Drivers Licence

Application Form
MDL 1
NEW APPLICATION INTERSTATE LICENCE
OVERSEAS LICENCE (Tick box below)
LEARNERS PERMIT RE-ISSUE LAPSED LICENCE NON- RECOGNISED COUNTRY
LICENCE VARIATION
(Additional class or removal of condition)
EXTRAORDINARY LICENCE RECOGNISED COUNTRY
REISSUE CANCELLED LICENCE RE-ISSUE SURRENDERED EXPERIENCED DRIVER
COUNTRY
LICENCE EXTENSION
Metropolitan or Regional T Extension
Tick appropriate box (P)
If you are applying for an F or T extension you must complete the following referee nomination.
Referee Nomination:
Referees must be persons who have known you for at least 4 years and who are not relatives.
These referees may be contacted by staff from the Driver and Vehicle Services (DVS) Centre to provide information to assist DVS in
determining your suitability to hold an F or T extension.
Referee One:
Family Name: Given Name/s:
Occupation:
Daytime telephone number: E-mail address:
Referee Two:
Family Name: Given Name/s:
Occupation:
Daytime telephone number: E-mail address:
I consent to offcers from DVS contacting the above
referees in relation to my application for an F or T extension and conveying any information to them relevant to my application,
including the details of any traffc or criminal convictions that may be recorded against me.
Signature : Date:
Witness: Date:
Witness: Site Code (if applicable):
Print applicants name
Applicants signature
Witnesss signature
Print witnesss name
Government of Western Australia
Department of Transport
Driver and Vehicle Services
LAST UPDATED: 11/01/2013
PAGE 2
PARTICULARS OF APPLICANT Please use BLOCK LETTERS (Applicant to complete page 2 in full)
FAMILY NAME: Given Names
Residential Address Post Code
Postal Address Post Code
Date of Birth Email
Home Phone Work Phone
Mobile Phone Fax
PERSONAL DETAILS (Not applicable for licence variation applicants)
SEX (tick (P) box applicable) Male Female HEIGHT cm
BUILD HAIR COLOUR EYE COLOUR
OCCUPATION COUNTRY OF BIRTH
DETAILS OF ANY LICENCE HELD (Including any previous WA licence held)
STATE/ COUNTRY OF ISSUE
LICENCE NUMBER
CLASSES HELD *INITIAL ISSUE DATE
PROVISIONAL EXPIRY DATE CURRENT EXPIRY DATE
REQUIRED CLASS OF LICENCE Place (P) in boxes See page 4 for classifcations of classes
Type of
Vehicle
Motor
Car
Light
Rigid
Medium
Rigid
Heavy
Rigid
Heavy
Combina-
tion
Multi-
Combina-
tion
Motorcycle Licence Extension
Moped LAMS Any
motorcycle
Carrying Passengers
for Reward
Taxi Other
Class C LR MR HR HC MC
R-N R-E R F T O
APPLICANT TO ANSWER ALL QUESTIONS - Your drivers licence may be suspended or cancelled for providing false or misleading information
QUESTION YES NO WHERE WHEN AND WHY
Have you ever been refused a licence?
Is your licence currently cancelled or
suspended, or are you disqualifed from holding
or obtaining a licence?
Has your licence ever been cancelled/
suspended or have you ever been disqualifed
from holding or obtaining a licence? Within WA
or Interstate?
Have you ever been convicted of a Traffc OR
Criminal offence other than those stated above
ANYWHERE in Australia or overseas?
MEDICAL QUESTIONS You are required by law to disclose any medical condition that may impair your ability to control a motor vehicle
Do you suffer
from?
EPILEPSY FITS GIDDINESS FAINTING SEIZURES PHYSICAL/ MENTAL DISABILITY
DIABETES ARTHRITIS
HIGH/LOW BLOOD
PRESSURE
HEART DISEASE DEPRESSION OTHER COMPLAINT OR DISEASE
GIVE DETAILS
Do you take Medication? Yes No
GIVE DETAILS
IMPORTANT: BEFORE SIGNING THIS DOCUMENT PLEASE READ INFORMATION ON PAGE 4
I certify that all information above is true and correct (penalty for false or misleading information)
Signature of Applicant Date of Application
OFFICE USE ONLY

Witness Offcer Name: Signature of Offcer:
SEE PAGE 4
approved
PAGE 3
OFFICE USE ONLY TO BE COMPLETED ON APPLICATION
(tick (P) box applicable
NEW APPLICATION INTERSTATE NON-RECOGNISED COUNTRY RECOGNISED COUNTRY EXPERIENCED
DRIVER COUNTRY
LEARNERS PERMIT RE-ISSUE
REISSUE CANCELLED RE-ISSUE SURRENDERED LICENCE EXTENSION EXTRAORDINARY

LAPSED
Western Australian Drivers LICENCE NUMBER
LICENCE TYPE LICENCE CLASSES APPLIED FOR
RESULT CTT MOTORCYCLE ORAL ALCOHOL HEAVY VEHICLE
PROVISIONAL EXPIRY DATE


EXTENSION/ CONDITION
Licence Conditions/ Extension

Class Conditions
Class Nat. Conditions State Conditions

EYESIGHT RESULTS
Right eye 6 Left eye 6 Both eyes 6
EYESIGHT TESTED BY
Signature .............................................................................
LICENCE VARIATION (Additional class or removal of condition)
LICENCE NUMBER
CLASSES RECOGNISED
STATE/ COUNTRY OF ISSUE ...........................................................................................
DATE OF ISSUE CURRENT EXPIRY DATE
OVERSEAS LICENCE CHECK LIST

Class conversion verifed tick (P) box ........................................................................................................................................................................
Print Name ................................................................................................... Signature ......................................................................................................
PROOF OF PRIMARY & SECONDARY IDENTIFICATION CHECKLIST (tick (P) box applicable)
All documents must be ORIGINAL (Not Photocopies)
Birth Certifcate
Australian Identity Document
(Not expired by more than 2 years)
Photographic Australian Drivers Licence
(Not expired by more than two years)
Visa or Immigration Documents
Western Australian Proof of Age Card
(not 18+Card)
Overseas Passport - Current
Australian Citizenship Papers
Australian Passport
(Not expired by more than 2 years)
Proof of Residency
Sighted/ Confrmed
Signature Verifed

PRIMARY IDENTIFICATION DOCUMENT NUMBER
SECONDARY IDENTIFICATION SIGHTED (tick (P) box) Type of Document .........................................................................................
LETTER OF CONSENT CONVICTION RECORDS CHECK
(Conditional licences only) (Lapsed Licence or EL Renewal)
Receipt Number ............................................................. DATE
Receipt Number ............................................................. DATE
Tested with Visual Aids Yes No
Visual Aids to be worn whist driving Yes No
S condition loaded/ removed Yes No
BRANCH/ SITE
.............................................................................
LICENCE VARIATION
(ADDITIONAL CLASS OR REMOVAL OF CONDITION)
IMPORTANT
The information you supply on this form may be disclosed to other government agencies where provided for in legislation. The Director
General 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.
DRIVER LICENCE CLASSES
CLASS VEHICLE DESCRIPTION EXPERIENCE CRITERIA FOR CLASSES
R-N
Moped
A moped is a motorcycle that:
(a) is designed so as not to be capable of a speed exceeding 50
km/h;
(b) and either
(i) has an engine capacity not exceeding 50 cc; or
(ii) is not powered by a piston engine, whether or not it is also
capable of being propelled by pedaling, but does not include a
power assisted pedal cycle
No experience required (minimum age 16 years).

Applicant can apply for Learners Permit at age of 15 years and
6 months.
R-E
Motorcycle
Smaller motorcycle or scooter.
A LAMS approved motorcycle listed in the publication LAMS
Approved Motorcycles list published on the Department of
Transport website at www.transport.wa.gov.au/lams
No experience required (minimum age 17 years).
R
Motorcycle
Any motorcycle with or without side car attachment. Any motor
carrier.
Must have held an R-E licence for at least one year.
C
Car
A motor vehicle with a gross vehicle mass that is not greater
than 4.5 tonnes and that is constructed or equipped to seat not
more than 12 adults (including the driver).
No experience required (minimum age 17 years).
LR
Light Rigid
A motor vehicle that:
has a gross vehicle mass greater than 4.5 tonnes but not
greater than 8 tonnes; or
seats more than 12 adults (including the driver) and has a
gross vehicle mass not greater than 8 tonnes.
Must have held a C (Car) licence for at least one year.
MR
Medium Rigid
A motor vehicle that has 2 axles and a gross vehicle mass
greater than 8 tonnes
Must have held a C (Car) licence for at least one year.
HR
Heavy Rigid
A motor vehicle that has 3 or more axles and a gross vehicle
mass greater than 8 tonnes
Must have held:
C (Car) licence for at least two years; or
LR or MR licence for at least one year.
HC
Heavy
Combination
A prime mover to which is attached a single semi trailer plus any
unladen converter dolly; or
A rigid motor vehicle to which is attached a trailer that has a
gross vehicle mass greater than 9 tonnes plus any unladen
converter dolly
Must have held:
C (Car) licence for at least three years; and
MR or HR licence for at least one year.
MC
Multi-
Combination
Any Heavy Combination unit towing one or more additional trail-
ers each having a gross vehicle mass greater than 9 tonnes
Must have held:
C (Car) licence for at least three years; and
HR or HC licence for at least one year.
LICENCE EXTENSION
T Extension Has reached the age of 20 years.
Taxis and Small Has held a drivers licence for a period of 3 years and is not a provisional driver
Charter Vehicles Has provided details of 2 referees on the front page of this form.
(Taxi) Is mentally and physically ft to drive a motor vehicle for the purposes of carrying passengers for reward.
Has successfully completed a training course or test approved by the Director General.
F Extension Has reached the age of 21.
Buses and Small Has held a drivers licence for a period of 4 years and is not a provisional driver.
Charter Vehicles Has provided details of 2 referees on the front page of this form.
(Not Taxis) Is mentally and physically ft to drive a motor vehicle for the purposes of carrying passengers
for reward.
PAGE 4
Initial Issue Date
Is the date your drivers licence was frst issued to you (not the current date of issue or previous renewal date)