APPLICATION FOR ENTRY INTO A BALLOT OF DEFINED RIGHTS FOR RESTRICTED TAXI LICENCES FOR WHEELCHAIR ACCESSIBLE TAXIS
23 MAY 2012 
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 OR A COMPANY MAY MAKE ONLY ONE(1) APPLICATION.	
			
•	AN APPLICATION FEE OF $25.00 IS REQUIRED, PAYMENT MAY BE BY CHEQUE OR MONEY ORDER.	
•	INDIVIDUAL APPLICANTS MUST PROVIDE PROOF OF IDENTIFICATION, IE LICENCE & PASSPORT (if applicable)	
•	FOR COMPANIES AN ASIC CERTIFICATE OF REGISTRATION IS REQUIRED	
			
COMPLETED APPLICATIONS, WITH ATTACHED PAYMENT AND ID DOCUMENTATION, SHOULD BE FORWARDED TO:	
			
RESTRICTED TAXI LICENCE BALLOT
PUBLIC TRANSPORT REGULATION
GPO BOX 158 CANBERRA CITY ACT 2601	Or submitted in person to:	PUBLIC TRANSPORT REGULATION
LEVEL 2, MACARTHUR HOUSE
12 WATTLE ST
LYNEHAM  ACT  2602	
PAYMENT ATTACHED	I IDENTIFICATION/CERTIFICATE OF REGISTRATION ATTACHED	
APPLICATIONS CLOSE 30 APRIL 2012 AT 2:00PM.
NOTE: The Road Transport Authority may require further information or documents to be provided in order to assess whether the application will be accepted.
OFFICE USE ONLY
Received by:
Signed:
Date:	Payment Fee:	
	Receipt No:	

APPLICATION FOR ENTRY INTO A BALLOT OF DEFINED RIGHTS FOR RESTRICTED TAXI LICENCES FOR WHEELCHAIR ACCESSIBLE TAXIS 
23 MAY 2012
APPLICANT CHECKLIST
I have read and understand the document “Ballot of defined rights for a Restricted Taxi Licence for Wheelchair Accessible Taxis, 23 May 2012, Information Sheet.
I have read and understand the document “Conditions of defined rights for restricted taxi licences for Wheelchair Accessible Taxis, 23 May 2012.
I understand that a restricted taxi licence is issued subject to the condition that the licence holder must NOT transfer or sub-lease the licence to anyone else.
I understand that the holder of a Wheelchair Accessible Taxi Licence must ensure that priority for the hiring of the taxi is given to wheelchair-dependant people.
I understand that the Road Transport Authority may change policies on the micromanagement of wheelchair accessible taxis licences at any time within the 6 year licence period.
I have made one application only to enter this ballot.
I do not operate more than two wheelchair accessible taxis.
I am 18 years of age or older.
I have completed the attached written statement demonstrating my experience in the taxi industry and working with people with disabilities and how I will manage my WAT drivers to ensure that they give priority to WAT hirings at all times.
I have attached a photocopy of my birth certificate, passport or driver licence confirming my
identity, (for an individual) and for a company a photocopy of an ASIC Certificate of Registration certifying the name and ACN of the company.
I am aware that I will be required to attend an interview with the RTA and representatives of ACT disability organisations.

For enquiries, please contact the Road Transport Authority on (02) 6207 1423 or 62078011

STATEMENT OF SUPPORT FOR ENTRY INTO A BALLOT OF DEFINED RIGHTS FOR A RESTRICTED TAXI LICENCE FOR A WHEELCHAIR ACCESSIBLE TAXI
I have the following demonstrated experience in the taxi industry (provide relevant details)

	

	

	

	
	
I have the following demonstrated experience working with people with disabilities (provide relevant details)	

	

	

	

	

How do you propose to manage your WAT Drivers?	

	

	

	

	
DECLARATION
NOTE:  Applicants will also be interviewed prior to their application being accepted for the Ballot.   At the interview applicants will be required to address a series of questions relating to the provision of wheelchair accessible taxi services.  Applicants may also wish to provide references.
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 a restricted taxi licence.
SIGNATURE_________________________________________	DATE__________________