MR22 Application for Client Concession - SA.GOV.AU

1 MR22. Application FOR Client Concession 07/19. Incapacitated Ex-Serviceperson, Incapacitated Person, Pensioner 1. About the applicant PLEASE USE BLOCK LETTERS. Surname Given Names Client / Licence Number Date of Birth / /. Residential (Home) Address Number and Street Mobile or daytime phone number Suburb / Town Postcode Email address Postal Address (if different to above address). Suburb / Town Postcode 2. Does this Application for Concession apply to a: (Not applicable to vehicles with an unladen mass or Driver's Licence and / or Registered Vehicle, Cycle or Trailer GVM greater than 4500kg). Plate number of your vehicle/cycle Plate number of your trailer/caravan 3. About the Concession Read other side for full details Which Concession applies to you?

2 (Please indicate by ticking and completing where necessary). Pensioner Commonwealth Card Number To claim Concession you must provide your Pension Card number at the time of lodging this Application . Concession can apply to only ONE vehicle or cycle and ONE trailer or caravan registered in your name. To qualify for Concession you must receive a pension and hold a COMMONWEALTH Pensioner Entitlement Card entitling you to travel on public transport at reduced fare. Please write your Concession card number in box above. Are you applying for exemption from stamp duty on Insurance only? (Go to Part 4) Yes No Incapacitated Ex-serviceperson Concession not applicable to trailers or caravans 1.

3 Are you receiving from the Commonwealth a pension relating to repatriation for total incapacity, or 70% of Yes No the rate for total incapacity, by reason of impairment of your power or locomotion? (if yes go to Part 4). 2. Are you totally and permanently incapacitated, blind or have you lost a leg or foot? (if yes go to Part 4) Yes No For your initial Application , you will be required to produce a Gold Card' issued by the Department of Veteran's Affairs (DVA) endorsed with TPI' or EDA'. Alternatively, a letter of confirmation from DVA is required as per the following: If pension is issued under the Veterans' Entitlements Act 1986 letter confirming you are in receipt of a pension at a rate of 70% or more for total incapacity; or If pension issued under the Military Rehabilitation and Compensation Act 2004 a letter confirming you have been assessed at 50 or more impairment points.

4 Incapacitated Person Concession not applicable to trailers or caravans Are you, as a consequence of the loss of the use of one or both legs, permanently unable to use public transport? (if yes go to Part 4) Yes No For your first Concession , a letter from a medical practitioner confirming the loss of use of one or both legs, and your permanent inability to use public transport is required. Parent / Legal Guardian of Incapacitated Child Concession not applicable to trailers or caravans 1. Are you the parent or legal guardian of a child, aged under 16, who, in consequence of the loss by the child Yes No of the use of one or both of his/her legs, is permanently unable to use public transport?

5 2. Will the vehicle described above be wholly or mainly used for transporting the child? Yes No (if you answered yes to the above questions go to Part 4). A letter from a medical practitioner advising of the person's loss of use of one or both legs and their inability to use public transport is required. 4. Declaration and consent by applicant I declare that the information supplied in making this Application is correct and that I am entitled to the Concession under the related conditions of the Motor Vehicles Act described overleaf. I further declare that my vehicle will not be used outside these conditions, unless a balance of the fee is paid. I authorise the Department of Planning, Transport and Infrastructure (DPTI) to verify my entitlements to a Concession with Centrelink/Department of Veterans' Affairs and understand my personal information, including my name and Concession card number, will be used to confirm my eligibility for a Concession .

6 This consent, once signed, remains valid while I am a customer of DPTI unless I withdraw the consent in writing or by any other electronic means. I can get proof of my details from the Department of Human Services so that my eligibility can be determined. If I withdraw my consent or do not provide proof of my details, I may not be eligible for a Concession . Personal signature of applicant Date Office Commencement Date / / Use Only / /. Lodge at any Service SA customer service centre Telephone Enquiries: 13 10 84 Post to: Service SA, GPO Box 1533, Adelaide SA 5001 ABN 92 366 288 135. CHECK CONDITIONS BELOW FOR YOUR ENTITLEMENT TO Concession . The following concessions are not applicable to vehicles with an unladen mass or manufacturer's GVM greater than 4500kg.

7 registration . INCAPACITATED PERSONS. EXEMPTION FROM PAYMENT OF stamp duty ON THIRD PARTY INSURANCE AND VALUE. A person who registers a vehicle under the conditions described in Section 38 or 38AB of the Motor Vehicles Act ( ). is automatically exempted from payment of stamp duty on the value of the vehicle and on the Third Party Insurance. The exemption applies to ONE VEHICLE ONLY registered in the person's name. INCAPACITATED EX-SERVICE PERSON ( ) INCAPACITATED PERSON. Section 38B ( rebate) Section 38B (50% rebate). (1) If the Registrar is satisfied by such evidence as the Registrar (1) If the Registrar is satisfied by such evidence as the Registrar requires that - requires that the owner of a motor vehicle is - (a) a motor vehicle is owned by a person who has been a member of a (a) in consequence of the loss of the use of one or both legs, naval, military, or air force of Her Majesty; and permanently unable to use public transport.

8 And (b) the owner, as a result of service in a naval, military, or air force, is totall (b) the motor vehicle will during the period for which it is sought and permanently incapacitated, or is blind, or has lost a leg or foot, or to be registered be wholly or mainly used for the transport of the owner;. receives under the laws of the Commonwealth relating to repatriation Or is the parent/guardian of a child who is - a pension at the rate for total incapacity, or a pension granted by reason of impairment of the power of locomotion at a rate not less than (a) in consequence of the loss of the use of one or both legs, seventy per cent of the rate for total incapacity; and permanently unable to use public transport.

9 And (c) the motor vehicle will during the period for which it is sought to be (b) the motor vehicle will during the period for which it is sought registered be wholly or mainly used for the transport of the owner, the to be registered be wholly or mainly used for the transport of the child, prescribed registration fee for that motor vehicle must be reduced by the prescribed registration fee for that motor vehicle must be reduced the prescribed amount. by the prescribed amount. (2) This section does not apply to or in relation to - (2) This section does not apply to or in relation to - (a) more than one motor vehicle owned by the same owner; or (a) more than one motor vehicle owned by the same owner; or (b) any motor vehicle in respect of the registration of which a reduced fee (b) any motor vehicle in respect of the registration of which a reduced fee is payable pursuant to any provision of this Act other than this section.

10 Is payable pursuant to any provision of this Act other than this section. (3) If the registered owner of a motor vehicle that has been registered at a (3) If the registered owner of a motor vehicle that has been registered at a reduced fee in accordance with this section dies, or ceases to be the reduced fee in accordance with this section dies, or ceases to be the owner of the vehicle, the registration will, subject to this Act, continue owner of the vehicle, the registration will, subject to this Act, continue in force for a period of one month after death, or the cessation of in force for a period of one month after death, or the cessation of ownership, and will, unless the balance of the prescribed registration ownership, and will, unless the balance of the prescribed registration fee is paid.