Government of Western Australia
Department of Transport
To create a DoTDirect account, the applicant/nominated Primary Delegate must Commonwealth law or in compliance with a Court Order issued within Australia.
provide primary and secondary proof of identity and/or Australian Company
Your personal details may also be disclosed to other driver licensing authorities
Number (ACN), Certicate of Registration of a Company’ issued by the Australian
to assess your application or verify any information you have provided.
Securities and Investments Commission or any other certicate of incorporation.
A DoTDirect organisation account can only be issued to an organisation as
Refer to Proof of identity requirements on www.transport.wa.gov.au/dvs.
dened in s.57A of the Corporations Act 2001 (Cth).
Your personal driver’s licence information, photograph, and vehicle licence
Refer to www.transport.wa.gov.au/dotdirect for registration process.
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),
ORGANISATION DETAILS
MOBILE PHONE
PHONE
EMAIL ADDRESS
RESIDENTIAL ADDRESS
SUBURB
SUBURB
POST CODE
POST CODE
STATE
STATE
POSTAL ADDRESS (IF DIFFERENT TO RESIDENTIAL ADDRESS)
FAMILY NAME
FIRST NAME
OTHER NAME/S
DOTDIRECT DETAILS
DATE OF BIRTH
/ /
OFFICE USE ONLY
Verifying applicant was contacted and conrmed completing
declaration
Applicant details conrmed
TYPE OF POI
OFFICER OFFICER SIGNATURE
DATE
/ /
Last updated: 24.05.2019
APPLICANT DETAILS
ORGANISATION NAME
E111
DoTDirect Organisation Application
GENDER
*Supporting documents required when gender
X is selected, refer to DoT website
Male Female X*
Do you have an existing DoTDirect account?
If yes, provide user name below
YES
NO
If no, nominate a DoTDirect account ‘user name’ below.
USER NAME (PREFERRED) ALTERNATE USER NAME
You may be contacted if the user names are unavailable.
APPLICANT/DELEGATE DECLARATION
I certify the information provided in this application is true and correct.
I understand that the provision of false or misleading information in
this application is an oence. Under s.127 of the Corporation Act 2001,
I have the authority to act on behalf of the organisation listed in this
application and submit this application on their behalf.
SIGNATURE
DATE
/ /
ORGANISATION TYPE
Company
Incorporated body
AUSTRALIAN
COMPANY NUMBER (ACN)
REGISTERED BUSINESS NAME AUSTRALIAN BUSINESS NUMBER
PRINCIPAL PLACE OF ORGANISATION (NOT PO BOX)
SUBURB
POST CODE
STATE
MOBILE PHONE
PHONE
EMAIL ADDRESS
A primary delegate is the main contact person for the organisation, who can
access the organisation account through their personal DoTDirect account.
Once the DoTDirect account is created the primary delegate can add other
users to the account.
Are you giving consent to act as the primary
YES NO
delegate on behalf of the organisation listed?
APPLICANT SIGNATURE
PRIMARY DELEGATE
/ /
DATE
/ /
ORGANISATION DIRECTOR SIGNATURE
DATE
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