Application for Registration - NSW Government

1 Application for Registration C. Office use only Check the back page for a guide to applying to register a vehicle. Plate number issued/allocated Attachments 1 Is the vehicle to be registered in the name of: 3 Corporation's details a person If the vehicle is being registered in the name of a corporation, the Representative's Authority must be filled in. a corporation now go to 3 For a company, the Director or an authorised delegate must complete and sign the Representative's section. In the 2 To register a vehicle in your name you must be at least 16 case of an incorporated association, it is the public officer years of age for a light vehicle ( tonnes GVM or less) who must sign.

2 In all cases, the authorised representative and at least 18 years of age for a heavy vehicle ( more must provide proof of their identity. than tonnes GVM). NSW Driver licence/Customer number Customer number (if issued). Surname Name Given names Business address Legal and renewal notices will be sent to the residential address below unless an alternative mailing address is nominated. You must notify Service NSW of your new residential and mailing address within 14 days of moving. Residential address State Postcode Mailing address for legal or renewal notices State Postcode Mailing address (If different from residential address.)

3 State Postcode All mail will be posted to this address). ABN (if applicable). State Postcode ACN, ARBN or other Date of birth (Evidence of incorporation required see page 4). day / month / year ABN (if applicable). 4 Courtesy name (only an organisation name can be recorded, if required). Gender male female Please provide your email address if you would like to register for an online service account, go to service. 5 Fleet manager or leasing company (if applicable). for more information. To be completed only if the legal or renewal notices are to Email address be mailed to the fleet manager Name and postal address of manager (for Registration renewals or legal notices).

4 Please provide a mobile number if you would like to receive communications from Service NSW this way Mobile number State Postcode Have you previously conducted business with Transport for NSW in another name? If 'Yes' please Customer number specify. To record a courtesy name go to 4, if the vehicle is to be leased or managed go to 5, if not go to 6. Catalogue No. 45070093 Form No. 1009 (09/2021) OFFICIAL: Page 1 of 4. ABN 18 804 239 602 Sensitive - Personal (when completed). 6 Is the vehicle new? 13 Declaration no WARNING: Any person who by false statement of yes now go to 8 misrepresentation obtains or attempts to obtain a certificate of Registration is liable to a penalty that may be in excess of $2,200.

5 7 Was the vehicle last registered in NSW? You declare that: no The information on this form is true and complete yes Last Registration number (if known) If the vehicle has Special Number Plates you have read and accept the Number Plates Terms and Conditions for Special Number Plates available at any service centre or on the myplates website if possible, present a previous certificate of Under road transport legislation, it is an offence to attempt to Registration with this form register or renew the Registration of a vehicle by a false statement or any misrepresentation or other dishonest means. 8 Purchase/Acquisition details Signature Date of purchase/acquisition day / month / year Print name and capacity ( if representing an organisation).

6 Sale price or market value (whichever is higher). 9 Vehicle's garage address (where the vehicle will most often be kept) Date day / month / year Personal Information Collection Notice Transport for NSW is committed to protecting your privacy and State Postcode ensuring your personal and health information is managed 10 Type of use intended for the vehicle according to law. Find out why we collect your personal information, including how we use and manage it, by reading our privacy Private used substantially for social, statement at or pleasure or domestic purposes phone 13 22 13 to request a copy. Business business use unless covered by In addition, where your Application concerns Special Number Plates another usage then we will also use your Personal Information in connection with the operation of our Special Number Plates business and we may Rental a motor vehicle which is let out disclose your Personal Information to any Concessionaire for hire without a driver appointed by us to manage our Special Number Plate business to second hand vehicle held for allow the Concessionaire to manage the Special Number Plate Resale business.

7 If the Special Number Plates attract an Annual Fee, we or resale by licensed motor dealers our Concessionaire, may send you Special Number Plate customer Demonstrator demonstration vehicle used by service information and marketing information unless you elect to licensed motor dealers opt-out. To opt-out please notify the Special Number Plates Concessionaire using the contact us information available at Accreditation or licence is required for the following: Taxi plate type T or TC OFFICE USE ONLY - BUNDLE C. Long distance tourist plate type TV Dealers and service centres only or charter service Mailing address checked on DRIVES (if applicable).

8 Regular passenger plate type MO or M/O. service Proof of identity record Person Hire Car plate type HC Stand-alone or primary proof Private Hire Vehicle general issue plate Tow truck operators licence is required for the following: Document number Tow Truck plate type TT. Other - please specify ( ambulance, road works, stand by taxi etc) Secondary proof (if necessary). 11 For heavy vehicles over tonnes GVM what is the Corporation ACN or ARBN verified from: (specify document). Nominated Configuration Code? (See nominated configuration code at roads-waterways. ). 12 Do you wish to apply for a Registration concession? (For example: pensioner, primary producer, charitable organisation).

9 No yes You must prove that you are eligible and may be asked to sign a separate declaration. Catalogue No. 45070093 Form No. 1009 (09/2021) OFFICIAL: Page 2 of 4. ABN 18 804 239 602 Sensitive - Personal (when completed). Verified by: Total number of seated Signature persons (including the driver) Number of doors Name Number of standing persons* Overall axle space Dealer number or service centre *(only required if the bus is to be used to carry standing passengers). ADR / category code Axle code Vehicle identification VIN or chassis/frame number Tow truck lift capacity Trailer brakes: power power Engine number assisted (A) operated (O).

10 Unassisted (U) mechanical (M). vacuum (V) exempt (E). Compliance date Approval number Measuring device/speed limiter details month / year Make Model year Fittings Model (In full - Name, Letters and/or Numbers and Variant). Conditions Colour(s). Shape Vehicle details inspected/certified correct: Note: shape BUS applies if Signature vehicle seats 10 or more (including driver). Inspection report details Certification permit/Examiner number Inspection report number AIS number Certified by dealer representative that vehicle details are Vehicle specifications correct and vehicle is suitable for safe use Specification sheet number DRIVES model code (if available) This vehicle is suitable for safe use and meets the requirements of road transport legislation.