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A Licence Application (You must live in NSW (New South Wales)

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UNCLASSIFIED
SENSITIVE: PERSONAL
The information given in this application form is correct at the time of printing
but is subject to change without notice.
Learner Licence
- Car, tractor, implement, light rigid vehicle and medium rigid vehicle.
Driver Licence
Office Use - BUNDLE A
National Heavy Vehicle
Driver Licence
Motorcycle Rider Licence
A current overseas passport.
An Australian naturalisation or citizenship document issued by the
Department of Immigration and Citizenship or the Department of Immigration
and Border Protection.
The following documents issued by the Department of Immigration and
Citizenship or Department of Immigration and Border Protection:
List 1
List 2
a current Certificate of Identity
A Roads and Maritime issued NSW photo driver licence or NSW Photo Card
that has been expired more than 2 years but less than 5 years. The licence
must display a card number and not have been revoked or be reported as
lost, stolen or destroyed.
A current photo driver licence from another Australian State or Territory or
one that expired within the last two years. If your interstate licence shows
your middle name(s) as initial(s), you will require another supporting List 1 or
List 2 document showing your full name.
A current photo identity card for the NSW Police Force, excluding civilian
staff or family.
A current consular photo identity card issued by the Department of Foreign
Affairs and Trade.
a current Document of Identity
- Vehicles with 3 or more axles and more than 8 tonnes gross vehicle mass.
Page 1 of 4
Proof of Identity (To be produced each time you attend a service centre or registry.)
To get a New South Wales licence you must prove your identity. You can use your current Roads and Maritime Services issued NSW photo driver licence
or NSW Photo Card or one which expired within the last two years. If you do not have this you must use one document from each of the lists below. Your
name should be the same on both documents. Your gender should be the same on both documents, if gender is shown. A copy of the brochure
'How to prove who you are' is available from your nearest service centre or registry.
NOTE: All documents from list 1 and 2 must be originals (photocopies are not acceptable) and at least one of them must show your signature. If you do
not have a document showing your signature you must complete question 19 on this form. Your photo will be stored on Roads and Maritime database.
An Australian full birth certificate showing parental details issued by an
Australian Registry of Births, Deaths and Marriages.
Note: Commemorative certificates are not acceptable (except for 1987 and
1988 NSW Historic Birth Certificates).
An overseas birth certificate showing parental details provided a passport or
an official Australian travel document is also shown.
A current Australian passport or one that expired within the last two years.
Validation with Australian Passport Office may be required for passports
issued within the last 2 years.
The following travel documents issued by the Department of Foreign Affairs
and Trade:
A current Medicare card, Pensioner Concession Card, Department of
Veterans' Affairs entitlement card, or any other current entitlement card
issued by the Commonwealth Government.
A current plastic credit card, or account card issued by a bank, building
society, credit union, American Express or Diners Club International,
showing your name and signature.
A passbook or account statement up to one year old, issued by a bank,
building society, credit union, American Express or Diners Club International.
An account statement must show your name and account number, as well as
the financial institution's letterhead or stamp.
A telephone, gas or electricity bill up to one year old.
A water rates, council rates or land valuation notice up to one year old.
A current student identity card, displaying the student's photograph, issued
by an Australian secondary school, TAFE or university. Where a student
identity card has an issue date, but no expiry date, it may be accepted up to
two years from the date of issue.
Evidence of enrolment at an Australian secondary school, TAFE or university
up to one year old showing the student's name and on the institution's
letterhead.
A current Mobility Parking Scheme (MPS) permit issued by Roads and
Maritime with or without a photo.
A current Roads and Maritime issued NSW photo Firearm, Security Industry
or Commercial Agents and Private Inquiry Agents operator licence.
A current photo identity card for the Australian Defence Force, excluding
civilian staff or family.
A Keypass issued by Australia Post with an expiry date on or after 1 October
2020 (whether under 18 or 18+).
Licence Application
(You must live in NSW to be issued with a NSW Licence)
a current Titre de Voyage
a Document for Travel to Australia (up to 5 years from the date of issue
on the accompanying visa)
Attachments
Customer number
Catalogue No. 45070018 Form No. 1001 (07/2019)
Evidence of Immigration Status (EIS) ImmiCard (current or expired)
Permanent Residence Evidence (PRE) ImmiCard
Residence Determination (RDI) ImmiCard
We no longer record organ donation details. For more information visit donatelife.gov.au
Change of Name If you have changed your name, you need to provide
one of the following documents: marriage certificate (for NSW marriage
certificates Roads and Maritime will only accept those issued by the
RBDM); divorce document bearing the name reverted to; deed poll
registered with the relevant authority; change of name certificate issued
by the RBDM; full birth certificate showing the name at birth and the new
name; a completed Instrument Evidencing Change of Name form which
has been registered in the Land Titles Office or a Permanent Resident
Evidence (PRE) ImmiCard. Your identity and change of name documents
should show a clear link between your names. All documents must be
originals.
Translations If a document is not in English it must be accompanied by
an official translation from Multicultural NSW or one provided from the
Community Relations Commission. Roads and Maritime also accepts
translations from the Free Translating Service provided by the
Department of Social Services (DSS). The Free Translating Service is
only available for eligible people. For information on this service please
go to the DSS website: translating.dss.gov.au
International Drivers If you are a visiting overseas driver and you want
to obtain a NSW licence for the first time and if you want the tenure
on your overseas licence recognised you must declare it and you may
be required to provide further documentary evidence. Licences issued
to temporary overseas visitors will be marked with a 'Q' to denote
that 'Evidence of permanent resident status not provided'. For more
information see our website at rms.nsw.gov.au or the brochure 'Guide for
International Drivers'.
Permanent Australian residency must be supported by acceptable
documentary evidence or verified online by Roads and Maritime. For a
full list of acceptable proof of Australian residency documents, see our
website.
Free Licences If you hold a current NSW Pensioner Concession Card
(PCC), a Centrelink Confirmation of Concession Card Entitlement form
stamped PCC, or a Department of Veterans' Affairs (DVA) Gold Card
endorsed 'TPI' or 'EDA' or 'War Widow' or 'War Widower', or a DVA letter
or statement certifying a disability pension of 70% or more, an
Intermediate pension, or an assessment at 50 or more impairment points,
you may be
eligible for a free licence. A current interstate licence may be
transferred to a NSW licence free of charge.
Eyesight, Knowledge, Driving and other Tests, Medical and Learner
Driver Log Book requirements You may be required to undergo an
eyesight test, knowledge test and in some cases a medical examination.
You may also need to do a driving test or undertake heavy vehicle
competency based assessment. Some applicants may be required to
pass a Hazard Perception Test and/or a Driver Qualification Test. Rider
training or a riding skills test may be needed if you apply for a motorcycle
licence. A Learner Driver Log Book may also be issued when you obtain
a learner driver licence.
Enquiries If you have any enquiries about applying for a licence, visit
rms.nsw.gov.au, call us on 13 77 88, contact a service centre or registry.
Hearing or speech impaired? Call us on the National Relay Service:
TTY users phone 13 36 77 then ask for 13 77 88. Speak and Listen users
phone 1300 555 727 and ask for 13 77 88.
Please note If you hold a Mobility Parking Scheme permit you may have
to supply a medical report before your licence is issued or renewed. This
will not be necessary if your licence is already subject to medical review
by Roads and Maritime.
A
Australian Migration Status (AMS) ImmiCard
UNCLASSIFIED
SENSITIVE: PERSONAL
Please note: If you answer Yes to any question from 10(a) and (b)
to 13 you may be required to provide a completed Roads and
Maritime medical form. Contact 13 77 88 to obtain a medical form.
Family name
Residential address (must be in NSW)
Customer details
1.
Postcode
Given name(s)
Pensioner / Interstate - eligible for a free licence or transfer?
Mailing address
Postcode
No Yes
5.
Give details
Have you ever been disqualified, prohibited or refused from
driving a motor vehicle/vessel or riding a motorcycle in NSW or
elsewhere?
What class of licence are you applying for?8.
State, Territory or Country
C
R
Licence number
LR
11. Have you ever had attacks or giddiness, blackouts, fainting or
other sudden periods of unconsciousness?
No Yes
Give details and bring the most recent
licence, or documentary proof with you.
Do you hold, or have you ever held, a licence or proof of such a
licence, issued by another State, Territory or Country?
7.
No Yes
First issue date For vehicle types
Expiry date
MR
Light rigid
Medium rigid
Car
Motor
cycle
HR
HC
MC
Multi combination
(B-double or road train)
Heavy rigid
Heavy combination
If it was issued by an Australian State or Territory it must be
surrendered. The issuing authority will be advised and the licence
destroyed.
If information needs to be verified, checks may take a number of
days.
if you have held your driver or motorcycle rider licence for less
than 3 years, you will receive a NSW provisional P1 or P2 licence.
(Motorcycle rider P2 exemptions may apply)
If you have held any other licence not already declared please
indicate the issuing State, Territory or Country.
You may be required to show
documentary evidence of this licence.
(Pensioner status must be validated online)
Date of birth
maleGender: female
Mobile number
Email address
Note:
you may be issued with a NSW provisional licence if your full first
issue date is not displayed on your licence or documentary proof.
Day Month Year
What is your last date
of entry in Australia
Are you an Australian citizen or a permanent resident of
Australia?
2.
No
Yes
you may be issued with a NSW learner licence if your overseas
licence cannot be validated.
Are you an Aboriginal person or Torres Strait Islander?
This question is optional. Do not tick either box if you do not
wish to answer it.
Answering this question is voluntary. Roads and Maritime may use
this information to develop driver licensing and vehicle registration
services for Aboriginal people. Roads and Maritime will not disclose
this information without your consent unless authorised by law.
3.
No
Yes
Day Month Year
No Yes
Day Month Year
Day Month Year
/ /
/ /
/ /
/ /
Evidence required. (Roads and Maritime may verify permanent
residency status online with the Department of Immigration
and Border Protection. For more information see our website).
Give details
Do you hold or have you ever held a licence to drive
or ride or a NSW Photo Card/Proof of Age Card in NSW in the
above name or in another name?
4.
Class of licence
Licence/Customer number
No
Yes
Expiry date
Other name
Day
Month
Year
/ /
6. Do you have a disqualification, cancellation, suspension or
pending charge against you in NSW or elsewhere or is your
licence subject to an appeal for driving, riding or Maritime
boating offences?
Give details
No Yes
Page 2 of 4Catalogue No. 45070018 Form No. 1001 (07/2019)
10. Do you have (a) diabetes?
(a) No
Yes
Controlled by:
Insulin (Oral medication
(eg tablets)
or (b) epilepsy?
Diet
(medical not required)
(b) No
Yes
(If different from your residential address.
Your licence card will be sent to this address)
Would you like a NSW Photo Card issued with your NSW driver
licence? (Fees may apply. Additional application form not required)
9.
5yr
No
Yes
10yr
UNCLASSIFIED
SENSITIVE: PERSONAL
14.
Do you have an eye or vision condition that may affect your
driving? eg monocular vision, double vision, visual field
defects, poor night vision.
If witnessed by a parent or guardian they must attend our
registry with you and show proof of their own identity.
Witness to applicant's signature19.
Required when you cannot provide an acceptable
proof of identity document that shows your signature.
Signature of applicant
Name of applicant (block letters)
Witness declaration
Signature of witness
Date
Daytime contact phone of witness
Business address of witness
(can be residential address of parent/guardian)
Name of witness (block letters)
Postcode
Position of witness - Employer / school principal / bank manager /
parent / guardian (cross out those not applicable)
I certify that the applicant, whose name and signature appears
above, has signed in the signature box above in my presence.
My personal information is being collected for verification of the
applicant's signature. It will be held by Roads and Maritime.
My witnessing of the applicant's signature is voluntary. My personal
information held by Roads and Maritime may be disclosed inside
and outside NSW to verify the contents of this application.
glassescontact lensesYes
Privacy Statement17.
We are collecting your personal and health information in connection
with your application for the issue of a driver licence, combined licence
or Photo Card and we may retain and use it for driver licensing, motor
vehicle, road safety, and marine legislation purposes. You are
required to provide this information under the Road Transport Act
2013 and we may refuse your application if you do not provide it. We
may disclose your health information to assess your application ot to
verify it. We may disclose your personal information in order to assess
your application or verify the information you provide. We may also
disclose your personal information in respect of inquiries about motor
accidents or marine accidents, and to other agencies responsible for
driver licensing, vehicle registration, marine management or vessel
registration and licensing. Other than described in this Statement we
will not disclose your personal or health information without your
consent unless authorised by law. Your personal and health
information will be held by Roads and Maritime Services and generally
you can contact us at www.rms.nsw.gov.au to access or correct it.
Provide an eyesight report from an optometrist or doctor.
No
Yes
No
Will you be wearing glasses or contact lenses when driving or
doing the eyesight test?
16. Does wearing prescription glasses or contact lenses correct or
control this condition?
No Yes
Day Month Year
Go to 16
/ /
15.
Go to 17
13.
What are they?
No Yes
Do you regularly use drugs (such as stimulants or drugs of
addiction) other than prescription medication, which may affect
your driving?
Page 3 of 4Catalogue No. 45070018 Form No. 1001 (07/2019)
12. Do you have any medical, physical or mental disabilities which
may affect your driving?
No
Yes
What are they?
Declaration and signature18.
Please read carefully before you sign. If you do not tell the truth you
can be fined. Any licence you hold could be cancelled.
• I declare that the contents of this application are true and correct
• I acknowledge that is is an offence under the Road Transport Act
2013 to seek to obtain or renew a driver licence by false statement
or dishonest means
Signature
NSW Photo Card issued
Interpreter's signature
Confirm identity - Applicant's signature Confirm identity - Applicant's signature
Confirm identity - Applicant's signature
Secondary proof
Stand-alone or primary proof
Document number
POI seen -
CSR Signature and Staff number
Stand-alone or primary proof
Passport/Visa - date of issue or E/D
Document number
Passport/Visa - date of issue or E/D
POI seen -
CSR Signature and Staff number
Proof of identity (must be produced with each visit)
Secondary proof - date of issue or E/D Secondary proof - date of issue or E/D
POI seen - CSR Signature and Staff number
Document number
Stand-alone or primary proof
Passport/Visa - date of issue or E/D
Secondary proof - date of issue or E/D
Parent or Guardian Proof of Identity
Type of Proof
Name of interpreter - if used
Eyesight test/Medical report
Driving test
Pass with glasses
or contacts
Pass without
glasses or contacts
Interpreter's signature
Knowledge Test / Hazard Perception Test / Driver Qualification Test (cross out whichever is not applicable)
Name of interpreter - if used
Testing officer's signature
Eyesight test given
Interpreter's authority Interpreter's authority
Confirm identity - Applicant's signatureConfirm identity - Applicant's signature
Test supervisor's signature and Staff number Test supervisor's signature and Staff number Test supervisor's signature and Staff number
Testing officer's signature Testing officer's signature
Issued licence
Licence issued - CSR Signature and Staff number
Licence number Type DateClass
Secondary proof Secondary proof
Date
Name of interpreter - if used
Interpreter's signature
Interpreter's authority
Confirm identity - Applicant's signature
NSW Photo Card
(No application form required)
Office Use - BUNDLE A
First NSW issue or Upgrade/Reissue
Eyesight/medical
report
Pass Fail DatePass Fail DatePass Fail
DatePass Fail DatePass Fail DatePass Fail
Page 4 of 4
Mailing address checked on DRIVES (if applicable)
Private
CSR Signature and Staff number
Commercial
Photo Comparison
No stored image
or not requested
MismatchedMatched
UNCLASSIFIED
SENSITIVE: PERSONAL
Form 1001 (07/19)
Cat No. 45070018
RMS ABN 76 236 371 088 Catalogue No. 45070018 Form No. 1001 (11/2011) Page 1 of 4
Page 1 of 4Catalogue No. 45070018 Form No. 1001 (11/2012) ABN 76 236 371 088
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A Licence Application (You must live in NSW (New South Wales)

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Completed 17 January 2021

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