Fillable of Registration Application Vehicle/Queensland Regulated Ship Cancellation (Department of the Environment and Energy)

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of Registration Application Vehicle/Queensland Regulated Ship Cancellation (Department of the Environment and Energy)

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The of Registration Application Vehicle/Queensland Regulated Ship Cancellation (Department of the Environment and Energy) form is 2 pages long and contains:

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  • 5 check-boxes
  • 60 other fields

Country of origin: AUSTRALIA
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Vehicle/Queensland Regulated Ship Cancellation
of Registration Application
Residential/Organisation’s address
Postcode
Postal address (if same as above write ‘as above’)
Postcode
If you are cancelling a vehicle, dealer plate or trailer trade plate go to section 2
If you are cancelling a ship, go to section 3
Vehicle Identication Number/Chassis number
Was the vehicle assessed by an insurer? (Vehicle only)
No
Insurer
If the vehicle is less than 16 years old, complete Written-o Vehicle Notication -
Individual (Form F4069) to determine if the vehicle is to be recorded on the written-o
vehicle register. Complete sections 6 (if applicable) and 7.
Cancellation date for a vehicle may be backdated to the day after the accident or event only if:
• Documentation from an ocial source (for example, Insurer or Police) is provided conrming the date of the accident or event; and
• Section 7 is completed, conrming that the vehicle has not been used on a road since the accident or event; and
• Written-o Vehicle Notication - Individual (form F4069) has been completed (only if the vehicle has not been assessed by an insurer).
Cancellation date for a ship is taken only on the day of the submission of the form.
Ship registration numbers
It will be necessary to ensure that the ship registration numbers are removed and that the following declaration is completed.
I/We declare that the registration numbers have been removed from the hull.
/ /
continued over page...
1. Registered operators details
Family/Organisation’s name
Given name/s
Transport Operations (Road Use Management) Act 1995, Transport Operations (Marine Safety) Act 1994
2. Vehicle details
Vehicle make/model (for example, Ford Falcon)Registration number
Go to section 4
3. Ship details
Registration number Ship manufacturer Engine number/s
Signature of person who removed the registration number Date
Accident or event (e.g. ood, re)
• Number plates: Number plates must be surrendered upon cancellation except if you are cancelling due to COVID-19. If you are cancelling
due to COVID-19 and you intend to re-register your vehicle at a later date, you should remove your number plates from the vehicle and
securely store them to be reattached when you re-register. The Department of Transport and Main Roads will customise your number plates
free of charge to facilitate this process. If you do not intend to re-register your vehicle, you should securely dispose of your number plates. If
you do not dispose of your plates securely and they are reattached to a vehicle, any camera-detected oences or toll infringements will
be sent to you as the last registered operator.
• Number plate conscation notice: A vehicle currently under a Number Plate Conscation Notice issued by the Queensland Police Service,
cannot be cancelled during the conscation period. Please contact the Queensland Police Service prior to lodging your application.
• Lodging your application: You can lodge your completed form by email to regocancellations@tmr.qld.gov.au or mail to Department of
Transport and Main Roads, Vehicle Cancellations, PO Box 372, LONGREACH QLD 4730. If you intend to cancel the registration of more
than 5 vehicles, complete this form once for the rst vehicle and send an attachment with all of the vehicle details as outlined in Question 2
to regocancellations@tmr.qld.gov.au. Please ensure your postal address provided to TMR is up to date prior to lodging your application as
all cancellations requested by email will be refunded by cheque. You must not use the vehicle after you have lodged your application for
cancellation. There are signicant nes for driving an unregistered vehicle.
• Direct Debit: If this vehicle is enrolled for Direct Debit, it is your responsibility to ensure the vehicle/ship is removed from the scheme prior
to the cancellation of registration.
Registered operator request
Vehicle re-registered in Queensland/Interstate
4. Reason for vehicle/ship cancellation
Claim number (if known)
Email address Mobile/Telephone number
Go to section 4
For vehicles - Complete sections 6 (if applicable) and 7.
Yes
Ship was stolen
Complete section 7.
Vehicle was stolen
Complete sections 5, 6 (if applicable) and 7.
TRB Forms Area F3517 V01 Jul 2021
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Privacy Statement: The Department of Transport and Main Roads collects information on this form to administer the register of vehicles under the Transport Operations (Road
Use Management) Act 1995 and ships under the Transport Operations (Marine Safety) Act 1994. This information may be used and released by the department under the
provisions stated in these Acts and Regulations. Your personal information will not be disclosed to other third parties without your consent unless authorised or required by law.
2
Yes
Note: This form can only be submitted after 31 days from the date of theft to allow for the vehicle recovery.
Date theft reported to police
/ /
No Yes Date of recovery Report or reference number
/ /
Were the number plate/s recovered?
The vehicle registration is being cancelled but the personalised/customised plates are being retained.
Number of plate/s surrendered?
Have full requirements been met?
Vehicle/Ship Registration cancelled from _____ /_____ /_____
5. Stolen Vehicle (complete if vehicle)
Has the vehicle been recovered?
6. Personalised/customised plate/s (to be completed for personalised/customised plate/s only, tick applicable statement)
User Id ____________________ Refund amount____________________
Oce use only
1
No
Initials ________________
It is an oence to give false or misleading information under the Transport Operations (Road Use Management) Act 1995.
Maximum penalty may exceed $7000.
First registered operator CRN ________________________ Second registered operator CRN (if applicable)_________________________
A police ocer must complete and stamp the section below.
Cancellation date can be back-dated to the day after theft reported.
No Yes
I hereby certify that the details shown are correct and the vehicle details are consistent with the vehicle reported stolen.
Police ocer’s name
Station (place ocial stamp here)
/ /
Rank and number Date
If you are attaching the plates to another vehicle, you must complete a Remove and/or Attach Personalised/Customised Plates Application
(form F2964).
The registration and the plates are being cancelled. All plate owner/s must sign below.
Note: If the personalised/customised plate/s have been taken by the Queensland Police Service as the vehicle is currently under a
Number Plate Conscation Notice, you cannot attach these plate/s to another vehicle during the conscation period.
7. Statement - This section must be completed (tick all that are applicable)
I/We declare that the vehicle/ship registration that I am cancelling was validly paid.
The reason for the cancellation is that the vehicle was written-o as a result of an accident or event and the cancellation date is to be
backdated. I/We declare that the vehicle has not been driven on the road since the accident or event.
One or both plate/s have been:
All information provided in this document is true to the best of my/our knowledge.
Destroyed
StolenLost
/ /
Signature of registered operator/s (in the case of joint registered operators - at least one must sign)
Date
If the refund is to be issued by EFTPOS/Credit Card:
I conrm that all requirements have been met to issue an electronic refund.
Verifying Operator’s Username_______________________________ Verifying Operator’s Signature_______________________________
When personalised/customised plate/s are in joint names both signatures are required.
/ /
Signature/s of personalised/customised plate/s owner/s
Date
Written-o vehicle disposed of by Insurer to Auction House and I am unable to access the vehicle to retrieve the number plates.
I intend to re-register the vehicle at a later date and would like to customise my standard plates so that I can retain them for
re-registration. Customised plates cannot be transferred or sold.
I do not intend to re-register the vehicle and have securely disposed of the plates myself.
or
or
Number plates
The reason for the cancellation is due to the COVID-19 emergency.
Vacant plates (not attached to a vehicle) are being cancelled. All plate owner/s must sign below.
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of Registration Application VehicleQueensland Regulated Ship Cancellation (Department of the Environment and Energy)

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Completed 17 March 2022

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