Government of Western Australia
Department of Transport
FIRST NAME
OTHER NAME/S
FAMILY NAME
POSTAL ADDRESS (IF DIFFERENT TO RESIDENTIAL ADDRESS)
SUBURB
POST CODE
STATE
SUBURB
POST CODE
STATE
W A
RESIDENTIAL ADDRESS (WA RESIDENTIAL ADDRESS ONLY)
OFFICE USE ONLY
RECEIVING OFFICER NAME
RECEIVING OFFICER SIGNATURE
SIGNATURE
(For organisations/companies this must be signed by company director,
secretary or authorised representative).
FIRST NAME
OTHER NAME/S
FAMILY NAME/COMPANY NAME
Do you hold any of the following:
WA driver’s licence, learner’s
permit or Photo Card
NUMBER
WA Recreational
Skipper’s Ticket card
NUMBER
Please list all vehicles, including trailers, licensed in your name. If there is
insucient space to list all vehicles please attach a separate sheet. If you
have the ‘Right to Display’ optional plates these details should be provided.
Original documentary evidence supporting a change of name, gender
or date of birth must be provided and must be presented in person.
Please refer to the website www.transport.wa.gov.au/licensing for details of
documentary evidence required for change of name, date of birth and gender.
If a boat registration or skipper’s ticket number has been provided CSO must
email to boat@transport.wa.gov.au, fax form to (08) 9435 7817.
Documentation supporting change of name, gender or DOB attached?
DATE OF BIRTH
//
The following boats are registered in my name:
BOAT REGISTRATION NUMBER
Change your address online at www.transport.wa.gov.au/licensing.
A DoTDirect online account is a free personalised account where you are able
to manage information relating to your vehicle licence, driver’s licence and boat
registration, as well as pay all bills associated with these licences.
Log in or register today at www.transport.wa.gov.au/dotdirect.
POSTAL ADDRESS: GPO BOX R1290, PERTH WA 6844.
IMPORTANT: The information you supply on this form may be disclosed to other
government agencies where provided for in legislation. The Chief Executive
Ocer of the Department of Transport also releases aggregated statistical
information to third parties. However, your personal identifying information will
not be released to these persons without your explicit consent.
DATE
/ /
DATE OF BIRTH
/
/
Last updated: 02.08.2019
MAKE
PLATE NUMBER
MAKE
PLATE NUMBER
MAKE
PLATE NUMBER
SITE
DATE
/ /
ORGANISATION/COMPANY *IF APPLICABLE
To change an organisation/company address, this form must be signed by
the company director, secretary or authorised representative. To change a
company name, a ‘Certication of Registration on Change of Name’ from the
Australian Securities and Investment Commission (ASIC) must be submitted.
DOCUMENT
NUMBER
DOCUMENT
NUMBER
Note: If you hold a WA rearm licence, you must also advise Western
Australia Police of your change of personal details by completing the
Change of Personal Details form available from the Western Australia
Police website.
AUSTRALIAN COMPANY NUMBER (ACN)
ORGANISATION CODE
TO BE COMPLETED WHERE A CHANGE OF NAME, GENDER OR
DATE OF BIRTH IS REQUIRED.
EMAIL ADDRESSCONTACT NUMBER
NEW DETAILS
PREVIOUS DETAILS
DETAILS TO BE CHANGED
APPLICATION FOR REPLACEMENT DOCUMENT
ORIGINAL LICENCE/PERMIT
Change of details
Destroyed/damaged or lost
REPLACEMENT REQUIRED
Driver’s licence
Learner’s permit
MAKE
PLATE NUMBER
C4
Change of Personal Details
GENDER
Male Female X
GENDER
Male Female X
If you like to receive an SMS or email when your
driver’s licence or vehicle licence/s are near expiry
please select one or both options.
EMAILSMS
Only applicable when attending a DVS Centre.
REPRESENTATIVE’S NAME
