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

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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 Home Affairs.
The following documents issued by the Department of Home Affairs:
List 1
List 2
a current Certificate of Identity
A Transport for NSW 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must display a card number and not have been revoked or be reported as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.)
To get a New South Wales licence you must prove your identity. You can use your current Transport for NSW 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.
All documents from list 1 and list 2 must be originals and at least one of them must show your signature. Copies, certified copies and laminated
documents are not acceptable.
Your name should be the same on both documents. Your gender should be the same on both documents, if gender is shown.
If you do not have a document showing your signature you must complete question 18 on this form. Your photo will be stored on the Transport for NSW
database.
An Australian full birth certificate showing parental details issued by an
Australian Registry of Births, Deaths and Marriages.
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 Transport for
NSW with or without a photo.
A current Transport for NSW 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 (03/2021)
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 Transport for NSW
will only accept those issued by the NSW Registry of Births, Deaths
and Marriages)
Divorce document bearing the name reverted to
A 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
An ImmiCard from list 1
Your identity and change of name documents should show a clear link
between your names.
All documents must be originals. Copies, certified copies and laminated
documents are not acceptable.
Translations
If a document is not in English it must be accompanied by an official
translation from Multicultural NSW (previously Community Relations
Commission of NSW) or the Translating and Interpreting Service of the
Department of Home Affairs.
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
roads-maritime.transport.nsw.gov.au.
Permanent Australian residency must be supported by acceptable
documentary evidence or verified online by Transport for NSW. 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. 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 roads-
maritime.transport.nsw.gov.au, call us on 13 22 13 or contact a service
centre. Hearing or speech impaired? Call us on the National Relay
Service: TTY users phone 133 677 then ask for 13 22 13. Speak and
Listen users phone 1300 555 727 then ask for 13 22 13.
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 Transport for NSW.
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 Transport
for NSW medical form. Contact 13 22 13 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. Transport for NSW may use
this information to develop driver licensing and vehicle registration
services for Aboriginal people. Transport for NSW 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. (Transport for NSW may verify permanent
residency status online with the Department Home Affairs. 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 (03/2021)
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 signature18.
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 Transport for NSW.
My witnessing of the applicant’s signature is voluntary. My personal
information held by Transport for NSW may be disclosed inside and
outside NSW to verify the contents of this application.
glassescontact lensesYes
Declaration and Signature17.
It is a criminal offence under Part 5A of the Crimes Act 1900 to
provide false or misleading information to Transport for NSW.
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 (03/2021)
12. Do you have any medical, physical or mental disabilities which
may affect your driving?
No
Yes
What are they?
• 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
Personal Information Collection Notice
Transport for NSW is committed to protecting your privacy and
ensuring your personal and health information is managed according
to law. Find out why we collect your personal information, including
how we use and mange it, by reading our privacy statement at
www.transport.nsw.gov.au/privacy-statement or phone 13 22 13
to request a copy.
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 (03/21)
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 28 February 2022

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