Research frequently reports that the majority of crashes (up to 80%), are the fault of drivers. Further, the WHO reports that most fatal crashes occur in low- and middle-income countries (LMIC). In LMIC, including Pakistan, most drivers have low levels of knowledge about traffic rules and regulations, have negative attitudes towards rules and regulations and often violate road safety rules. This study used a structured survey of drivers in Karachi, Pakistan (n=260). Most respondents were aware that helmet use for motorbike riders is compulsory (74.6%), agreed it was important to follow road signs (74.2%) and wear a seat belt (64.6%). However, over half did not know the speed limit in residential areas (54.6%) and almost half considered drug use when driving was not dangerous or were against the penalty or fine for violation of traffic laws (45.4%). In addition, 45.8% of all drivers thought driving licenses were unnecessary. This study suggests there may be low levels of driver knowledge of certain road rules (e.g. speed limit), negative attitudes about certain safe driving practices (drug driving), and low levels of value placed on driving license in Karachi, Pakistan. Analysis suggest that knowledge and attitude affect driver practices in Karachi, Pakistan. Strengthening enforcement and related public communication measures about traffic rules and greater penalties that are sufficiently deterring for the violators of the traffic rules is needed. There must also be a formal mechanism to issue the driving licence after a proper test of the knowledge of road rules and driving following those rules.