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Official Registration Form

Kobby Free Driving School

Community Road Safety & Free Driver Licensing Initiative • Takoradi Constituency

Affix Passport Photo Here(Recent photo, plain background)

INSTRUCTIONS: Complete this form in BLOCK LETTERS using a black or blue ink pen. Ensure all information provided is accurate and verifiable. Return the completed form to the designated community coordinator or registry office.

1. Personal & Identification Profile

Title:

[ ] Mr [ ] Mrs [ ] Miss [ ] Ms

1. Surname (Family Name):

2. First / Other Names:

3. Gender:

[ ] Male [ ] Female [ ] Other

7. Date of Birth (DD/MM/YYYY):

8. Place of Birth:

11. Nationality:

5. National ID Type:

[ ] Ghana Card [ ] Voter [ ] Other

6. National ID Number:

2. Contact & Residential Details

13. Contact Phone Number (WhatsApp / Voice):

12. Email Address:

10. House No. / Digital Address:

9. Postal Address (Optional):

House Address / Street Name / Locality:

3. Where do you live or vote in Takoradi Constituency? (Tick One)

1. Amanful West

2. Amanful East

3. Beach Road

4. Essikafo Ambitem No. 1

5. Essikafo Ambitem No. 2

6. Chapel Hill

7. Railway & Harbour

8. New-Takoradi Lower

9. Poasi - Upper New-Takoradi

10. Airforce ( Airforce, adakope, kokompe & princess)

11. Old Adra

12. Cassava Farm

13. Zenith

14. Airport Ridge

15. Presby

16. Other

4. What will you use the driver training for? (Tick One)

A. Personal

Private driving for daily commutes and family use

B. Commercial Driver

Taxi, ride-hailing, trotro, bus, or haulage transport

C. Agricultural

Farm machinery, tractors, and agricultural logistics

D. Private

Dedicated personal / corporate chauffeur and executive transport

E. Equipment Handling

Forklifts, earthmovers, construction, and heavy machinery

5. Preferred Training Schedule in Takoradi (Tick One)

1. Early morning (6am to 10am)

Early session before daytime commitments

2. Mid morning (10am to 2pm)

Optimal daylight practical driving session

3. Late afternoon (2pm to 6pm)

Afternoon to evening session for late schedules

6. Are you currently employed? (Tick One)

Yes, I am employed

Currently working / self-employed

No, I am unemployed

Currently seeking employment

7. Candidate Declaration & Signature

I hereby declare that the particulars provided in this application form are true, correct, and complete to the best of my knowledge and belief. I agree to abide by all the rules, attendance requirements, and road safety regulations set forth by the Kobby Free Driving School Program.

Applicant Signature / Thumbprint:

Date (DD/MM/YYYY):

FOR OFFICIAL USE ONLY (PROGRAM REGISTRAR / ENROLLMENT COMMITTEE)

Assigned Ref Number:

Enrollment Status:

[ ] Approved [ ] Waitlist

Officer Signature & Stamp:

Kobby Free Driving School Portal: https://kobbydrive.vercel.app • Official Registration Record