License Application
You must be registered with Waitaha to receive a license
Customer Details:
Full Name (As on License)
*
First Name
Last Name
DOB
*
-
Day
-
Month
Year
Date of Birth
If you are under 18yrs old we will need to find your parent on our Database- what is your Parents name (Waitaha Parent)
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
E-mail
*
example@example.com
Current license
*
License Number
*
Version Number
*
Expiry date
*
Do you attend Te Puke High School?
Do you require driving lessons
Have you had any previous driving experience?
*
Please Select
Yes
No
If yes how many hours
*
Hours.
Submit
Should be Empty: