License Application

Registration number: _________________

Office use
License Application

You must be registered with Waitaha to receive a license, You can do so by going onto our website https://waitaha-iwi.org.nz/iwi-register/
If you are not ready to sit your license but require lessons, please apply for the lessons on the correct form, then come back to apply for your license when you are ready to recieve the putea and book youir license.
Is this for a resit that we have funded previously? (We do not fund resits)*
Customer Details:
Full Name (As on License)*

First NameLast Name
DOB*

DayMonthYear
Date of Birth
If you are under 18yrs old we will need to find your parent on our Database- what is your Waitaha Parents name:

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
E-mail*
example@example.com
What license are you going for?*
Forklift, Learners, Restricted, Full
License Number*
Version Number*
Expiry date*
Have you had any previous driving experience?*
If yes how many hours * Hours.
Please upload your account details, please make sure the name on the account is correct.

Cancelof
Should be Empty:

Registration number: _________________