Application for Registration - Roads and Maritime Services

Application for RegistrationCheck the back page for a guide to applying to register a vehicle.You must also complete a Description of Heavy Vehicle form (1120)when registering vehicles over 4.5 tonnes GVM.Office use onlyPlate number issued/allocatedAttachments1 Is the vehicle to be registered in the name of:a person2a corporationnow go to 3To register a vehicle in your name you must be at least16 years of age for a light vehicle (i.e. 4.5 tonnes GVMor less) and at least 18 years of age for a heavy vehicle(i.e. more than 4.5 tonnes GVM).NSW Driver's licence/Customer number3Corporation's detailsIf the vehicle is being registered in the name of acorporation, the Representative's Authority must be filled in.For a company, the Director or an authorised delegatemust complete and sign the Representative's section. In thecase of an incorporated association, it is the public officerwho must sign. In all cases, the authorised representativemust provide proof of their identity.Customer number (if issued)SurnameNameGiven namesLegal and renewal notices will be sent to the residentialaddress below unless an alternative mailing address isnominated. You must notify Roads and Maritime Services(RMS) of your new residential and mailing address within 14days of moving.Residential addressBusiness addressStatePostcodePostal address for legal or renewal noticesStatePostcodeMailing address (if different from residential address)ABN (if applicable)StatePostcodeDate of birth/ /Stateday month yearPostcodeACN, ARBN or other(Evidence of incorporation required see page 4)ABN (if applicable)4 Courtesy name(only an organisation name can be recorded, if required)SexmalefemalePlease provide your email address if you would like toregister for an online service account, go to myRTA.com for more information.Email addressPlease provide a mobile number if you would like toreceive communications from RMS this wayMobile number5 Fleet manager or leasing company (if applicable)To be completed only if the legal or renewal notices are tobe mailed to the fleet managerName and postal address of manager for registrationrenewalsHave you previously conducted business with RMS inanother name? If 'Yes' please specify.Customer numberStatePostcodeIf vehicle is to be leased or managed go to 5, if not go to 6Catalogue No. 45070093 Form No. 1009 (06a/2013) ABN 76 236 371 088Page 1 of 4

6Is the vehicle new?12Privacy statement and Declaration789noyesnow go to 8Was the vehicle last registered in NSW?noyes Last registration number (if known)if possible, present a previous certificate ofregistration with this formPurchase/Acquisition detailsDate of purchase/acquisition/ /day month yearSale price or market value (whichever is higher)Vehicle's garage address (where the vehicle will most often be kept)Please read carefully before you sign.If you do not tell the truth you can be prosecuted.Roads and Maritime Services (RMS) is collecting your personalinformation in relation to your application to register a vehicle andmay retain and use it for driver licensing, motor vehicle, roadtransport and safety purposes.You are required to provide your personal information under roadtransport legislation and RMS may refuse your application if you donot provide it.RMS may disclose your personal information to other driverlicensing and vehicle registration agencies, to assess yourapplication or verify the information you provide, for inquiries aboutmotor accidents, to confirm compulsory third party (bodily injury)insurance is current, to anyone proposing to acquire an interest inyour vehicle and in respect of inquiries relating to stolen orabandoned vehicles.Otherwise RMS will not disclose your personal information withoutyour consent unless authorised by law.RMS is subject to the Privacy and Personal Information ProtectionAct 1998 and the Health Records and Information Privacy Act 2002.Your personal information will be held by RMS at 101 Miller Street,North Sydney NSW 2060. You have the right to access andcorrect the information if you believe that it is incorrect.You declare that the information on this form is true and complete.Under road transport legislation, it is an offence to attempt toregister or renew the registration of a vehicle by false statement orany misrepresentation or other dishonest means.StatePostcodeSignature10Type of use intended for the vehiclePrivateused substantially for social,pleasure or domestic purposesBusinessbusiness use unless covered byanother usageRentala motor vehicle which is let outfor hire without a driverResaleDemonstratorsecond hand vehicles held forresale by licensed motor dealersdemonstrator vehicles used bylicensed motor dealersAccreditation or licence is required for the following:Capacity if representative of corporationDate/ /day month yearDealers, RMS and agencies onlyProof of identity recordPersonStand-alone or primary proofTaxiLong distance touristor charter serviceRegular passengerserviceplate type T or TCplate type TVplate type MO or M/ODocument numberSecondary proof (if necessary)Hire CarTow truck operators licence is required for the following:Tow Truckplate type HCplate type TTOther - please specify(e.g ambulance, road works, stand by taxi etc)Corporation ACN or ARBN verified from: (specify document)Proof or garage address (for heavy vehicles over 4.5 tonnes GVM)11Do you wish to apply for a registration concession?(For example: pensioner, primary producer, charityorganisation)noyesYou must prove that you are eligible and may be askedto sign a separate declaration.Registration term 2 years 3 yearsVerified by:SignatureNameCSO or dealer number, or agency nameCatalogue No. 45070093 Form No. 1009 (06a/2013) ABN 76 236 371 088Page 2 of 4

Vehicle identificationADR / category codeAxle codeVIN or chassis/frame numberTow truck lift capacityEngine numberCompliance plate datemonth/yearApproval numberTrailer brakes:powerassistedunassistedvacuum(A)(U)(V)poweroperated (O)mechanical (M)exempt(E)MakeModel yearMeasuring device/speed limiter detailsModel (in full - name, letters and/or numbers, variant)FittingsColour(s)ShapeInspection report detailsInspection report numberNote: shape BUS applies ifvehicle seats 10 or more(including driver).AIS numberConditionsVehicle details inspected/certified correct:SignatureVehicle specificationsSpecification sheet numberEngine variantDRIVES model code (if available)or Engine makeCertification permit/Examiner numberCertified by dealer representative that vehicle details arecorrect and vehicle is roadworthyThis vehicle is suitable for safe use and meets the requirements ofroad transport legislation.SignatureEngine capacityno. of cyls or no. of rotorsmotive powerCompany stampInduction:K/W PowerM/Cycles OnlynormalGVMturbosuperchargedGCMTare weightWheelbaseRight or left handdrive: right left bothno. ofGear type: automatic manual forwardgearsDriven wheels: 2 4 6 8Sleeping berth fitted: no yesTotal number of seatedpersons (including the driver)Number of standing persons(only required if the bus is to beused to carry standing passengers)Number of doorsOverall axle spaceCatalogue No. 45070093 Form No. 1009 (06a/2013) ABN 76 236 371 088Proof of registration entitlement (PORE)Proof of source - receipt, bill of sale, consignment note, etc.Proof of previous registrationPlate issuePlate numberDate plate and label issuedDealers:/ /day month yearFleetcommon expiry datedaymonthAttach the CTP certificate and any other relevantdocuments- such as compliance plate details form,weighbridge ticket, evidence of previous registration./Page 3 of 4

Applying to register an unregistered vehicleIf the vehicle comes from a licensed motor dealer:The dealer will tell you what you need to do. Most dealers areauthorised to check your identification on behalf of RMS. Showproof of your identity to the dealer.If the vehicle does not come from a licensed motor dealer:You need to have the vehicle inspected and identified. Mostvehicles can be taken to an appropriate Authorised InspectionStation (AIS) or Authorised Unregistered Vehicle Inspection Station(AUVIS), but some must be presented at special motor registrieswhere inspections are done. Please contact our Contact Centre on13 22 13 for information about where you can get your vehiclechecked. If your vehicle is inspected and identified at an AIS/AUVIS, the examiner should complete the vehicle details on thisform and give you an inspection report.To register the vehicle:You will need to go to a registry or send an authorisedrepresentative. If you send a representative you must fill in theRepresentative's Authority on this page. If the vehicle is beingregistered in the name of a corporation, the Representative'sAuthority must be filled in. For a company, the Director or anauthorised delegate must complete and sign the Representative'ssection. In the cases of an incorporation association, it is the publicofficer who must sign. In all cases, the authorised representativemust provide proof of their identity.Take with you:Proof of your identity;RMS copy of your compulsory third party insurance certificate(green slip). Note: CTP insurers cannot send electronicgreenslips for establish registrations;The inspection report ( blue slip);An original receipt for the vehicle, which clearly shows yourname, the seller's name, address and signature, the date youpurchased the vehicle; how much you paid for it; the registrationnumber; the VIN or chassis number;Evidence of the vehicle's previous registration;Proof of garage address for heavy vehicles; andThe old number plates if still in your possession.For home-made new trailers being registered for the first time, aProof of Registration Entitlement form will be provided by theregistry staff, to be completed at the registry, when you attend.Stamp duty charges:Stamp duty is charged in most cases. It is at least 3% of the saleprice or market value of the vehicle (whichever is higher). Forcertain vehicles exceeding $45,000 a 2% surcharge will apply forany amount over $45,000. (If necessary, the market value isrounded up to the next hundred dollars - for example the stampduty is the same for a vehicle worth $1450 as for a vehicle worth$1500.) RMS collects stamp duty charges on behalf of the Office ofState Revenue (OSR). The OSR conducts regular audits ofdeclared values. Understatements of market value may attractadditional duty together with penalties and interest.Note: If the vehicle you have is currently registered interstate, orhas expired interstate registration, you must provide evidence thatyou have paid stamp duty in the State in which the vehicle waspreviously registered. You must provide a current certificate ofregistration. If the certificate of registration has been lost, ourregistry can organise verification (minimum 48 hours required forverification).Proof of Identity (POI):When you attend our registry, you need to show proof of identity(POI). You can use your current RMS issued NSW driver photolicence or one which expired within the last 2 years.A brochure listing other acceptable POI documents is available fromour registries, by calling our Contact Centre on 13 22 13.Hearing or speech impaired? Call us on the National RelayService: TTY users phone 13 36 77 then ask for 13 22 13. Speakand Listen users phone 1300 555 727 and ask for 13 22 13. or byvisiting our Website at www.rms.nsw.gov.au. Your POI documentsmust be originals and must include your signature and yourresidential address.Corporations are required to provide evidence of incorporation. Thiscan be any one of the following:Certificate of Registration with Australian Company Number(ACN);A current Extract of the Company with ACN;Certificate of Registration on Change of Name with ACNA printed extract from the Australian Securities InvestmentCommision (ASIC) website with ACN;Certificate of Incorporation issued by the NSW Office of FairTrading;Certificate of Registration of a Foreign Company, with AustralianRegistered Body Number (ARBN) for companies incorporatedoverseas.Government authorities or organisations incorporated underlegislation must provide on letterhead the name of the Act underwhich they are incorporated.Catalogue No. 45070093 Form No. 1009 (06a/2013) ABN 76 236 371 088Courtesy name:This field may be used to record an organisation name. This namewill be recorded on the Certificate of Registration. The namerecorded in this field is not the registered operator of the vehicle.Proof of garage address:For heavy vehicles over 4.5 tonnes GVM acceptable proofs are:Certificate of Title of ownership for premises;Lease agreement or rent book;Council rate notice;Utility accounts relating to street address;Where the customer's residential and garage address is identical,acceptable proof of residential address such as a current driver'slicence.If no evidence is available, a statutory declaration is accepted.Terms and Conditions for the issue of Special PlatesThe Terms and Conditions for the issue of Special Number Platesare available from myPlates on phone 13 17 58 or can be found onwww.myPlates.com.auRepresentative's AuthorityComplete this to authorise another person to register a vehicle inyour name.I declare that the person named below is my authorisedrepresentative.SignatureDatedayRepresentative's detailsNSW Driver's licence/Customer numberSurnameGiven namesAddressDate of birthday//monthmonthyearRepresentative's signatureSexmalefemaleNote: Signatory capacity must be declared by a Limited CompanyDateday/monthOffice use: dealers and agenciesGive details of the changes calculated for the vehicleFee + taxStamp dutyOther charges (e.g. HVIS)TOTAL (includes GST if any)///StateyearCapacity if representative of corporationyearPostcodeInformation shown is correct at time of printing but maychange without notice.Page 4 of 4