Registration Form - RDZ
https://rijschooldirkzellik-crz.be/
Please fill out the form below to register for a driving course or test. We will contact you as soon as possible to make an appointment.
Identity
First name
Last name
Birth date
Place of birth
Email address
Confirmation Email address
Cellphone number
Phone number
Identity card number
Social Security Number
Do you have the Belgian Nationality ?
Yes
No
In which language do you want to follow the classes?
Dutch
French
English
Address Information
Street + number
Postal code
City
Billing Information
VAT number
Email Address
Company name
Phone number
Street + number
Zip code
City
Current/provisional driver's license
I have a temporary driverslicense
Yes
No
Current temporary driver's license
M36
M18
M12
Date of issue provisional drivers license
Date of issue 2nd provisional drivers license
The date of issue is the date that you took your driving license from the municipality.
Validity end date of provisional drivers license
Date on which you passed the theoretical test
The date of theory is the day you took your theory examination. See back of provisional driver's license.
Do you already have a foreign drivers license ?
Yes
No
Do you have a certificate of delivery of provisional driving license (attachment4) ?
Yes
No
Do you already take previous tests ?
Yes,
times
No
ATTENTION: The number of attempts with previous driving license also count!
Have you already taken a risk perception test in the Brussels region?
Yes,
times
No
Desired training
Driving license category
Driving license B - Auto
Driving license B+E - Auto + aanhangwagen
Theory
Number of lessons of tests
Desired date theory class
12 uur theorie lessen (13/05/2024 tem 16/05/2024 )
Car transmission type
Manual
Automatic
Motorcycle experience
None
Little
Lots
Very much
Moped experience
None
Little
Lots
Very much
Availability & comment
Which days are you available ?
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Availability
Remarks
Adres
: Zuiderlaan 51 1731 Zellik --
GSM
: 0498/085.007 --
info.rijschool.rdz@gmail.com