alternations &
Observations Pages).
3. Original of the Italian Residency Certificate: (Certificato di Residenza STORICO con la data
dellimmigrazione dallo Sri Lanka )
4. A Copy of the Stay Visa (SOGGIORNO)
5. A copy of the Identity Issued by the Government of Italy, CARTA D'IDENTITA.

I declare that the information furnished in this application is true and correct to the best of my knowledge.

.. .
Date Applicant Signature