APPLICATION FOR ENTRY INTO A BALLOT OF DEFINED RIGHTS 
FOR CONDITIONAL NON-TRANSFERABLE LEASED TAXI LICENCES
27 MAY 2008

 Section 84G of the Road Transport (Public Passenger Services) Regulation 2002

TO BE COMPLETED BY APPLICANT

SURNAME/COMPANY NAME		

GIVEN NAME(S)		

ADDRESS

PHONE NUMBER (B/H)		

MOBILE PHONE NUMBER		

TAXI SERVICE OPERATOR ACCREDITATION NUMBER (IF APPLICABLE)		

AN INDIVIDUAL MAY MAKE ONLY ONE (1) APPLICATION.  
A COMPANY MAY MAKE ONLY ONE (1) APPLICATION. 

•	AN APPLICATION FEE OF $25.00 IS REQUIRED. PAYMENT MAY BE MADE BY CHEQUE OR MONEY ORDER. 
•	APPLICANTS MUST PROVIDE PHOTOCOPIES OF SUITABLE IDENTIFICATION (FOR INDIVIDUALS) OR OF AN ASIC CERTIFICATE OF REGISTRATION (FOR COMPANIES).

COMPLETED APPLICATIONS, WITH ATTACHED PAYMENT AND ID DOCUMENTATION, SHOULD BE FORWARDED TO:

ROAD TRANSPORT AUTHORITY
LEVEL 2, MACARTHUR HOUSE
12 WATTLE ST
LYNEHAM  ACT  2602

TAXI LICENCE RELEASE PROGRAM
ROAD TRANSPORT AUTHORITY	       OR SUBMITTED IN PERSON TO	
DEPARTMENT OF TERRITORY &
MUNICIPAL SERVICES	        
PO BOX 151 
CIVIC SQUARE  ACT  2608

	PAYMENT ATTACHED			   IDENTIFICATION/CERTIFICATE OF REGISTRATION ATTACHED

APPLICATIONS CLOSE 20 MAY 2008 AT 2:00PM
The Road Transport Authority may require an applicant to provide further information or documents needed to decide the application.

APPLICATION FOR ENTRY INTO A BALLOT OF DEFINED RIGHTS 
FOR CONDITIONAL NON-TRANSFERABLE LEASED TAXI LICENCES
27 MAY 2008

 Section 84G of the Road Transport (Public Passenger Services) Regulation 2002.

APPLICANT CHECKLIST

	I have read and understand the document “Ballot of Defined Rights for Conditional Non-transferable Leased Taxi Licences, 27 May 2008, Information Sheet.”

	I have read and understand the document “Conditions of Defined Rights for Conditional Non-transferable Leased Taxi Licences, 27 May 2008”.

	I understand that a conditional non-transferable leased taxi licence is issued subject to the condition that the licence holder must NOT transfer the licence to anyone else.

	I understand that a conditional non-transferable leased taxi licence is issued subject to the condition that the vehicle used is capable of carrying six (6) or more passengers and is wheelchair accessible.

    I have made one application only to enter this ballot.

	I am 18 years of age or older.

	I have attached (for an individual) a photocopy of my birth certificate, passport or driver licence confirming my identity, or (for a company) a photocopy of an ASIC Certificate of Registration certifying the name and ACN of the company. 

I declare that the information provided in this application is true and correct.  I hereby apply for entry into the ballot of defined rights for non-transferable leased taxi licences.

SIGNATURE: ________________________________	DATE: _____________________

For enquiries, please contact the Road Transport Authority on
(02) 6207 1423 or (02) 6207 1381.