dangerous goods vehicle licence application - form€¦ · dangerous goods safety act 2004...

Page | 1 100 Plain Street, East Perth WA 6004 Telephone: 08 9358 8001 www.dmirs.wa.gov.au RSD-APP-001

Dangerous goods vehicle licence application (for online use only) Includes transfer of an existing licence

Dangerous Goods Safety Act 2004

Dangerous Goods Safety (Road and Rail Transport of Non-explosives) Regulations 2007

ABN: 69 410 335 356

Please refer to Applying for a dangerous goods vehicle licence before completing this application.

1. Application type (new or transfer)

New licence (new or used vehicle)

Enter other dangerous goods vehicle licences, if held. DVB DVB

Transfer of existing licence (transfer by agreement) DVB

Attach an image of the dangerous goods vehicle licence.

Attach an image of the motor vehicle licence in the new licence holder’s name.

Complete sections 4, 6, 9, 10, 11 and 12.

2. Vehicle type

Please tick the relevant vehicle type:

Tank type New tank Used tank Non-tank

Body type New tank Rigid trailer Non-tank vehicle

3. Required supporting documentation

Tank type

Situation Approval of tank design

letter

See (1) below

AS 2809 professional

engineers report

Previous dangerous

goods licence

Motor vehicle licence

See (2) below

New Vehicle less than 12 months old and never licensed to transport dangerous goods.

Yes No No Yes

Used Vehicle greater than 12 months old and never

licensed to transport dangerous goods. Yes Yes No Yes

Used Vehicle previously licensed to transport dangerous goods in WA and dangerous goods vehicle licence expired within the last 12 months.

Yes No No Yes

Used Vehicle previously licensed to transport dangerous goods interstate and dangerous goods vehicle licence expired within the last 12 months.

Yes No Yes Yes

Used Vehicle previously licensed to transport dangerous goods in WA but not licensed to transport dangerous goods for more than 12 months.

Yes Yes No Yes

Used Vehicle previously licensed to transport dangerous goods interstate but not licensed to transport dangerous goods for more than 12 months.

Yes Yes No Yes

Used Vehicle has been modified (re-horsed), or damaged and repaired since the original design approval.

Yes Yes No Yes

Non Non-tank vehicle. No No No Yes

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4. Registered vehicle owner/lessee details (must be same name as on motor vehicle licence)

Name of vehicle owner / lessee

ABN (if applicable) Phone no.

Mobile no. Email

Residential address

Unit no. Street no. Lot no. Street Type

Town / suburb State Postcode

Postal address (complete if different from above)

Unit no. Street no. Lot no. Street Type

PO Box no. Town / suburb State Postcode

5. Vehicle details

Registration no. Licence expiry date

Engine no. (rigid tank only) Chassis/VIN no.

Vehicle make Fleet no.

Has the tank vehicle been modified (re-horsed), or damaged and repaired since the original design? Yes No

If Yes, the tanker design approval letter and AS 2809 professional engineer’s report is required. Continue to section 6.

If No, continue to section 6.

6. Vehicle location where normally garaged

Business / trading name (if applicable)

Property name (if applicable)

Phone no. Fax no.

Street address

Unit no. Street no. Lot no. Street Type

Town / suburb State Postcode

7. Classes or divisions of dangerous goods to be transported

Please tick the applicable boxes: 2.1 2.2 2.3 3 4 5.1 6.1 8 9

8. Tank details (tankers only)

Tank serial no. Year of manufacture State of manufacture

Competent authority approval no.

Date of last pressure-tightness test for tanker (except for pressure vessels)

1. An Application for approval of tank design is required if the approval of tank design letter is not provided. A separate submissionmust be lodged via the departmental submissions portal as an additional fee is payable. Please refer to the application form forlodgement details.

2. Motor vehicle licences are issued under Part III of the Road Traffic Act 1974 (WA), or under the Federal Interstate RoadTransport Act 1985 and must be current at time of lodgement.

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9. Approved emergency responder

Is the applicant an approved emergency responder, or do you have a contract with an approved emergency responder?

Please tick the applicable boxes: Applicant Contract

10. Insurance

Have you obtained a minimum of $5,000,000 public liability insurance in accordance with part 18 of the Dangerous Goods Safety (Road and Rail Transport of Non-explosives) Regulations 2007?

Yes No

If No, do you have approval from the Chief Officer to transport dangerous goods under alternative provisions?

If Yes or No, continue to section 11.

Yes No

11. Integrity information

Is the applicant prohibited by a court order from involvement in the transport of dangerous goods by road? Yes No

If No, continue to section 12.

If Yes, contact the Department before submitting your application.

12. Declaration (the person declaring must be the owner or someone familiar with the vehicle specifications)

I understand by submitting this application:

I am certifying this vehicle fully complies with all relevant requirements of the Australian Dangerous Goods Code current edition, and

Receive all future correspondence from the Department electronically.

13. Lodging your submission

Your application must be lodged via the online departmental submissions portal. Paper or emailed applications are not accepted.

When completed, save the application form to your computer.

If logged in to the departmental submissions portal, return and complete your personal details. Attach the saved application form and any required supporting information (see section 3 for required supporting information for a new application and section 1 for a transfer).

The licence fee is payable at the end of the submission process and can be made by MasterCard or Visa. Transfer applications do not require a fee.

Incomplete applications may delay the processing of the application. If we require any further information, we will contact you via the email provided at time of submitting the application.

Allow approximately 20 working days for processing.

For more information on how to submit an application electronically, please view the Departmental submissions flyer

If you are no longer logged in to the departmental submissions portal, click Submit application to recommence your submission.

Submit application