APPLICATION FOR ENTRY INTO A BALLOT OF DEFINED RIGHTS 
FOR NON-TRANSFERABLE LEASED TAXI LICENCES
13 APRIL 2011

 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 ONLY. 
•	APPLICANTS MUST PROVIDE ORIGINAL DOCUMENTS FOR PROOF OF IDENTIFICATION AND 
ASIC CERTIFICATE OF REGISTRATION (FOR COMPANIES OR LEGAL PARTNERSHIP).

COMPLETED APPLICATIONS, PAYMENT AND ID DOCUMENTATIONS, SHOULD BE SUBMITTED IN PERSON TO:

	ROAD TRANSPORT AUTHORITY
MACARTHUR HOUSE
12 WATTLE ST
LYNEHAM  ACT  2602

	PAYMENT ATTACHED			  IDENTIFICATION/CERTIFICATE OF REGISTRATION ATTACHED

APPLICATIONS CLOSE ON 6 APRIL 2011 AT 2:00PM

NOTE: 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, 13 APRIL 2011

 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, 13 April 2011, Information Sheet.”

	I have read and understand the document “Defined Rights Conditions for Non-Transferable Leased Taxi Licences”.

	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 only one application to enter this ballot.

	I am 18 years of age or older.

	I am an Australian citizen or a permanent resident of Australia.

	I am a permanent resident of the ACT.

	I have provided primary proof of my identity (for an individual).

	We have provided primary proof of all directors/executive office holders (for a legal partnership or company) and a copy 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 13 April 2011  ballot of defined rights for non-transferable leased taxi licences.

NAME:	____________________________	DATE: _____________________

SIGNATURE: ________________________________

For enquiries, please contact the Road Transport Authority on
(02) 6207 1423 or (02) 6207 7159