The minimum driving age is 18 in Pakistan, but underage driving is prevalent across the country, and is common among Motorcycle Rickshaw Drivers (MRDs). Motorcycle Rickshaws (MRs) are an unregulated three-wheeled public transport mode in Pakistan. Data collected as part of the first author’s PhD study revealed that MRs (together with the less common Auto-rickshaws) were the second most frequent vehicle type involved in road crashes attended by Rescue 1122 ambulances in Punjab, Pakistan during 2014–2015. The current study presents some road safety characteristics of underage MRDs. Observational and quantitative surveys were conducted across Lahore in 2015. Road safety practices of 500 MRDs were observed and 300 MRDs were interviewed using a survey questionnaire. Nearly a quarter of MRDs appeared to be underage in the observational survey, and 18% reported being underage in the quantitative survey, with some stating that they started MR driving at 9 or 10 years old. Being underage, none had a driving licence, although most MRDs of all ages lacked a valid driving licence. While almost three-quarters of MRDs reported being involved in road crashes during past 12 months, the odds of crash involvement were over 3 times higher for underage MRDs, although they were no more likely to be involved in traffic conflicts. T-test analysis showed that crash-involved MRDs had higher levels of agreement with the statements: ‘when a traffic warden is not present, I do not stop at red-lights, ‘speeding carefully does not cause crashes’, and ‘crashes are caused by nature’. Underage MRDs are operating illegally as commercial drivers, presenting a safety risk for themselves, MR occupants and other road users. However, socioeconomic factors such as poverty often contribute to underage MR driving. Therefore, unregulated operation of MRs and underage MRDs across Pakistan needs to be addressed sensitively through road safety and transport policies.