Photo Identification Card Act 2008; Tow Truck Act 1973; Transport Operations (Marine Safety) Act
1994; Transport Operations (Passenger Transport) Act 1994; Transport Operations (Road Use
Management) Act 1995; Transport Planning and Coordination Act 1994
Release of Information Application
Page 1 of 2
TRB Forms Area
F2121 CFD V01 Apr 2019
Please use this form if you are applying for the release of information or
documents collected by the Department of Transport and Main Roads.
Fees may apply for some applications. Please refer to section 5 and to
www.qld.gov.au/transport for applicable fees, payable in Australian
dollars.
Applying for
driver licence, industry authority, Marine Licence
Indicator, Adult Proof
of Age (APA) card, or Photo Identification
(Photo ID) card information
You may apply for information about your driver licence, APA card,
Photo ID card, industry authority or Marine Licence Indicator, for example,
licence details and history. Your application for the release of industry
authority or marine licence information may not be considered at the time
of lodgement. If your application is approved, the information will be
sent to your mailing or email address. Information about your driver
licence including the type and class of licence you hold, and whether
your licence is valid (not expired, suspended or cancelled) is also available
online at www.qld.gov.au/transport.
Applying for your traffic history
You may apply for details of your traffic history relating to contraventions
for which you have been dealt with under the relevant Act, including the
recording of demerit points.
You may also apply for your traffic history online at
www.qld.gov.au/transport.
Applying for your marine licence information
You may apply for details of your marine licence or your marine history
relating to contraventions for which you have been dealt with under the
relevant Act. You may also apply for details of your marine licence online
at www.qld.gov.au/transport.
Applying for another persons information
If you are applying for information from another persons record, you
must have the written consent of that person. Your application will take
longer as the person whose information you are applying for must be
contacted by the department to confirm the consent given. This application
will be refused if the person whose information you are applying for
cannot be contacted during business hours.
Applying for a copy of a document
Please use form F4013 Application for Copy of Document Release Request.
/ /
3
Licence number/CRN
Day Month Year
Date of birth
Daytime contact phone number
(must be an Australian number)
Residential address
Postal address (if same as residential, write as above)
Postcode
Evidence of Identity (EOI) Requirements
You must give evidence of your identity. If you are applying in person,
you may do so by showing your Queensland driver licence, industry
authority, Marine Licence Indicator (conditions apply),
APA card or
Photo ID card. All cards must be current or expired by less than two
years.
If you are unable to show one of the above you will need to present
three other acceptable EOI documents. All documents must be originals.
If you are applying by mail (interstate, overseas and remote applicants
only) certified copies of EOI documents are acceptable. Refer to
www.qld.gov.au/transport.
For a full list of acceptable EOI, please refer to the Evidence of Identity
Requirements for Individuals (form F4362) or visit
www.qld.gov.au/transport.
Postcode
Can you show your Qld driver licence, industry
authority, Marine Licence Indicator, APA card or Photo
ID card?
Go to section 4
Category A (please print)
Category B (please print)
Have you changed your name?4
Category A or B (please print)
Change of name (please print)
Document number
(e.g. X0100011)
Document type
(e.g. Qld BDM issued Birth
Certificate)
Document number or expiry date
(do not give credit/debit card number)
Document type
Email address
Expiry date
(if applicable)
Document type (e.g. Medicare card)
Registration year
(e.g. 2010)
Document type
(e.g. Qld BDM issued
Marriage Certificate)
Document number
(e.g. 001000)
/ /
Are you applying for your own information or
documents?
1
Applicants details
Family name (please print)
Given name/s
2
Yes
No You are required to show three EOI documents (refer
to EOI Requirements for Individuals (form F4362))
Please provide details of your documents.
No
Yes You are required to show a change of name document.
Please provide details of your document.
No
Yes Please fill in sections 2 to 5 and section 8.
Please fill in all sections of the form.
Print Form
Reset Form
Privacy Statement: The department provides this form under the provisions of the
Acts nominated on this form so that you may apply for a copy of your own information
or documents or another persons information or documents that are held by the
department. The information, documents and digital photo collected for the purpose
of this application may be accessible by authorised departmental persons and
some of this information may be disclosed to the Queensland Police Service as
allowed under the relevant transport Acts or otherwise authorised under the Police
Powers and Responsibilities Act 2000. The department will not disclose your
information, documents, digitised signature or digital photo to any other third
parties without your consent unless required or authorised by law.
I declare that I have read all the answers I have given to the questions in
this application and that the answers are complete, true and correct in every
detail. 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
or documents for the purposes associated with my application as required
under the relevant transport Acts and the Photo Identification Card Act or
otherwise authorised by law.
I consent to the department verifying my EOI documents or information
provided by me with the issuing authority or their agencies.
Date
Applicants signature
8
It is an offence under the relevant Transport Act or the Photo Identification
Card Act to state anything or give a document to an authorised person if
you know it contains false or misleading information. Penalties apply.
Address history (fees apply)
Other information
Name history
(d)
Marine licence indicator details
(e)
Marine licence indicator
Marine licence indicator history
Current industry authority details
(f)
Industry authority
Industry authority history
Which category?
Dangerous goods driver
Driver trainer
Pilot vehicle driver
Tow truck assistant
Traffic controller
Driver Authorisation
Escort vehicle driver
Rider trainer
Tow truck driver
(g) Is this information or document required for a specific
period?
/ /
Period from
/ /
To
Town and country of birth
Details of the person whose information or documents
you are applying for
Family name (please print)
Given name/s
/ /
Day Month Year
Date of birth
Daytime Australian contact phone number
Residential address
Qld driver licence number
Postcode
6
Applicants declaration
I authorise the department to release information or documents relating
to my Qld driver licence, industry authority, Marine Licence Indicator,
APA card or Photo ID card to the person described in section 1 Applicants
details. I give permission for the authorising person to contact me to
verify any statement made by me in this application. I agree to give
any further information that the authorising person may ask for.
7 Driver licence, industry authority, Marine Licence
Indicator, APA card or Photo ID card holders
authorisation
Date
Card holders signature
Office use only
Date
Authorising persons signature
Date
Signature
Office stamp
What information or documents are you applying for?
(visit www.qld.gov.au/transport for applicable fees)
5
(a)
Driver licence details
(fees apply)
Driver licence
Driver licence history
(fees apply)
Traffic history (fees apply)
(b)
APA card details
APA card
Note: Go to section 8 if you are applying for your own information.
If you are applying for another persons information, sections 6 and
7 must be completed to provide their details and confirm their consent.
Page 2 of 2 TRB Forms Area F2121 CFD V01 Apr 2019
(c)
Photo ID card details
Photo ID card
No
Ye
s
Applicants details confirmed in TRAILS/TICA
Applicant
s EOI confirmed
1:1 match performed
Licence, industry authority, Marine Licence Indicator, APA card
or Photo ID card holder has been contacted and their statements
made on this form have been verified
Comments
Application approved
Comments
Application not approved
Application filed Document/File ID
Filing persons name
click to sign
signature
click to edit
click to sign
signature
click to edit
click to sign
signature
click to edit
click to sign
signature
click to edit
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