Year of manufacture
NSW Driver licence/Customer number
1 Registered operator details
2
Catalogue No.45070938 Form No. 1245 (10/2016)
Vehicle Suitable for Safe Use Declaration
Vehicle identification
Plate number (if known)
Vehicle use
Recreation
Earthwork/
Roadwork
Farm
3
Forestry Mining
Other (please specify)
9 Privacy statement and declaration
I declare that:
a) the vehicle has the equipment and fittings marked on this form
and are in operating condition.
b) I will be responsible for the vehicle to be suitable for safe use
until the expiry of the registration or permit.
c)
day month year
Office use:
For non complying vehicles do equipment and fittings nominated
comply with the relevant Conditional Registration Vehicle Sheet?
Yes
Is an overmass/overdimension permit required?
No
Refer to the Special Permits Unit or National
Heavy Vehicle Regulator before registering the
vehicle.
Yes
Customer Service Representative signature
Staff number
(Primary Producer
declaration required)
Vehicle description (eg. sedan,trailer,motorcycle, combine-
harvester,cotton picker, forklift,mini loader,bucket loader)
VIN or chassis/frame or serial number
Does the vehicle have steel tracks?
Apply condition L099
Yes
the information on this form is true and complete.
day month year
Date
Date
Signature
/ /
/ /
(Stockton Beach)
Your Personal Information is collected and held by Roads and
Maritime Services, 20-44 Ennis Road, Milsons Point NSW 2061. I
understand that I must supply the information in accordance with
Road Transport legislation.
Failure to supply full details and sign/confirm this declaration can
result in the transaction not proceeding. Your "personal information"
held by us may be disclosed inside and outside NSW to driver
licensing and vehicle registration agencies, for verification of a fee
concession entitlement with Centrelink and DVA, law enforcement
agencies, providers of compulsory third party (bodily injury)
insurance, proposed acquirers of vehicles, solicitors in regard to
motor vehicle accidents, and to verify and validate the contents of
this application and any supporting documents, for the administration
of driver licensing and vehicle registration legislation and law
enforcement, and for the purpose of the protection of public revenue,
road safety, compulsory third party (bodily injury) insurance, and
inquiries relating to motor vehicle accidents or abandoned vehicles
or which would be relevant to any acquisition of this vehicle.
Unregistered Vehicle Permit
6 Weight limits
Is the vehicle within weight limits?
For acceptable mass weight limits please refer to the
National Heavy Vehicle Regulator website www.nhvr.gov.au
NoYes
7 Is the vehicle in a safe operating condition?
(if unsure seek mechanical advice)
A permit or conditional registration
cannot be issued
Yes
No
Equipment and fittings4
Non complying vehicle (eg tractor, grader, forklift)
For Conditional Registration or Unregistered Vehicle Permit
What fittings and equipment are on this vehicle?
Brake lights
Turn lights
Headlights
Tail lights
Clearance lights
Rear number plate light
Rear and side reflective tape
Effective brake system
Seat belt
(all seating positions)
Horn
Rear Mudguards/flaps
Amber rotating beacon
Hydraulic steering failure
warning device or sign
Dual control steering sign
Chain guard
Left-hand drive sign
Tracks, rubber
(tracks instead of wheels)
Rear vision mirror
Tracks, steel
(tracks instead of wheels)
2 red rear reflectors
5 Dimensions
Is the vehicle within limits for length (12.5m), width (2.5m),
height (4.3m)?
NoYes
Operators of oversize vehicles must
also comply with the conditions of the
relevant access notice or permit. For
more information contact:
Special Permits Unit on 1300 656 371
for intrastate permits, and the National
Heavy Vehicle Regulator on 1300 696
487 for interstate permits.
Conditional Registration (select from the below options)
OR
IMPORTANT: Your vehicle must be safe for use on the
road. Penalties apply for driving a defective vehicle.
Delineators
Type of Notice/Permit required.
Notice OM2 Permit OM3
Type of Notice/Permit required.
Notice OS1 Permit OS2
Registered operator's phone number
www.rms.nsw.gov.au/vehicle-sheets
Note: If this is not completed correctly your application maybe refused.
Operators of overmass vehicles must
also comply with the conditions of the
relevant access notice or permit. For
more information contact:
Special Permits Unit on 1300 656 371
for intrastate permits, and the National
Heavy Vehicle Regulator on 1300 696
487 for interstate permits.
For a full description of non complying vehicle descriptions see:
Complying vehicle (eg sedan, motorcycle, trailer)
For Unregistered Vehicle Permit ONLY
What fittings and equipment are on this vehicle?
Wheels and tyres
Windscreens and windows
Lights and indicators
Steering
Brakes
Seats and seatbelts
Horn
(now go to 6)
(now go to 7)
month year
/
8 Where will the vehicle be operated?
UNCLASSIFIED
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