Application for Concession (Form C1)

1 Government of Western AustraliaDepartment of TransportVEHICLE LICENCE CONCESSIONThe appropriate pensioner Concession card and/or letter from the pension provider must be produced for you to be eligible for a is a list of the documentation that must be presented when making Application for a motor vehicle of Veterans Affairs (DVA) concessions if you are applying for a refund you may be required to provide a letter from DVA confirming the date of MOTOR VEHICLE LICENCE Concession APPLIES TO ONLY ONE OF THE FOLLOWING:1.

2 A car or bus with an unloaded mass not exceeding 3000 kg;2. a goods vehicle with an unloaded mass not exceeding 3000 kg;3. a motor propelled caravan (mobile caravan);4. a motor cycle; or5. a moped as defined in the Road Traffic (Authorisation to Drive) Regulations ConcessionTo be eligible for a 100% vehicle licence fee Concession (exemption) and exemption from vehicle licence duty you must hold one of the following: Letter from Centrelink stating you are receiving the maximum rate of pension and one of the following: Centrelink Pensioner Card (blind); or Centrelink Disability Support Pension Card; or Centrelink Pensioner Card (carer).

3 Or one of the following: Letter from DVA certifying the applicant has been assessed at 60 or more impairment points under the Military Rehabilitation and Compensation Act 2004 (MRCA); or DVA Veteran Card (Gold) printed with TPI or EDA or a letter confirming the applicant is in receipt of or eligible for the Special Rate of disability pension either under the MRCA or the Veterans Entitlements Act 1986 (VEA).Note: if the applicant was entitled to the maximum rate of Disability Support Pension prior to the Age Pension, a Concession Entitlement Verification (E113) form endorsed by Centrelink (Services australia ) must also be ConcessionTo be eligible for a 50% vehicle licence fee Concession you must hold one of the following: Pensioner Concession Card issued by Centrelink or DVA; or WA Seniors Card and commonwealth Seniors Health Card issued by Centrelink or DVA (both cards must be presented).

4 DRIVER S LICENCE CONCESSION100% ConcessionTo be eligible for a 100% Concession on your driver s licence you must present one of the following cards: Pensioner Concession Card issued by Centrelink or DVA and in receipt of the Age Pension; WA Seniors Card and commonwealth Seniors Health Card issued by Centrelink or DVA (both cards must be presented); DVA Veteran Card (Gold) printed with TPI or EDA or a letter confirming the applicant is in receipt of or eligible for the Special Rate of disability pension either under the MRCA or the ConcessionTo be eligible for a 50% Concession on your driver s licence you must present one of the following cards: Pensioner Concession Card issued by Centrelink or DVA.

5 WA Seniors Photo Card ConcessionThe Concession on your driver s licence will be applied to your future photo card Application for Concessionpenalties and your vehicle may not be OF BIRTHCONCESSION DETAILSCONCESSION INFORMATIONAPPLICANT declare that I am in receipt of theI declare that the information on this form is true and correct. I understand that under the Road Traffic (Administration) Act 2008, it is an offence to provide false or misleading information. I consent to checks being carried out to confirm my ongoing entitlement to concessions, and will report any changes to my eligibility.

6 * Concession can only be applied to one vehicle at one Concession CARDCard numberDate of grantExpiry dateCOMMONWEALTH SENIORS HEALTH CARDCard numberDate of grantExpiry dateWA SENIORS CARD (Driver s licence only)Card numberCONCESSION Application TYPECard numberDate of grantExpiry datePENSIONER Concession CARDFAMILY NAMEFIRST NAME/SPHONE NUMBEREMAIL ADDRESSDATE//WASUBURBRESIDENTIAL ADDRESSSTATEPOST CODEVEHICLE LICENCE*DRIVER S LICENCEWhen blank, this form is classed as OFFICIAL, when completed, this form is classed as OFFICIAL SENSITIVEThe information you supply on this form will be used to confirm your entitlement to a Concession .

7 With legislative authority, the information on this form may be disclosed to other government agencies. The Chief Executive Officer of the Department of Transport also releases aggregated statistical information to third parties. However, your personal identifying information will not be released to these persons without your explicit consent. See the General Information on the back of the form for where you can present this form. If your Concession entitlement is reduced or withdrawn, you must notify the Department of Transport immediately.

8 If you continue to claim Concession rates on a vehicle and you are no longer entitled to that Concession , the vehicle licence will be deemed invalid. The continued use of the vehicle on any road will be in contravention of the Road Traffic (Vehicles) Act 2012. You may be fined, required to pay additional Last updated: form may be presented at any Drivers and Vehicles (DV) centre, regional Department of Transport (DoT) centre or agent. Visit for location information. Alternatively, it can be posted along with certified/witnessed copies of the front and back of your Concession cards and any other documentation relevant to you to: Driver and Vehicles, GPO Box R1290, Perth WA certifying/witnessing your Concession cards must qualify or currently be employed in one of the following professional or occupational groups.

9 Academic (post-secondary Local Government CEO or Deputy institution)CEO Accountant Local Government Councillor Architect Loss Adjuster Australian Consular Officer Marriage Celebrant Australian Diplomatic Officer Member of Parliament (State or BailiffCommonwealth) Bank Manager Minister of Religion Chartered Secretary Nurse Chemist Optometrist Chiropractor Patent Attorney Company Auditor or Liquidator Physiotherapist Court Officer (Judge, Magistrate, PodiatristRegistrar or Clerk) Police Officer Defence Force Officer Post Officer Manager(Commissioned, Warrant or NCO Psychologistwith 5 years continuous service) Public Notary Dentist Public Servant (State or DoctorCommonwealth)

10 Electorate Officer of a member of State Parliament Real Estate Agent Engineer Settlement Agent Industrial Organisation Secretary Sheriff or Deputy Sheriff Insurance Broker Surveyor Justice of the Peace Teacher Landgate Officer Tribunal Officer Lawyer Veterinary SurgeonOr, any person before whom, under the statutory Declarations Act 1959 of the commonwealth , a statutory declaration may be USE ONLYGENERAL INFORMATIONVEHICLE LICENCE Concession CHECKLISTSOCIAL 100% CONCESSIONS CODE 411 Letter from Centrelink stating the applicant is receiving the maximum rate of pension and one of the following:Centrelink Pensioner Card (Blind)Centrelink Disability Support Pensioner CardCentrelink Pensioner Card (Carer)Photocopy of card(s) attachedOr one of the following.