Fillable Application for Replacement/Certied Copy of Drivers Licence, Learners (Services Australia)

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Application for Replacement/Certied Copy of Drivers Licence, Learners (Services Australia)

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Services Australia, (previously DHS - Department of Human Services) is responsible for delivering services relating to health and welfare of Australian citizens. It processes payment of child support other services.

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Government of Western Australia
Department of Transport
Last updated: 21/04/2021
DL26
Application for Replacement/Certified Copy of
Driver’s Licence, Learner’s Permit or Learner Log Book
If your driver’s licence has been stolen, you do not need to pay for a replacement if it has been reported to the Western Australia Police Force (WAPF) and you
provide the police report number (this is not applicable for learner’s permit cards and Log Books). To register your intention for organ donation, call Medicare
Australia on freecall 1800 777 203.
Credit card Authorisation (only required if posting this form) * Required elds
CARDHOLDER NAME *
CARD NUMBER *
CREDIT CARD
TYPE *
EXPIRATION DATE *
BILLING ADDRESS *
CITY * STATE/PROVINCE * POST CODE * COUNTRY *
PHONE NUMBER * EMAIL ADDRESS
I authorise the Department of Transport to charge my credit card in the amount of: $
(refer to www.transport.wa.gov.au for current fees)
PRINTED NAME * SIGNATURE * DATE *
Visa Mastercard
Department of Transport sta/agents ONLY to detach the below credit card authorisation slip from this form.
Your credit card details will be securely destroyed once your payment has been processed.
ORIGINAL LICENCE/PERMIT/LOG BOOK
Stolen (complete declaration)
Destroyed,
damaged or lost
Change of
details
REPLACEMENT REQUIRED
Driver’s licence
Learner’s permit Learner Log Book
LICENCE HOLDER DETAILS
STATUTORY DECLARATION (DRIVER’S LICENCE ONLY)
You can renew your driver’s licence up to 6 months early. If you are eligible,
do you authorise the Department of Transport to charge a renewal payment
to your credit card? (only available when posting with below authorisation).
YES NORenewal period 1 YEAR 5 YEARS
DATE OF BIRTH
/ /
FAMILY NAME
FIRST NAME/OTHER NAMES
PHONE
EMAIL
LICENCE/PERMIT NUMBER (if known)
RESIDENTIAL ADDRESS
SUBURB
STATE
POST CODE
W A
POSTAL ADDRESS
SUBURB
STATE POST CODE
DATE
/ /
SIGNATURE OF APPLICANT
FAMILY NAME
FIRST NAME/OTHER NAMES
sincerely declare that to the best of my knowledge, my driver’s licence has
been stolen and reported to WAPF.
of
WESTERN AUSTRALIAN POLICE INCIDENT REPORT NUMBER
Signature of declarantDeclared at
DECLARED BEFORE ME
Witness Surname Other names
Occupation Signature
See IMPORTANT INFORMATION section for who can witness a Statutory
Declaration.
This declaration is true and I know that it is an oence to make a declaration
knowing that it is false in a material matter.
This declaration is made under Oaths, Adavits and Statutory Declarations
Act 2005.
A certied copy will be issued at no charge if the driver’s licence has
been stolen in WA and a WAPF incident report number provided.
I,
DATE
/ /
RESIDENTIAL ADDRESS
SUBURB
STATE POST CODE
OCCUPATION
When blank, this form is classed as OFFICIAL, when completed, this form is classed as OFFICIAL SENSITIVE
The Learner Log Book must be applied for in person at any Driver and Vehicle
Services (DVS) centre, regional Department of Transport (DoT) centre or
agent.
LODGING YOUR APPLICATION BY POST
(GPO BOX R1290, Perth WA 6844)
To lodge your application by post you must also supply the following:
• Certied copies of primary and secondary proof of identication
(information on acceptable proof of identity documents can be located
online at www.transport.wa.gov.au).
• WA Police incident report number - for stolen driver’s licence documents
only.
• Payment for lost, damaged and replacement cards and documents.
This form may be presented at any Driver and Vehicle Services (DVS) centre,
regional DoT centre or agent along with primary and secondary identication.
Visit our website at www.transport.wa.gov.au for locations.
More information is available online at www.transport.wa.gov.au or call
13 11 56.
IMPORTANT INFORMATION
PROOF OF IDENTITY CHECK
PRIMARY
SECONDARY (specify)
DVS CENTRE/AGENT
SIGNATURE
NEW LOG BOOK NUMBERPREVIOUS LOG BOOK NUMBER
OFFICE USE ONLY
DATE
Your personal driver’s licence information, photograph, and vehicle licence
information may be used, or disclosed to a third party, where authorised
under ‘road law’ (as dened in the Road Trac (Administration) Act 2008),
or Commonwealth law or in compliance with a Court Order issued within
Australia. Your personal details may also be disclosed to other driver
licensing authorities to assess your application or verify any information you
have provided.
/ /
Birth certicate Citizenship
Previous licence document Passport
Naturalisation document Immigration document
Proof of Age card/WA Photo Card
The declaration must be made before any of the following persons:
Or, any person before whom, under the Statutory Declarations Act 1959 of
the Commonwealth, a statutory declaration may be made.
• Academic (post-secondary
institution)
• Accountant
• Architect
• Australian Consular Ocer
• Australian Diplomatic Ocer
• Baili
• Bank Manager
• Chartered Secretary
• Chemist
• Chiropractor
• Company Auditor or Liquidator
• Court Ocer (Judge, Magistrate,
Registrar or Clerk)
• Defence Force Ocer
(Commissioned, Warrant or NCO
with 5 years continuous service)
• Dentist
• Doctor
• Electorate Ocer of a member of
State Parliament
• Engineer
• Industrial Organisation Secretary
• Insurance Broker
• Justice of the Peace
• Landgate Ocer
• Lawyer
• Local Government CEO or Deputy
CEO
• Local Government Councillor
• Loss Adjuster
• Marriage Celebrant
• Member of Parliament (State or
Commonwealth)
• Minister of Religion
• Nurse
• Optometrist
• Patent Attorney
• Physiotherapist
• Podiatrist
• Police Ocer
• Post Ocer Manager
• Psychologist
• Public Notary
• Public Servant (State or
Commonwealth)
• Real Estate Agent
• Settlement Agent
• Sheri or Deputy Sheri
• Surveyor
• Teacher
• Tribunal Ocer
• Veterinary Surgeon
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Application for ReplacementCertied Copy of Drivers Licence, Learners (Services Australia)

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Completed 9 April 2022

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