Fillable Vehicle Modication Application (Department of the Environment and Energy)

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Vehicle Modication Application (Department of the Environment and Energy)

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The Vehicle Modication Application (Department of the Environment and Energy) form is 3 pages long and contains:

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Country of origin: AUSTRALIA
File type: PDF

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Vehicle modier details
Vehicle owner details (only if different than vehicle modier)
Vehicle details
Address
Address
Postcode
Postcode
Telephone number
Telephone number
Page 1 of 3 TRB Forms Area Form F1854 CFD V01 Apr 2016
continued page 2...
Vehicle Modication Application
(Transport Operations (Road Use Management) Act 1995
Name
Name
Registration number
VIN or Chassis number
Shape (utility, sedan, wagon and so on)
Make
Engine number
Month and year of manufacture
Model
/
Preferred response method: Post Email
Email address
This form is to be used when applying for approval to modify a light vehicle (a vehicle with a Gross Vehicle Mass (GVM) or
Aggregate Trailer Mass (ATM) not exceeding 4.5 tonnes) in a way not provided for in an approved code of practice.
For modications to heavy vehicles (vehicles with a GVM or ATM over 4.5t) please contact the National Heavy Vehicle Regulator
(www.nhvr.gov.au).
This application is to be completed by the person modifying the vehicle
Modifying a vehicle, using or permitting a modied vehicle to be used without approval from the Director-General, Department of
Transport and Main Roads is a breach of the Transport Operations (Road Use Management) Act.
Engine capacity
cc
Fuel type: Petrol Diesel LPG
Natural Gas Other (specify)
Tare mass
kg
Gross vehicle mass (GVM)
kg
Gross combination mass (GCM)
kg
Print Form
Reset Form
Page 2 of 3 TRB Forms Area Form F1854 CFD V01 Apr 2016
continued page 3...
Vehicle Modication Application continued... Page 2 of 3
Proposed modication details
All the sections below must be completed. For items which are not to be modied and are standard as tted by the manufacturer,
show as Standard
þ
Chassis/frame/body
Standard
Modied
Provide details
Suspension Front
Standard
Modied
Provide details
Rear
Standard
Modied
Provide details
Axles Front
Standard
Modied
Provide details
Rear
Standard
Modied
Provide details
Brakes Front
Standard
Modied
Modied to?
Rear
Drum
Disc Make/model
Standard
Modied
Modied to?
Drum
Disc Make/model
Steering Front
Standard
Modied
Provide details
Wheel rims Front
Standard
Modied
Provide details Width
mm
Diameter
mm
Rear
Standard
Modied
Provide details Width
mm
Diameter
mm
Specify)
Tyres Front
Standard
Modied
Rear
Track
(Note: track is
measured from
the
centre of
tread on one
tyre to the
centre of
tread on the
opposite tyre)
Front
Standard
Modied
Provide details Width
mm
Rear
Standard
Modied
Provide details Width
mm
Specify)
Standard
Modied
Wheelbase
Standard
Modied
Provide details Standard
mm
Modied
mm
Transmission
Standard
Modied
Provide details
Page 3 of 3 TRB Forms Area Form F1854 CFD V01 Apr 2016
Vehicle Modication Application continued... Page 3 of 3
Engine
Standard
Modied
Replaced
Provide details
Provide details of donor vehicle
Manufacturer Model
Year of manufacture Number of cylinders/rotors
Engine capacity
cc
Fuel type: Petrol Diesel LPG
Natural Gas
Other (specify)
Engine number
Additional information
Privacy Statement: The Department of Transport and Main Roads collects the information on this form under the Transport Operations (Road Use Management) Act to
assess your application for approval of a modication. This information may be released by the department or its agents/contractors to parties such as vehicle insurers,
statutory/insolvency entities, lawyers, persons involved in vehicle accidents/incidents and to or through interstate registering authorities. The information is accessible
by authorised departmental ofcers and your personal information will not be disclosed to other third parties without your consent unless authorised or required by law.
Declaration
I hereby declare the information provided on this form, and any supporting information provided, to be true and correct.
Date
/ /
Signature of applicant
Business name (if applicable)
This completed form can be emailed to vehiclestandards@tmr.qld.gov.au or sent to:
Vehicle Standards
Department of Transport and Main Roads
PO Box 673
Fortitude Valley, Qld 4006
For further information visit the Department of Transport and Main Roads website at www.tmr.qld.gov.au.
Ofce Use Only
Date received File reference number
/ /
Incoming reference
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Vehicle Modication Application (Department of the Environment and Energy)

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Completed 22 July 2020

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