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How to fill out the Annex D Form online
The Annex D Form is essential for assessing and managing driving needs for individuals who may require accommodations. This guide provides clear, step-by-step instructions to help you complete the form online effectively.
Follow the steps to fill out the Annex D Form accurately.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- In the identification section, provide the name of the person applying. Indicate whether the person is a new driver and if they currently hold a driver's permit. Fill in the driver's permit number and its expiration date in the specified format (year/month/day).
- For the reason for the referral, select the appropriate option indicating either a driving evaluation or vehicle modifications, and specify if the referral is for the driver or passenger.
- In the additional information section, answer questions regarding mobility. Indicate if the person can walk short distances independently, whether they use mobility aids, and if so, provide specific details about the type and model of the aids.
- Indicate if the person can sit in the driver's seat and place the mobility aid in the vehicle without assistance. Answer questions regarding the need for transport of a motorized wheelchair and whether the person plans to sit in it while driving.
- Fill out the vehicle section by selecting the type of vehicle, providing the model, year, and mileage. Choose the transmission type and indicate plans for purchasing a new vehicle in the coming year.
- List any health care professionals involved in the assessment, along with their contact details, including name, profession, establishment, and telephone.
- Attach required documents for the referral, for example, the medical examination report and authorization to communicate personal information form. Ensure to also include any additional documents as specified for adaptations.
- Finally, provide the name of the person making the referral, their signature, and the date. Review the form for accuracy and completeness.
- Once completed, save changes, and utilize the online options to download, print, or share the form as needed.
Begin filling out the Annex D Form online to ensure your driving needs are properly assessed.
The details to be filled in Annexure- D include: Minor's Name, date of birth and place of birth. Minor's parent's Names and address. Name of the legal guardian, if any. Passports details of parents, if any held.
Fill Annex D Form
Page 1. Annexure-'D'. Authorization letter and BIR ARTA ID of the authorized representative to pick-up document. ANNEX D. Signature Over Printed Name. The total amount of points allocated for the financial component is 30. This application form should be completed after all call documents have been read.
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