APPLICATION FOR ENTRY INTO A BALLOT OF DEFINED RIGHTS 
FOR NON-TRANSFERABLE LEASED TAXI LICENCES, 
6 OCTOBER 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, MADE OUT TO THE ROAD TRANSPORT AUTHORITY. 
•	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

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 AT 2.00pm on 29 September 2008

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 NON-TRANSFERABLE LEASED TAXI LICENCES, 
6 OCTOBER 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          non-transferable leased taxi licences, 6 October 2008, Information Sheet.”

	I have read and understand the document “Conditions of defined rights for   non-transferable leased taxi licences, 6 October 2008”.

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

    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.