UNCLASSIFIED
SENSITIVE: PERSONAL
Page 1 of 2
Application for a Passenger Transport Licence Code
for NSW Driver Licence Holders
Catalogue No. 45072066 Form No. 1844 (03/2021)
Family name
Residential address (must be in NSW)
Customer details
1.
Postcode
Given name(s)
Mailing address
Postcode
2.
Give details
Have you ever been disqualified, prohibited or refused from
driving a motor vehicle or riding a motorcycle in NSW or
elsewhere?
Date of birth
Mobile number
Email address
Day Month Year
No Yes
/ /
(If different from your residential address)
9.
glassescontact lensesYesNo
Will you be wearing glasses or contact lenses when driving?
8.
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?
Please note: If you answer Yes to any question from 4 to 10 you
may be required to provide a completed Transport for NSW
medical form. Contact 13 22 13 to obtain a medical form.
3. 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 offences?
Give details
No Yes
Do you have an eye or vision condition that may affect your
driving? eg poor visual acuity, monocular vision, double vision,
visual field defects, poor night vision.
No Yes
10.
6. Have you ever had attacks or giddiness, blackouts, fainting or
other sudden periods of unconsciousness?
No Yes
4. Do you have diabetes?
No
Yes
Controlled by:
Insulin (Oral
medication
(eg tablets)
Diet
(medical not
required)
Important. Please read the following carefully
Disclosure Consent and Declaration11.
Signature
Date
Day Month Year
/ /
Driver licence number
Do you have epilepsy?
No
Yes
5.
Do you have any medical, physical or mental disabilities which
may affect your driving?
7.
No
Yes
What are they?
Consent. You consent to Transport for NSW exchanging Relevant
Information with Relevant Organisations in connection with
Transport for NSW and those Relevant Organisations carrying out
their obligations and functions under Relevant Legislation. You
agree that your consent remains valid so long as you apply for or
hold a driver licence with a passenger transport code. “Relevant
Information” includes (but is not limited to) charges, convictions,
traffic infringements, complaints, suspensions or cancellations of
licences and licence details relevant to your eligibility to provide a
passenger service or community transport/small vehicle service as a
driver. “Relevant legislation” means road transport law and
includes (but is not limited to) the Passenger Transport Act 2014 and
the Point to Point Transport (Taxis and Hire Vehicles) Act 2016.
“Relevant Organisations” include (but are not limited to) booking or
taxi service providers, community transport providers or small
vehicle service providers, the Point to Point Transport
Commissioner, police, the judiciary, and other driver licensing or
passenger transport authorities whether or not in NSW.
Declaration. You declare that the information on this form is true
and complete. Under road transport legislation it is an offence for
anyone to attempt to obtain or renew a driver licence by false
statement or dishonest means.
Please note: Drivers of public passenger vehicles are required to
meet the commercial eyesight standards set out in the Assessing
Fitness to Drive Guidelines published by Austroads and the National
Transport Commission (
http://www.austroads.com.au/drivers-
vehicles/assessing-fitness-to-drive). As the holder of a passenger
transport licence code, you will be required to pass an eyesight test
at the commercial level on renewal of your driver licence and you will
be limited to a 5 year licence term. Prior to your next licence
renewal, you should make your own enquiries or consult your GP or
optometrist about your ability to meet the required eyesight standard.
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 manage it, by reading our privacy statement at
www.transport.nsw.gov.au/privacy-statement or phone 13 22 13
to request a copy.
