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8/8/2019 D1FF03FEd01
1/2
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)
8/8/2019 D1FF03FEd01
2/2
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