What date did you come to live in the UK?* Day12345678910111213141516171819202122232425262728293031MonthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberYear200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950

In which European Union or European Economic Area country have you lived in the last 12 months?*

Disqualification date* Day12345678910111213141516171819202122232425262728293031MonthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberYear200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950

Court Name*

In which European Union or European Economic Area country have you lived in the last 12 months?*

Medical Conditions* If you have a medical condition we may need further information from you or your doctor to confirm that you meet the medical standards of fitness to drive. When you have completed your application it will go to the medical department for consideration Diabetes controlled by insulin (No need to notify us if you have diabetes controlled by tablets or other injections unless you experience hypoglycaemia requiring the assistance of another person)EpilepsyAny condition affecting both eyes, or the remaining eye if you only have one eye. Not including colour blindness or short or long sightStroke, with any symptoms lasting longer than one month or TIAsFits or blackoutsAny type of brain surgery, severe head injury involving in-patient treatment, or brain tumourAn implanted cardiac pacemakerAn implanted cardiac defibrillator (ICD)Repeated attacks of sudden disabling giddinessAny other chronic neurological condition including Multiple Sclerosis, Motor Neurone and Huntington's diseaseA serious problem with memory or periods of confusionPersistent alcohol misuse or dependencePersistent drug misuse or dependenceSerious psychiatric illness or mental ill healthParkinson's diseaseSleep apnoea syndromeNarcolepsyAny condition affecting your visual fieldTotal loss of sight in one eyeAny persisting limb problem which needs driving to be restricted to certain types of vehicles or those with adapted controlsSevere learning disability