Declaration of Eligibility for a Registration …

1 UNCLASSIFIED SENSITIVE: PERSONALP lease tick the appropriate Registration concession box then sign the Declaration on page 2. Light vehicles up to tonnes Gross Vehicle Mass attract vehicle tax. Heavy vehicles over tonnes Gross Vehicle Mass attract Registration of Eligibility for a Registration ConcessionRegistration Plate NumberAmbulance Vehicle (AMBU)Light or heavy vehicle other than a government owned vehicle, specially constructed and solely used for carrying sick or injured persons. Concession does not entitle an operator to fit flashing lights and sirens. Only vehicles used solely by the Ambulance Service of NSW as defined under the Health Services Act 1997 or a vehicle delegated by the Ambulance Service of NSW under their delegated authority may be fitted with flashing lights and for people with a disability (HAND)Light or heavy passenger vehicle used solely for the work of conveying sick or injured (including intellectually or mobility impaired) people.

2 Vehicles registered to government agencies are not eligible. Goods vehicles are not eligible, for example utilities and Crane (MCRA)Light mobile crane not let for Rescue Vehicle (MINE)Light or heavy vehicle used solely for mine rescue work in accordance with the Coal Industry Act on page 2 Primary Producer Vehicle (PPG)Light or heavy vehicle used by a primary producer as defined under the Motor Vehicles Taxation Act 1988, or rural co-operative but not used or let for hire, and solely or principally forCarting primary leaves which another primary producer has gathered and from which eucalyptus or other oil is to be goods of any kind for use in a primary producers business or connected with the clearing of land to be used for primary possess one of the following forms of evidence of Eligibility for this concession and will provide it to Roads and Maritime Services if required:A Tax Averaging or Assessment Certificate (not more than two years old),A Declaration stating that you are a primary producer as defined by the Motor Vehicles Taxation Act 1988, signed by your tax agent or accountant (not more than 12 months old), or An energy grants credits scheme claim assessment (not more than two years old), provided the activity printed under Claims Details is shown as Agriculture, Forestry or 1 of 2 Note: Under the Motor Vehicles Taxation Act 1988, fish farmers and plantation forest cultivators are primary producers.

3 Commercial fishers and loggers are not primary producers under this legislation and are therefore not entitled to a primary producer Registration Certificate of Incorporation from the Office of Fair Trading (for rural co-operatives).NSW Driver licence/Customer numberSurname or Name of OrganisationGiven names (if applicable)DayMonthYearDate of birth (if applicable)Customer/Organisation detailsStatePostcodeAddressCivil Defence Vehicle (CIVL) / State Emergency Service (SES)Light or heavy vehicle used by a civil defence group, an industrial mutual aid group or a rescue organisation solely in connection with civil defence or rescue work arising from some general emergency or catastrophe such as drought, flood, fire or similar emergency. Vehicles must be registered in the name of the organisation controlling the work. Vehicles registered to government agencies, other than councils are not Concession Type (select appropriate) Fighting Vehicle (not Fire and Rescue NSW) (FIRE)Company-owned light vehicle - used solely for and in connection with the control of bush light vehicle - used for bush fire control, and may also be used for road maintenance repair and construction, but not for any other No.

4 45070829 Form No. 1193 (09/2015) ABN 76 236 371 088 ORSee attached Registration Plate Number Schedule Heavy vehicle used to carry goods, produce or passengers to or from another State or Territory, in accordance with the Interstate Road Transport Act Interstate Vehicle (FIRS, FIBS, FIPP)SignatureI understand that my personal information is being collected and held for Registration purposes by the Roads and Maritime Services 101 Miller Street, North Sydney NSW 2060. Roads and Maritime is collecting your personal information in relation to your application for a vehicle Registration concession and may retain and use it for driver licensing, motor vehicle, road transport and safety purposes. You are required to provide your personal information under road transport legislation and the Motor Vehicles Taxation Act 1988. We may refuse your application if you do not provide it. We may disclose your personal information to other driver licensing and vehicle Registration agencies, to assess your application or verify the information you provide, for inquiries about motor accidents, to confirm compulsory third party (bodily injury) insurance is current, to anyone proposing to acquire an interest in your vehicle and in respect of inquiries relating to stolen or abandoned vehicles.

5 Otherwise we will not disclose your personal information without your consent unless authorised by law. Roads and Maritime is subject to the Privacy and Personal Information Protection Act 1998 and the Health Records and Information Privacy Act 2002. Your personal information will be held with us at 101 Miller Street, North Sydney NSW 2060. You have the right to access and correct the information if you believe that it is incorrect. You declare that:SydneyNewcastleWollongongOther Transport DistrictTow Trucks with 'Crane and Hook' Body (TOW)Light vehicle constructed to Partially lift and tow other vehicles, but not carry other vehicles, and the vehicle will be garaged in: (please tick the appropriate Transport District)School Student Driver Education Vehicle (SCHL)Light vehicle used solely or principally by a Government school or a registered non-Government school for the purpose of driver education of Life Saving Club Vehicle (SURF)Light or heavy vehicle used on road or road related areas solely to transport surf rescue vehicle used solely for:the construction, maintenance or repair of roads or bridges; orremoval of garbage or night soil; and isa self-propelled plant;a roadwork plant trailer.

6 Ora trailer used to carry roadwork General (RDWK)Police Youth Club Vehicle (POLC)Light vehicle owned by a Police Youth Club and used solely for Police Youth by a Council, Park or Cemetery Trust (RDWK)Light vehicle owned by a Council, Park or Cemetery Trust and used solely for or in accordance with the:construction, maintenance or repair of roads, bridges or cemeteries including supervising such work; or removal of garbage or night soil; orrolling or maintenance of tennis courts, cricket pitches, lawns or pathways; or improving the surface of the ground or similar work and is not let for / Organisation vehicle used substantially for private purposes and modified to allow wheelchair access and to transport them safely and securely (eg hoists, anchor points, additional doors etc). A compliance certificate issued by a licenced certifier on Roads and Maritime's Vehicle Safety Compliance Certification Scheme is also Modified Vehicle (PRIV, with vehicle condition code V88)Light truck or trailer used solely for the functions of Local Land Lands Protection Board Vehicle (PAST)Page 2 of 2 Catalogue No.

7 45070829 Form No. 1193 (09/2015) ABN 76 236 371 088 You are eligible for the will notify us within 14 days if your concession Eligibility understand that we have the right to require that you provide evidence that you are eligible for the concession and that failure to provide the required evidence may result in vehicle tax or Registration charge being payable by you; or the Registration being suspended or cancelledUnder road transport legislation, it is an offence to attempt to register or renew the Registration of a vehicle by false statement or any misrepresentation or other dishonest meansUNCLASSIFIED SENSITIVE: PERSONAL