Fillable Driver Licence Application/Renewal (Department of the Environment and Energy)

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Driver Licence Application/Renewal (Department of the Environment and Energy)

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  • 14 check-boxes
  • 89 other fields

Country of origin: AUSTRALIA
File type: PDF

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Are you eligible for a Queensland (Qld) Driver Licence?
To be eligible for a driver licence in Qld you must:
• prove your identity using original documents
• be a resident of Qld
• disclose medical conditions that may adversely affect your ability to
drive safely.
You are not eligible to make this application if your licence is
suspendedoryouaredisqualiedfromdrivinginanyAustralianstate
or territory or any other country.
The information you provide in this document must be true and
correct otherwise the licence granted to you will be void and you may
be prosecuted for providing false or misleading information.
If your application/renewal is approved, your licence will be mailed to
you. This may take up to 2 weeks. You will receive a Driver Licence
Receipt today which will allow you to drive until you receive your
licence.
Please PRINT clearly in dark pen (do not use pencil or erasable ink)
1. Personal details
Family name
Given name/s
Date of birth
/ /
dd mm yy
Town, state and country of birth
Residential address
Postcode
Postal address (if same as residential address, write ‘as above’)
Postcode
Daytime contact phone number
Email address
2. Previous name or aliases
Do you currently hold or have you ever been issued a Qld driver
licence, industry authority, marine licence, adult proof of age card
or vehicle/vessel registration, in any other name? (e.g. name at
birth, maiden name, previous married names, adoptive name, or
other aliases)
YesNo
Provide details below
Previous family name
Previous given name/s
3. Evidence of identity (EOI) and Qld residency
Can you show your Qld Driver Licence, Industry Authority,
Marine Licence (with photo) or Adult Proof of Age card that is
current or expired less than 2 years ago?
Go to 4.
Licence/reference number
If you cannot show identication listed above, you must provide:
3 EOI documents + evidence of Qld residency. At least 1 EOI
document must show your signature.
(For a full list of acceptable EOI documents please see Evidence of
Identity Requirements for Individuals (form F4362) or visit www.qld.gov.au)
All EOI documents must be ORIGINAL and include:
1 category A + 2 category B OR 2 category A + 1 category B.
b.
a.
Category A
(e.g. passport, birth certicate, Australian photo driver licence)
Document Type Document number (e.g. X0100011)
Category B (e.g. Medicare card)
Document Type Expiry date (if applicable)
Category A or B
Document Type Document number or expiry date
Evidence of Qld residency address (e.g. bills for phone, electricity, rates)
Document Type Issue date
4. Is your name different from the name on your current
driver licence or EOI documents above?
YesNo You must show an EOI change of name document
Document Type Document number Issue date
/ / dd mm yy
/ / dd mm yy
Change of name document
(e.g. Australian change of name certicate)
5. Do you have a driver licence issued by another
Australian state or territory or country?
Fill in details below. If you have a licence
issued by another Australian state or territory,
you must surrender it to be eligible for a Qld
driver licence.
Licence/reference number
Effective date
/ /
dd mm yy
State/territory/country of issue
Expiry date
/ /
dd mm yy
Licence type
(e.g. L/P/O) Licence class/es (e.g. C/LR/MR)
6. Licence type and class
Learner
P
P1
P2
Open
Licence Type Licence Class
Car
Car (Automatic
Condition)
Motorbike
Learner Approved
Motorbike
Light Rigid
Medium Rigid
Heavy Rigid
Heavy Combination
Multi-combination
C
CA
RE
R
LR
MR
HR
HC
MC
What type/class of licence(s) are you renewing or applying for?
Are you applying for a licence or class of licence that you held
more than 5 years ago?
You must provide evidence of your previous licence
TRB_LC&A Page 1 of 2 F3000 V01 Dec 2016
YesNo
YesNo
YesNo
(do not give credit/debit card number)
(e.g. C0100011)
Driver Licence Application/Renewal
(Learner, P1, P2, P type and Open Licence)
Transport Operations (Road Use Management) Act 1995
Transport Planning and Coordination Act 1994
Male (M)
Female (F)
Gender:
Note: An evidence of identity document linking your previous
name and your current name may be required.
Print Form
Reset Form
Reason for cancellation/disqualication
7. Medical Condition Reporting
Do you need to wear glasses/contact lenses for driving?
S condition will be shown on your licence
Do you have any of the following conditions? Check each statement.b.
a.
TRB_LC&A Page 2 of 2 F3000 V01 Dec 2016
You must report any medical condition/s that may adversely
affect your ability to drive.
No Yes
Vision or eye disorder (other than wearing glasses
or contact lenses) that may adversely affect your
driving
Diabetes that requires treatment by tablet, insulin or
other medication
Been diagnosed with epilepsy, experienced a
seizure; or been required to take anti-epileptic
medication after the age of 11
Any other medical condition/s that is likely to
adversely affect your ability to drive safely
If you have answered Yes to any statement at 7b, you must
provide a Medical Certicate for Motor Vehicle Driver (form F3712)
completed by your treating doctor.
8. Trafc history
Have you currently, or within the last 5 years, had your licence
cancelled or been disqualied from driving or obtaining a driver
licence by an Australian or overseas court?
Provide details below
a.
State/territory/country
Duration
Reason for suspension
Is your licence currently suspended for any reason including
speeding offences, demerit points, unpaid nes or any other
reason?
Provide details below
b.
State/territory/country Duration
9. Court Orders - restricted licence
Have you been granted a current court order for any of the
following? Check each statement.
No Yes Code
A drink or drug driving conviction X1
Special Hardship Order (SHO) X3
An order allowing you to drive until your drink or
drug driving charge is heard in court
X4
If you have answered Yes to any of the above, you will need to
show your court order/s. The relevant code will be shown on your
licence. You must comply with the court order and carry it with you
when driving.
Privacy statement: The Department of Transport and Main Roads (the
department) collects this information under the provisions of the Transport
Operations (Road Use Management) Act and Transport Planning and
Coordination Act so that you may apply for a Qld driver licence. The department
may disclose this information to interstate and foreign driver licensing authorities,
and the Queensland Police Service (QPS). Your digital photo may also be
released to the QPS. The department’s card production contractor will have
controlled access to your information, digitised signature and digital photo to
make your card. Information, including your digital photo or digitised signature,
may be disclosed to an authorised agency if the information is connected to
an application for its product. Your information will not be disclosed to any
other third party without your consent, unless required or authorised by law.
10. Applicant’s declaration
Sign only in the presence of an authorised person.
I declare that I have read the answers I have given to the
questions in this application and that the answers are complete,
true and correct in every detail.
If undertaking a practical driving test, I declare that I have the
consent of the registered operator to use the vehicle for the test.
I also declare that the registered operator has given consent for
any Driving Examiner employed by the department or any Police
Ofcer, to drive the vehicle during or in connection with the test
undertaken in the vehicle, if required.
I understand that if I have stated anything that is false or
misleading, the driver licence granted to me as a result of this
application will be absolutely void and have no legal effect
whatsoever.
I understand that I may be prosecuted for giving or stating any
false or misleading information or documents.
I consent to the department taking, keeping and using my
personal information, documents, digital photo and digitised
signature for the purposes associated with my application.
I consent to the department verifying my EOI or evidence of
previous licence provided by me with the issuing authority or their
agencies.
Additional declaration by interstate or overseas licence holders.
I understand that by signing this declaration I agree to the
surrender of my interstate driver licence.
I also consent to the department releasing information about
my application for a Qld licence to the issuing authority or their
agencies.
Applicant’s signature
Date
/ /
dd mm yy
It is an offence under the Transport Operations (Road Use Management)
Act 1995 to state anything or give a document to an authorised person
if you know it contains false or misleading information. The maximum
penalty may be more than $7000.
Authorising person’s checklist
EOI sighted - address and details current on system
S or M conditions checked/added/amended
M condition reported - F3712 attached if required
Court orders/restrictions - sighted and copies attached, codes added
O/S - licence/documents sighted, copied and attached if required
O/S - translations of O/S document copied and attached if required
Application Approved / Refused
Comments by authorising person
Authorising person’s declaration
I have witnessed the applicant’s signature and checked that it
matches the applicant’s evidence of identity which I have sighted.
Signature
Authorising person’s name
Ofce stamp / date
YesNo
YesNo
YesNo
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Driver Licence ApplicationRenewal (Department of the Environment and Energy)

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Completed 28 July 2020

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