Fillable Photo Card Application (Services Australia)

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Photo Card Application (Services Australia)

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The Photo Card Application (Services Australia) form is 2 pages long and contains:

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Services Australia, (previously DHS - Department of Human Services) is responsible for delivering services relating to health and welfare of Australian citizens. It processes payment of child support other services.

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Government of Western Australia
Department of Transport
PC1
Photo Card Application
Issued under the
Western Australian Photo Card Act 2014
Last updated: 03.09.2020
APPLICATION TYPE
ADDITIONAL CARD
CERTIFIED COPY
CARD WITH RESIDENTIAL ADDRESS
REPLACEMENT CARD
NEW APPLICATION
CARD WITHOUT RESIDENTIAL ADDRESS
Reason for replacement/certied copy:
LOST STOLEN
DAMAGED NOT PRODUCED
SURRENDERED
BUILD SLIM
MEDIUM SOLID
GENDER Supporting documents required
when gender X is selected,
refer to the DoT website.
MALE FEMALE X
HEIGHT CM
NATURAL HAIR COLOUR
EYE COLOUR
COUNTRY OF BIRTH
If you hold a concession, complete the section below and present your
concession card/s at the time of application.
The concession details will also be applied to your WA driver’s licence.
WA SENIORS CARD NUMBER
COMMONWEALTH SENIORS HEALTH CARD NUMBER
PENSIONER CONCESSION CARD NUMBER
APPLICANT SIGNATURE
It is an oence to give false or misleading information. Penalties will
be enforced under the Western Australian Photo Card Act 2014 and
Western Australian Photo Card Regulations 2014.
Applicants should be aware that there is no obligation on an institution to
accept the Photo Card for proof of identity purposes.
It is a requirement under s.6 of the Western Australian Photo Card Act 2014
that a signature is provided for use on the Photo Card unless the applicant
is unable to sign because of permanent disability. If you are unable to
provide a signature because of a permanent disability, the declaration on the
back of this form must be completed by a person who has reached the age
of 18 years.
FIRST NAME
OTHER NAME/S
FAMILY NAME
DECLARATION
I,
declare that the information provided in this application is true and
correct.
DATE
/ /
DATE OF BIRTH
/ /
MOBILE PHONE
HOME PHONE
WORK PHONE
EMAIL ADDRESS
RESIDENTIAL ADDRESS (MUST BE IN WA)
SUBURB
POST CODESTATE
W A
POSTAL ADDRESS (IF DIFFERENT TO RESIDENTIAL ADDRESS)
SUBURB
POST CODESTATE
APPLICANT DETAILS
When applying for a Photo Card, you must attend a Driver and Vehicle Services (DVS) centre, regional Department of Transport (DoT) oce or
regional agent in person and provide relevant proof of identity documents (see overleaf). Visit www.transport.wa.gov.au/licensing for locations.
The Photo Card is valid for ve years. Applicants must be over the age of 16 to be eligible.
VETERANS’ AFFAIRS GOLD CARD - ENDORSED TPI OR EDA
VETERANS’ AFFAIRS PENSIONER CONCESSION CARD*
*Where the holder is of pension age a 100% concession will apply.
Where the holder is not of pension age a 50% concession will apply.
You must advise the Department of Transport in writing if your
concessional entitlement is reduced or withdrawn. Written
correspondence to be mailed to Driver and Vehicle Services, GPO Box R1290
Perth WA 6844.
IF YES DETAIL YOUR PREVIOUS/OTHER NAME/S
HAVE YOU EVER BEEN KNOWN BY ANY OTHER NAME?
(e.g. name at birth, maiden name, previous married names, alias, adoptive
name or foster name)
YES
NO
WA LICENCE NUMBER
PERSONAL DETAILS
CONCESSION DETAILS
DECLARATION
When blank, this form is classed as OFFICIAL, when completed, this form is classed as OFFICIAL SENSITIVE
DECLARATION SIGNATURE REQUIREMENTS
OFFICE USE ONLY
DECLARANT FIRST NAME
DECLARANT OTHER NAME/S
DECLARANT FAMILY NAME
I,
declare that
APPLICANT FIRST NAME
APPLICANT OTHER NAME/S
APPLICANT FAMILY NAME
is unable to provide a signature for use on the Photo Card due to a permanent
disability.
I declare that the information I have given on this form is true and correct and
I am aware that it is an oence to give a false or misleading statement under
the Western Australian Photo Card Act 2014.
PROOF OF IDENTITY
To be eligible for a Photo Card you are required to show proof of your identity.
A combination of ve original documents must be presented to verify your full
name, date of birth and current residential address. You must supply original
documents; certied copies will not be accepted. One document must show
your signature.
Holders of an existing WA driver’s licence, WA learners permit or WA Photo
Card will not be required to provide full proof of identity (POI) when applying
for a photo card.
A full list of acceptable identication documents are available online at
www.transport.wa.gov.au/licensing.
IMPORTANT INFORMATION: Your personal driver’s licence information,
photograph, and vehicle licence 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), or Commonwealth law or in compliance with
a Court Order issued within Australia. Your personal details may also be
disclosed to other driver licensing authorities to assess your application or
verify any information you have provided.
A
C C D D
OPTION 2
• 1 document from Category A
• 2 from Category C and
• 2 from Category D
OPTION 1
• 1 document from Category A
• 1 from Category B
• 2 from Category C and
• 1 from Category D (not DL69)
A
B C C D
PROOF OF IDENTITY REQUIREMENTS FOR AN INITIAL APPLICATION
MUST BE MET. (WA driver’s licence/learners permit/Photo Card not held)
I have checked that the applicant has met the proof of identity requirements
and have attached copies of all documents provided. The applicant’s
signature has also been veried.
DECLARANT SIGNATURE
DATE
SIGNATURE
DATE
/ /
SITE
OFFICER’S NAME
All other applicants must supply 1 document from Category A and C
or 1 document from Category B.
A
C B
OR
/ /
Concession Code (A, P or S)
WA Seniors Card sighted
Concession Type (A, H or V)
Commonwealth Seniors Health Card sighted
Pensioner Concession Card sighted
Concession details entered on record
Photocopy of card(s) attached
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Photo Card Application (Services Australia)

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Completed 2 November 2020

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