restricted access vehicle operator registration form
TRANSCRIPT
4 Government / Not-for-Profit or Charity
To register as a new Operator To update my Operator details
1 What do you want to do?
Name
ACN
First NameSurname Other Name(s)
2 Individual Operator / Sole Trader Details
Driver's Licence NumberDate of Birth
Australian Business Number (ABN)
ABN
*This person must sign Authority and Declaration
Address
Suburb
Postal Address
Postcode
StateSuburb
Fax Number
Email AddressMobile Number
Phone Number
Postcode
State
To operate a Restricted Access Vehicle (RAV) in WA, you must register as an Operator with Main Roads WA. The permit type required will determine whether you require WA Heavy Vehicle Accreditation.
3 Company Details
Licence Class State of Issue
Individual Operators/Sole Traders Complete Sections 1, 2, 6, 7, 9, 10. An individual operator must also complete Section 5, if they are trading using a Registered Business Name Company Complete Sections 1, 3, 6, 7, 8, 9, 10. Section 5 must be completed, if a Registered Business Name is used. Government/Not-for-Profit or Charity Complete Sections 1, 4, 6, 7, 8, 9, 10. Section 5 must be completed if a Registered Business Name is used.
Operator Number
Restricted Access Vehicle Operator Registration Form
Apply and pay for permits online
Licence Expiry Date
Name ABN
6 Address
5 Registered Business Name Registered Business Name
7 How would you like us to contact you ? Preferred General Communication Type Preferred Permits Communication Type Email Fax Post
8 Authorised Contact Person (To be completed by Company, Government, Non-Profit or Charity only)
Surname First Name Other Name(s)
Position
Address
Suburb State Postcode
Phone Number Mobile Number
Email Address*For an existing organisation registered with Main Roads Western Australia Heavy Vehicle Services, only the currently recorded Authorised Contact Person has the authority to amend RAV registration information, by signing the authority and declaration below. If that person is no longer the Authorised Contact Person, then a new registration must be completed with an authority and declaration signed by a Responsible Person of the organisation. A Responsible Person is an officer of that organisation who is authorised to apply for registration as an operator of a RAV.
9 Authority and Declarationi. I have read and understand the legal requirements described within this form and acknowledge that all the information provided within, or as supporting documentation forming as part of this application, is true and correct. ii. I agree to operate heavy vehicles in accordance with any requirements to holding Western Australian Heavy Vehicle Accreditation, where applicable. iii. I acknowledge that I will abide by any terms and conditions of any Order or Permit, or any other law or statute, under which I am operating a Restricted Access Vehicle. iv. I declare that I am authorised by the relevant applicant organisation, to be their Authorised Contact Person and be able to submit this registration form on their behalf. Name Signature
Position Date
Email completed form to: [email protected] or fax to (08) 9475 8455 or post to PO Box 374 Welshpool DC 6986
10 Supporting Documentation and Checklist Please ensure the following items have been completed/attached before submitting your application. (Do not attach original documents.) If the applicant is a Company
If the applicant is an IndividualCertificate of Registration or Australian Business Register Driver's Licence or other form of primary identification
Not-for-profit or CharityExtract of Registration of the Not-for-profit or Charity
Current Company Extract (available from the ASIC Website, cannot be more than 3 months old)If the ABN is a Trust
Trust Deed (Front Page, Schedule & Signed page only of the trust documentation)OrATO Australian Business Register showing the name of trust and the trustee
Email Fax Post
Cannot be a PO Box Address
Yes No