Removal of licence disqualificationPart 2 – Form and affidavits

32 St Georges TerracePERTH WA 6000

InfoLine: 1300 650 579www.legalaid.wa.gov.au

IntroductionThis is Part 2 of Legal Aid WA’s Removal of licence disqualification kit and includes the form and affidavits to be used if you are applying to have your driver’s licence disqualification removed.

BEFORE USING THE FORM AND AFFIDAVITS please read Removal of licence disqualification – Part 1 – Information kit, which provides important information about when and how you may apply, as well as instructions for completing the documents contained here in Part 2.

Form and affidavits The form and affidavits included here have been adapted specifically for use in applying to remove a licence disqualification. They have also been specifically adapted for an application in the District Court. If your application is in the Supreme Court, each form and affidavit needs to be amended to read “Supreme Court” instead of “District Court”.

You can access an electronic copy of Parts 1 and 2 of this kit online on the Legal Aid WA website: www.legalaid.wa.gov.au under Information about the law > Cars and driving > Driver’s licences > Removal of driver’s licence disqualification, scroll down to the link to Part 1 and Part 2 of the kit. Part 2 is in word format so you may download it and type directly into each document.

Alternatively, you can print or request a hard copy of Parts 1 and 2 of this kit by contacting the Legal Aid WA InfoLine on 1300 650 57 or any Legal Aid WA office. Please note that some documents cannot be completed by hand and must be provided in typed format. Refer to the instructions for completing these documents in Part 1 of the kit.

The following form and affidavits are included here: Form 104: Application for removal of disqualification Affidavit and annexures (yours) Affidavit and annexures (witness’) Affidavit of service and annexures

Disclaimer and CopyrightCopyright © Legal Aid Western Australia 2016. Any part of this publication may be copied, reproduced or adapted to meet local needs by community based organisations without permission from Legal Aid Western Australia provided the copies are distributed free or at cost (not for profit) and the source is fully acknowledged. For any reproduction with commercial ends or by government agencies, permission must first be obtained from Legal Aid Western Australia.

This Kit provides information about the law only and does not constitute legal advice. You should seek legal advice if you have a specific legal problem.

Every effort is made to ensure that the information contained in this Kit is correct as at the date of publication. However, please note that the law may change at any time and may impact on the accuracy of this information. Legal Aid WA accepts no responsibility for any inaccuracies, errors or omissions in this information or incorporated into it by reference.

This information was last reviewed on 16 May 2016.

104. Application for removal of disqualification (O. 81C r. 2(4))

Road Traffic (Authorisation to Drive) Act 2008 (WA) s. 24(1)District Court of Western AustraliaCIVO No:

APPLICATION FOR REMOVAL OF DISQUALIFICATION

Applicant Full name

Address

Date of birth

Occupation

Details of order disqualifying applicant from holding or obtaining a driver’s licence

Court that made the order

Date of order

Period disqualified

Reason1

Application Under the Road Traffic (Authorisation to Drive) Act 2008 (WA) s. 24(1), I apply for an order removing the above disqualification.

Grounds for this application2

1.

Certificate by applicant

An application made under the Road Traffic (Authorisation to Drive) Act 2008 (WA) s. 24(1) in respect of the above disqualification has not been refused in the year preceding the date of this application.

Signature of applicant

Date

Hearing details This application will be heard —

on [date]

at [time] or as soon after as possible,

at [place]

Notes to Form No. 104 —

1. State the offence(s) for which the applicant was disqualified and, if the offence was against the Road Traffic Act 1974 (WA) s.63, 64, 67 or 67A, state whether the conviction was the applicant’s first, second or subsequent for the offence. If disqualified for some other reason, give details.

2. Note the Road Traffic (Authorisation to Drive) Act 2008 (WA) s. 24(5). Use numbered paragraphs.

TO: The RespondentThe Director General of TransportGPO Box R1290PERTH WA 6844

IN THE DISTRICT COURT OF WESTERN AUSTRALIA CIVO No.     of 20HELD AT

IN THE MATTER of section 24(1) of the Road Traffic (Authorisation to Drive) Act 2008 (WA)

and

IN THE MATTER of an application to remove a disqualification from holding a motor driver's licence

B E T W E E N:

Applicant

- and -

The Director General of Transport Respondent

AFFIDAVIT OF (Applicant)

TOGETHER WITH ANNEXURESSWORN/AFFIRMED IN SUPPORT OF APPLICATION FOR AN ORDER REMOVING

DISQUALIFICATION

Date of signing:Date of filing:Filed by: The ApplicantName:

(Applicant’s name)

Address:

Telephone:

Annexures

Annexure Description Page No:

____________________________________________

I,(Applicant’s name)

of(Applicant’s address)

in the State of Western Australia,(Applicant’s occupation)

being duly sworn make oath and say/do solemnly and sincerely declare and affirm as follows:

1. I am the applicant. I swear/affirm this Affidavit in support of my application to remove my disqualification from holding or obtaining a motor drivers licence.

2. The information deposed to in this affidavit is true to the best of my knowledge.

3. The disqualification which I am applying to set aside was imposed by the

Court at(Magistrates Court or District) (Place)

on the

.

(Date)

4. Annexed to this Affidavit and marked with the letter “A” is a copy of my history for court document (criminal history).

5. Annexed to this Affidavit and marked with the letter “B” is a copy of my record of traffic infringement notices (delete if you do not have a record of traffic infringement notices).

6. Attached to this Affidavit is:(Any other relevant document eg. Extraordinary driver’s licence)

7. The circumstances leading up to me committing the offence and the circumstances of the offence itself for which I received my licence disqualification, were as follows:

8. As to the other offences on my history for court document (criminal history), the circumstances were as follows:

9. At the time of committing the offences on my history for court document (criminal history), I was a drinker of alcohol to the following extent:(Set out frequency, degree and amount of alcohol usage - how much, how often)

10. At present, I am a drinker of alcohol to the following extent:(Set out frequency, degree and amount of alcohol consumed)

11. Despite my traffic convictions, I am no longer a danger to the public when driving a motor vehicle for the following reasons:

12. My personal circumstances are as follows:

Date of birth:Marital status:Number of dependant children and ages:Occupation:Spouse’s / defacto’s occupation:Any other relevant personal information:

13. My financial position is as follows:

ApplicantSpouse

or defacto

Income

Weekly income and source

Net wages

Centrelink benefit

Other sources of income (amount and type)

Total weekly income $

Expenses

Weekly expenses

Mortgage payments

Board or rent

Other expenses (list)

Total weekly expenses $

Assets

Home

Other land

Motor vehicle

Money in banks

Money in building societies

Cash on hand

Any other assets (list)

Total value of assets $

Liabilities (debts)

Give details:

Total liabilities $

14. My work history, including periods of unemployment, is as follows:

15. The reasons why I would like to have my driver’s licence back are as follows:

16. The further information which I would like to put in support of my application is as follows:

SWORN/AFFIRMED by the abovenamed )deponent at )in the State )of Western Australia this )day of 20 )

Before me:

Signature of authorised witness

Name of authorised witness

Occupation of authorised witness

IN THE DISTRICT COURT OF WESTERN AUSTRALIA CIVO No.      of 20 HELD AT

IN THE MATTER of section 24(1) of the Road Traffic (Authorisation to Drive) Act 2008 (WA)

and

IN THE MATTER of an Application to remove a disqualification from holding a motor driver's licence

B E T W E E N:

Applicant

- and -

The Director General of Transport Respondent

AFFIDAVIT OF (Name)

TOGETHER WITH ANNEXURESSWORN/AFFIRMED IN SUPPORT OF APPLICATION FOR AN ORDER REMOVING

DISQUALIFICATION

Date of signing:Date of filing:Filed by: The ApplicantName:

(Applicant’s name)

Address:

Telephone:

Annexures

Annexure Description Page No:

____________________________________________

I,(Witnesses name)

of(Witnesses address)

in the State of Western Australia,

(Witnesses occupation)

being duly sworn make oath and say/do solemnly and sincerely declare and affirm as follows:

1. I swear/affirm this affidavit in support of the application of to remove his/her disqualification from holding or obtaining a motor driver's licence.

2. Annexed to this affidavit is my letter / reference / report in support of the application.

3. The contents of my letter / reference / report are true to the best of my knowledge and belief.

SWORN/AFFIRMED by the abovenamed )deponent at )in the State )of Western Australia this ) day of 20 ) Signature of deponent

Before me:

Signature of authorised witness

Name of authorised witness

Occupation of authorised witness

IN THE DISTRICT COURT OF WESTERN AUSTRALIA CIVO No.     of 20 HELD AT

IN THE MATTER of section 24(1) of the Road Traffic (Authorisation to Drive) Act 2008 (WA)

and

IN THE MATTER of an Application to remove a disqualification from holding a motor driver's licence

BETWEEN:

Applicant

- and -

The Director General of Transport Respondent

AFFIDAVIT OF SERVICE OF________________________(Name of person)

Date of signing:Date of filing:Filed by: The ApplicantName:

(Applicant’s name)

Address:

Telephone:

Annexures

Annexure Description Page No:

____________________________________________

I,(Applicant’s name)

of(Applicant’s address)

in the State of Western Australia,(Applicant’s occupation)

being duly sworn make oath and say/do solemnly and sincerely declare and affirm as follows:

1. On I served the Director General of Transport with (date)

the application to remove disqualification by hand.

SWORN/AFFIRMED by the abovenamed )deponent at )in the State )of Western Australia this ) day of 20 ) (Signature of deponent)

Before me:

(Signature of authorised witness)

(Name of authorised witness)

(Occupation of authorised witness)