Eligibility to Obtain a Driver’s Licence
Application to obtain Amendment to an Addition of driving
a driver’s licence
X existing application experience
APPLICANT
Last name First name
Mohan Prithiviraj
Date of birth (Y-M-D) Citizenship Date of arrival in Canada (Y-M-D)
1987-06-24 Inde 2023-09-13
Year-Month-Day
Applicant’s
Date of settlement in Québec 2024-06-25 status TT Specify: Travailleur temporaire
Telephone Extension
438-728-1593
DOCUMENTS PRESENTED
Origin Number Class(es) Endorsement(s)
Driver’s Inde TN3120080003212 5
licence Year-Month-Day Year-Month-Day Year-Month-Day
Date of issue of Expiry date of Applicant claims to have
licence presented 2008-06-11 licence presented 2028-06-10 held a licence since 2008-06-11
Issuing authority Canadian citizenship Number
and birth certificate number certificate
Origin Number
Passport
Inde W4693135
Immigration and other documents (provide the name of each document): Permis de travail EB067 298 965 ID
1134751616
Proof of residency in Québec: Compte de téléphone
APPLICANT’S CONSENT
I authorize the SAAQ to check the information I have provided by sharing it as necessary, for the purposes of verifying its authenticity
and accuracy, with Citizenship and Immigration Canada, the Ministère de l’Immigration de la Diversité et de l’Inclusion, the relevant
police or motor vehicle transport authorities, the embassies or consulates of the jurisdictions concerned and any other relevant body. A
photocopy or digitized reproduction of this authorization has the same validity as the original.
Applicant’s signature Date (Year-Month-Day)
DECLARATION
I certify that the information provided is accurate and complete and that all documents presented are authentic and valid.
In witness whereof I have signed at , on
Municipality Date (Year-Month-Day)
Applicant’s signature:
RÉSERVÉ À LA SOCIÉTÉ (Do not write here)
Numéro de dossier Numéro du centre de services Numéro de l’opération (ID) Nombre de mois
M500724068703 UO00047584 A069287716 d’expérience étrangère reconnu 192
Demande Préposé Date (Année-Mois-Jour)
ACCEPTÉE 2024-06-25
Société de l’assurance automobile du Québec
7361A 92 (2023-06) Original document in French Page 1 of 2
CLIENT
PROTECTION OF PERSONAL INFORMATION
The SAAQ only collects personal information that is necessary for it to exercise its powers and
apply the laws it administers. All personal information gathered by authorized personnel is handled
confidentially. This information may be shared with its licensing agents and certain government
departments or agencies, including those located outside Québec, in accordance with the Act
respecting Access to documents held by public bodies and the Protection of personal information.
It may also be used for statistical, survey, study, audit or investigative purposes. Failure to provide this
information can result in a refusal of service. You may consult, correct or obtain a copy of any personal
information concerning you.
For more information, consult the Policy on Privacy on the SAAQ’s website at saaq.gouv.qc.ca/confidentialite
or contact the SAAQ’s call centre.
WARNING ABOUT THE CONSEQENCES OF PROVIDING
FALSE INFORMATION OR DOCUMENTS
The SAAQ may cancel a licence issued by error or on the strength of misleading or false information.
Before issuing a Québec licence on the strength of a licence issued by another jurisdiction, the
SAAQ must ensure the authenticity and accuracy of the information and documentation provided by the
applicant, as well as the validity of the applicant’s licence.
Société de l’assurance automobile du Québec
7361A 92 (2023-06) Page 2 of 2
