The application is for: First driving licence Renewal Adding category/ies Certificate of professional competence Return Exchange of foreign

driving licence

Blankett NA-0201 engelsk– januar 2013

Read through the questions below thoroughly before answering them and signing the application form.

AM145 moped (applicants born before 1 Jan 1985)

AM146 moped (applicants born after 1 Jan 1985)

AM147 three- and four-wheel moped

S tracked motorcycle/snowmobile

T tractor

A1 light motorcycle

A2 medium-sized motorcycle

A motorcycle

B1 four-wheel motorcycle

Last name, first name, middle name

Address

Postal code

National identity no. (11 digits)

Telephone no.

E-mail

Application for driving licence/certificate of professional competence Must be sent or taken to the Driver and Vehicle Licensing Office.

For online applications and information on the categories you may apply for online,

see www.vegvesen.no.

Declaration of Health – see the reverse side of the form for information

Application for a licence or renewal of a licence for categories C1,C1E,C,CE,D1,D1E,D, or DE and certificate of professional competence for emer-gency vehicle driver always requires a health certificate (form NA-0202) issued by a medical practitioner (for certain illnesses a specialist medical report is also required – see the reverse side of the form for information).

I am aware that withholding information or giving false information is a punishable offence.If I experience long-term changes to my health that may interfere with my driving, I am obligated to see a doctor.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Place and date Applicant’s signature

Postal district I would like my driving licence issued in (form of Norwegian): Bokmål Nynorsk

B car/van

B96 trailer for category B (car and

trailer combination 3501-4250 kg)

BE trailer for category B

C1 light lorry 3500-7500 kg

C1E trailer for category C1

C lorry

CE trailer for category C

D1 minibus

D1E trailer for category D1

D bus

DE trailer for category D

Certificate of professional competence

Professional driver: goods transport

Professional driver: passenger transport

Emergency vehicle driver (code 160)

1. Do you use eyeglasses or contact lenses?

2. Do you have reduced vision in one or both eyes?

3. Do you have reduced peripheral vision in one or both eyes?

Can you answer “yes” to any of questions 1-3? Yes No

If you have answered «yes», a vision certificate from a licensed optician or medical practitioner is required.

4. Have you had an episode of reduced consciousness at any time during the last 12 months?

5. Have you had an episode of reduced consciousness at any time during the last 10 years?

6. Have you had an episode of reduced consciousness at any time after turning 18 years of age?

7. Have you suffered from or been treated for a serious mental disorder?

8. Do you use insulin and/or other forms of medication for diabetes?

9. Do you abuse alcohol or other intoxicating substances?

10. Do you have reduced mobility in your arms and/or legs?

11. Do you have any other illnesses that make or could make you unfit to drive a motor vehicle?

12. Do you suffer from ADHD?

13. Do you use any medications that may interfere with your driving?

Can you answer “yes” to any of questions 4-13? Yes No

If you have answered «yes», a health certificate (form NA-0202) issued by a medical practitioner is required, as well as any specialist medical reports (see the reverse side of the form for information).

Mobile no. (for SMS)

Do you have a driving licence issued by another country?

If «yes»; please give additional information in the fields provided

Complete if the application is for the return of a revoked driving licence:

Driving licence category/ies

Issued by (country)

Revoked by police district in Norway / authority in another country Revoked from (date)

Issue date Expiry date

Revoked until (date)

Yes No

General information

ID: You must produce a valid ID with your name, Norwegian national identity number (11 digits) and a photo for the theoretical and practical driving tests, as well as before a driving licence or certificate of professional competence is issued.

Photo: A photo will be taken at the Driver and Vehicle Licensing Office, unless a photo has already been stored electronically.

Fee: A fee must be paid before each theoretical and practical test, for a new photo and for a new signature, as well as before the issue of a driving licence or certificate of professional competence.

Training: The driving school, the training institution or the training provider must report to the Norwegian Public Roads Administration that you have completed the mandatory training. This must be reported no later than three days before the practical test. For Driver certificate of professional competence, the training must be reported before the theoretical test is taken.

Storage of data: The Norwegian Public Roads Administration (NPRA) is required to keep records of matters related to driving licences. Personal data and information pertaining to your driving licence is registered and can be used by the NPRA, the police and the Norwegian customs authorities. Information of a non-confidential nature can be released to third parties, in accordance with the Freedom of Information Act.

Further information on driving licence and health requirements may be found in Regulations pertaining to driving licences, etc. on www.lovdata.no and our website www.vegvesen.no. Contact information for the NPRA is also available on our website.

Requirements regarding the declaration of health

Declaration of “Yes” to questions 4-13 health: When applying for category AM145,AM146,AM147,S,T,A1,A2,A,B1,B,B96, or BE driving licences, a medical certificate is required (see form Helseattest NA-0202) if you answer “yes” to any of questions 4 – 13 of your declaration of health on page one. A medical certificate (form NA-0202) may also be required by the Driver and Vehicle Licensing Office or the police.

Heavy vehicle categories and certificate of professional competence for emergency vehicle driver A medical certificate (form NA-0202) is always required when applying for a driving licence or renewal for category C1, C1E, C, CE, D1, D1E, D, or DE and certificate of professional competence for emergency vehicle driver.

Exemptions: If the health requirements are not met, an application for exemption from the driving licence regulations’ health requirements can be sent to the County Governor. The health requirements are found in the Regulations pertaining to driving licences etc., Appendix 1 - Health requirements on www.lovdata.no. The applicant must submit an application for exemption, a health certificate (form NA-0202) and any medical specialist reports to the County Governor of his/her county of residence.

Reports from For certain conditions, a specialist medical report is required in addition to the health certificate (form NA-0202) medical when applying for a driving licence category or renewal of an existing licence. See overview in the table specialists: below. If a star appears in the field of the licence category(ies) for which you are applying, a supplemental medical specialist report as described in the far right column must be attached to the health certificate (form NA-0202).

Overview of supplemental medical specialist reports that must accompany health certificate (form NA-0202) if I experience certain conditions:

* = supplemental medical specialist report must accompany health certificate (form NA-0202).(*) = supplemental medical specialist report is to be submitted with health certificate (form NA-0202), if the doctor finds it necessary.

The application is for category(ies):

If «yes» to question:

AM145, AM146, AM147, S ,T,

A1, A2, A, B1, B, B96 and BE

C1, C1E, C and

CE

D1, D1E, D, DE and code 160

The following medical specialist reports must be submitted :

4. An episode with loss of consciousness during the last 12 months * * * Supplemental medical report from a specialist in

neurology/internal medicine

5. An episode with loss of consciousness during the last 10 years * * Supplemental medical report from a specialist in

neurology/internal medicine

6. An episode with loss of consciousness after the age of 18 * Supplemental medical report from a specialist in

neurology/internal medicine

7. Serious mental disorder (*) (*) (*)Supplemental medical report from the responsible doctor/ psychologist/specialist in psychiatry ought to be submitted (at the doctor’s discretion)

8. Use of insulin and/or other medication for diabetes * * * Supplemental medical report from a specialist in internal

medicine (form no. NA-0202b)

9. Abuse of alcohol or other substances

10. Reduced mobility in arms and/or legs

11. Any illness that makes or may make you unfit to drive a motor vehicle (*) (*) (*)

Supplemental medical report from the responsible doctor/specialist ought to be submitted (at the doctor’s discretion)

12. ADHD (*) (*) (*)Supplemental medical report from the responsible doctor/specialist ought to be submitted (at the doctor’s discretion)

13. Use of medication that may interfere with your driving

Blankett NA-0201 engelsk– januar 2013