UNCLASSIFIED
SENSITIVE: PERSONAL
Office use only
If the change is a change of name, the bus driver
authority must be surrendered when they receive their
new Bus Driver Authority card.
Customer number
Is new address displayed on driver licence?
day month year
/ /
Date
Updated by
Print name
Signature
I have listed all details of charges pending against me,
convictions recorded against me or proven offences
against me for any offence(s).
I am in possession of a valid Australian/New Zealand
passport, birth certificate or visa.
I am aware that any person who attempts to obtain a bus
driver authority by false statement, misrepresentation or
omission of details likely to affect such application, shall be
guilty of an offence and shall be liable to a penalty of up to
$2,200 and any authority issued may be cancelled.
I will comply with the Passenger Transport Act 1990 and
2014, associated regulations and conditions relevant to a
driver authority and understand that failure to do so may
result in my authority being suspended, cancelled or varied.
I consent for Transport for NSW to obtain any information it
requires to determine whether to grant, renew or cancel my bus
driver authority and to assess whether I am a fit and proper
person and of good repute. This may include (but is not limited
to) complaints, charges, convictions, traffic infringements and
driver licence suspensions and cancellations. I consent to third
parties (including but not limited to police, judiciary and licensing
authorities) releasing that information to Transport for NSW.
This consent continues and may not be revoked by me so long
as I hold (or apply for) a bus driver authority or while any legal
action is proposed against me in respect of a bus driver
authority including a suspended, cancelled or expired authority.
No
Yes
Since last obtaining your bus driver authority, have you
been disqualified, cancelled, suspended or is there a charge
pending against you or is your licence subject to an appeal
for driving or riding offences?
2.
Give details
No
Yes
Notification of Change of Details - Bus Driver continued
Since last obtaining your bus driver authority, have you
been found guilty or convicted by a court in NSW or
elsewhere or are there any charges pending against you for
any criminal offences?
3.
Give details
No
Yes
To obtain a New South Wales Bus Driver Authority you must
prove your identity. Please provide a copy of your Australian
Driver's licence.
We are collecting your personal and health information in
connection with your application for a driver authority under the
Passenger Transport Act 1990 and 2014 and may retain and
use it for the purposes of that Act and for driver licensing, motor
vehicle, road transport or road safety purposes. Providing this
information is voluntary but we may refuse your application
unless you do so.
We may disclose your personal information and health
information in order to verify it and to assess your application.
We may disclose your personal information in respect of motor
accidents enquiries and to other driver licensing and vehicle
registration agencies in connection with the administration of the
Passenger Transport Act 1990 and 2014. Otherwise we will not
disclose your personal or health information without your
consent unless authorised by law.
This Privacy Statement also applies in respect of your personal
and health information we may subsequently collect in relation to
your driver authority. Your personal and health information will
be held by Transport for NSW at 20-44 Ennis Road, Milsons
Point NSW 2061 and generally you can contact us to access or
correct it.
Important
Catalogue No. 45071814 Form No. 1713 (03/2020)
Page 2 of 2
Since last obtaining your bus driver authority, have you had
an application for a driver licence refused, or have you had
a bus driver authority cancelled, suspended or varied?
1.
Give details
No
Yes
I declare that:
I have read and understood all the information and
questions on this form and my answers and the information
provided by me are, to the best of my knowledge, true,
correct and accurate in every detail.
