Standard Number Plate/s Replacement Application

1 Page 1 of 2 LTSR Forms Area F3540 CFD V01 Aug 2021 Plate/s which are to be replaced must be surrendered at a Customer Service Centre when lodging this Application . For more information about replacing Standard Number plates and/or personalised or customised plates go to You must provide evidence of identity (EOI) at the time of making this Application . For example, original Queensland Driver Licence. Refer to the separate Evidence of Identity Requirements for Individuals and Organisations (form F4362) or for EOI requirements. This form is to be used when one of the following circumstances apply:(a) you wish to replace your Standard issue Number plates with another set of Standard issue Number : in the case of vehicles registered in joint names, only one registered operator may sign and provide identification.(b) you wish to order an accessory plate. An accessory plate can be attached to an accessory on the front or back of the vehicle, for example bike racks, wheelchair lifts.

2 (c) you wish to customise your existing Number plates (that is, you wish to keep the same plate Number ). Note: in the case of vehicles registered in joint names, both registered operators must sign and provide Number Plate/s Replacement ApplicationTransport Operations (Road Use Management) Act 1995 Full name and residential/business addressIf the Plate/s have been taken by the Queensland Police Service as the vehicle is currently under a Number Plate Confiscation Notice, you cannot apply for Replacement plates or an accessory plate during the confiscation period. Is the vehicle currently under a Number Plate Confiscation Notice issued by the Queensland Police Service?3 NoYesThis Application cannot be processed during the confiscation operator s detailsNote: If these Number Plate/s are in joint names either may complete this operator s Customer Reference Number (CRN). The CRN is the operator's Qld Driver Licence Number , Adult Proof of Age or Photo Identification Card Number or your reference Number issued by the Department of Transport and Main you replacing your Plate/s ?

3 Poor qualityNot receivedDescribe the circumstancesLost/Stolen/DestroyedDamage dOtherPlease specifyVehicle details1 Make/model (for example, Ford, Falcon)Plate number4 Postal address (if same as residential/business write as above )PostcodeTelephone numberEmail address5 Are you applying for the same plate Number and/or require an accessory plate?Note: If you are applying for the same plate Number you will need to customise your Standard registration plate Number . A higher fee will apply in this instance. If plates are damaged and being remade, you must attach the most legible plate to the rear of the vehicle until you receive Replacement to 6 YesWhat Plate/s do you require?Accessory plateOne plate (motorbike or large trailer only)Two Standard size platesOne Standard and one slimline plateNote: the slimline plate is only 100mm high and can only be attached to the front of the someone lodging this Application on your behalf?Your representative will need to bring EOI as well as your 's detailsRepresentative s signatureName (in full)6 NoYesGo to 5 Select reason belowPage 2 of 2 LTSR Forms Area F3540 CFD V01 Aug 2021 Office use onlyHow many Plate/s returned?

4 New registration Number plate/sAmount paidApplication received atOperator/receipt numbersInitialsEOI supplied$Departmental or agent use only Note: This section is valid only if stamped with the official stamp of the department or its Number plate/sApplication date/ / Standard Number Plate/s Replacement Application page 2 of 2 Registered operator declaration7I/We declare that the information provided is true and consent to the department verifying my EOI documents or information with the issuing authority or their statement: The department is collecting the information on this form for the purposes of maintaining the department s vehicle/vessel registration register as required under the Transport Operations (Road Use Management) Act. The department or its agents/contractors may use your information in its communications with you and where relevant, may give some of the information to vehicle insurers, statutory entities, insolvency entities, lawyers, person s involved in vehicle incidents/accidents,vehicle manufacturers, third parties who are involved in or intend to commence legal proceedings, tolling entities, law enforcement agencies and interstate registering authorities.

5 Your personal information will not be disclosed to any other third party without your consent, unless authorised or required to do so by is an offence to give false or misleading information under the Transport Operations (Road Use Management) Act. Maximum penalty may exceed $ : In the case of vehicles registered in joint names, only oneregistered operator may sign. However, where the plates arecustomised plates, both registered operators must sign.