Queensland Garaging Address Statement
Transport Operations (Road Use Management) Act 1995
This form should be used if a vehicle’s principal depot or base of operations is in Queensland, and the registered operator is unable
to provide proof of a Queensland garaging address.
LTSR Forms Area Form F4408 CFD V01 Jul 2020
1. Personal details
2. Vehicle details
3. Reason for completing form:
Family name (Please print)
Vehicle identication number (VIN)/Chassis number
Make/Body shape
Registration number
Given name/s
Customer reference number (CRN)
Date of birth
/ /
I reside in Queensland but I am not the property owner/
rentee/tenant of the property where I garage my vehicle.
I am a displaced person (without a home) residing in
Queensland and do not have a permanent Queensland
garage address.
I am a traveller from interstate/overseas and do not have
a permanent Queensland garage address.
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Go to 4
Go to 4
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5. Garage address
6. Verication of garage address
The following statement must be completed by a person who:
• is at least 18 years of age
• r e s i d e s a t / o w n s t h e p r o p e r t y a t q u e s t i o n 5
and
- holds a Queensland driver licence
or
- can provide evidence of identity and proof that they
reside at the garage address
Verifying person’s statement
I give permission for the:
• person making this statement to garage their vehicle
mentioned in question 2 at my address mentioned at
question 4 which I own/reside at
• authorising ofcer to contact me for further information
about this statement and access my driver licence
record (if applicable) to conrm the information provided
by me in this statement.
Verifying person’s signature
Date
It is an offence to give false or misleading information under
the Transport Operations (Road Use Management) Act.
Maximum penalty may exceed $7500.
It is an offence to give false or misleading information under
the Transport Operations (Road Use Management) Act.
Maximum penalty may exceed $7500.
Sign 7 in front of verifying person (if applicable)
7. Personal statement
• I declare that the vehicle listed in section 2 has its
principal depot or base of operations in Queensland.
• I declare that the information I have provided in this
statement is complete, true and correct in every detail.
• I understand that failure to provide complete, true and
correct information in this statement may result in my
statement being refused.
• I authorise the authorising ofcer to make any enquiries
considered necessary to verify the information provided
by me in this statement.
• I will notify the Department of Transport and Main Roads
(TMR) within 14 days if my garage address changes.
Signature
Date
Privacy statement: TMR is collecting the information on this form for the
purposes of maintaining TMR’s vehicle registration register, as required under
the Transport Operations (Road Use Management) Act. Where required, TMR
or its agents/contractors may give some or all of this information to vehicle
insurers, statutory entities, insolvency entities, lawyers, persons involved
in vehicle incidents/accidents, vehicle manufacturers, third parties who are
involved in or intend to commence various legal proceedings, tolling entities,
law enforcement agencies and to or through interstate registering authorities.
Your personal information will not be disclosed to any other third party without
your consent, unless authorised or required to do so by law.
4. Queensland contact address
(e.g. friend, shelter, relative)
Given name/s
CRN (if applicable)
Daytime phone number
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Verifying person’s details
Family name (Please print)
YesStatement approved?
No
Ofce use only
Authorising person’s signature
Date
/ /
Authorising person’s name
click to sign
signature
click to edit
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click to sign
signature
click to edit
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