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New Heavy Vehicle License Application

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Name *

First

Middle

Last

Date Born *

Birth Certificate Registration Number: *

Phone *

Email *

Residential Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Postal Address- if different to above

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

License Application for: *

Light Rigid <10t
Heavy Rigid >10t
Heavy Combination
Multi Combination

I hereby confirm; *

I have no medical conditions that may affect my ability to drive safely
I have medical conditions that may affect my ability to drive safely, and I have included relevant Medical evidence
I require prescription glasses to drive
I am restricted to daylight driving conditions only

tick all that apply

Medical File Upload

Drag & Drop Files, Choose Files to Upload You can upload up to 2 files.

I hereby confirm; *

I agree to donate my organs in the event of an accident and my next of kin is aware
I do not agree to donate my organs in the event of an accident and my next of kin is aware

ID Photograph *

Camera Preview

3

Disclaimer: Use a bright lit area with a blank/solid background Any and all incomplete images will not be accepted and you may not be refunded your application fee

License Term *

Shipping *

Australia
International- no tracking
International-with tracking

Signature *

Clear Signature

Applicant Declaration *

I, the applicant, do hereby confirm that the details as provided in this application are true and correct to the best of my ability and consent to the Crown Licensing Regulatory Authority verifying my information and using my private information contained herein and existing on the Crown Licensing Regulatory Authority database, including but not limited to my digital photograph and autograph and consent for the Crown Licensing Regulatory Authority to conduct enquires necessary to assess this application for the purposes associated with approval of this application, including but not limited to criminal and driving history checks.
I, the applicant, understand that by providing any false or misleading information to the Crown Licensing Regulatory Authority may result in this application being refused and if applicable the cancellation of the International Driver license
I, the applicant, understand the responsibilities of holding an International Driver License and will comply with requirements under the International Crown Licensing Regulatory Authority, as found under the Legal Compliance section

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Total

$0.00

International Transfers:

Please be advised that your bank may charge transaction and exchange fees may apply

Stripe Credit Card

to Born Address-

International Crown Licensing Regulatory Authority

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