Heavy Vehicle Pilot Licence Application Form · Heavy Vehicle Pilot Licence Application Form. To...
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Heavy Vehicle Pilot Licence Application Form To obtain a Heavy Vehicle Pilot Licence in Western Australia, you must register as a Pilot with Main Roads. Please note that you are not able to operate as a Pilot until you are authorised and in possession of your licence, which will be valid for 3 years. Further information is available on our website at https://www.mainroads.wa.gov.au/UsingRoads/HVS/Pages/pilots.aspx or futher more information please call Heavy Vehicle Services on 138 HVO (138 486). Please print clearly and ensure the form is filled out correctly to avoid any delays in processing of the application. Licence Number Licence Class Expiry Date Date of Training Course Name of Training Provider Your Western Australian drivers licence may include restrictions and conditions, please specify if any: EFTPOS** VISA Card Mastercard Cash Cheque Name on Card Card Number Expiry Date CVV Code **To use the Eftpos facility, you will need to visit the Main Roads WA Heavy Vehicle Services office at 525 Great Eastern Hwy, Redcliffe, during business hours 8:30am - 4:30pm, Monday to Friday. First Name Surname Other Name(s) Date of Birth Residential Address Suburb (Cannot be a PO Box Address.) Postal Address Postcode State Suburb Email Address Mobile Phone Number Contact Phone Number Postcode State If same as above write "As Above" Pilot Licence Number I want to register as a new Pilot What do you want to do? (Please tick only one option) Applicant Details Driver's Licence Details Training Details Licence Payment Details Signature State of Issue I am updating my Pilot Licensing details Supporting Documentation and Checklist Copy of Australian Motor Drivers Licence Fee of $205.00 Certificate of Competency on the 5 accredited units and Bridge Supervision Unit by a Registered Training Provider. I opt to collect the Licence from the Heavy Vehicle Service front counter I opt to have the Licence sent to my postal address stated above Please note the processing of the application can take up to 20 working days pending no further information is required Copy of a Current Medical Declaration I declare that all information provided in this application is true and correct. I understand that if I have failed to disclose any relevant information or if any information that I have provided is found to be false or misleading, any exemption granted as a result of this application may be deemed invalid. Signature Applicant Name Date Email completed form to: [email protected] or Alternatively return completed forms to: Heavy Vehicle Services Main Roads WA 525 Great Eastern Highway | REDCLIFFE | WA PO Box 374 | WELSHPOOL DC | WA 6986 | Telephone 138 HVO (486) | Fax (08) 9475 8455 www.mainroads.wa.gov.au
Transcript of Heavy Vehicle Pilot Licence Application Form · Heavy Vehicle Pilot Licence Application Form. To...
Heavy Vehicle Pilot Licence Application FormTo obtain a Heavy Vehicle Pilot Licence in Western Australia, you must register as a Pilot with Main Roads. Please note that you are not able to operate as a Pilot until you are authorised and in possession of your licence, which will be valid for 3 years. Further information is available on our website at https://www.mainroads.wa.gov.au/UsingRoads/HVS/Pages/pilots.aspx or futher more information please call Heavy Vehicle Services on 138 HVO (138 486). Please print clearly and ensure the form is filled out correctly to avoid any delays in processing of the application.
Licence Number Licence Class
Expiry Date
Date of Training Course
Name of Training Provider
Your Western Australian drivers licence may include restrictions and conditions, please specify if any:
EFTPOS** VISA Card Mastercard Cash Cheque
Name on CardCard Number
Expiry Date CVV Code
**To use the Eftpos facility, you will need to visit the Main Roads WA Heavy Vehicle Services office at 525 Great Eastern Hwy, Redcliffe, during business hours 8:30am - 4:30pm, Monday to Friday.
First NameSurname Other Name(s)
Date of Birth
Residential Address
Suburb(Cannot be a PO Box Address.)
Postal Address
PostcodeStateSuburb
Email AddressMobile Phone Number
Contact Phone Number
PostcodeState
If same as above write "As Above"
Pilot Licence Number
I want to register as a new PilotWhat do you want to do? (Please tick only one option)
Applicant Details
Driver's Licence Details
Training Details
Licence Payment Details
Signature
State of Issue
I am updating my Pilot Licensing details
Supporting Documentation and ChecklistCopy of Australian Motor Drivers Licence
Fee of $205.00Certificate of Competency on the 5 accredited units and Bridge Supervision Unit by a Registered Training Provider.
I opt to collect the Licence from the Heavy Vehicle Service front counter
I opt to have the Licence sent to my postal address stated above
Please note the processing of the application can take up to 20 working days pending no further information is required
Copy of a Current Medical
DeclarationI declare that all information provided in this application is true and correct. I understand that if I have failed to disclose any relevant information or if any information that I have provided is found to be false or misleading, any exemption granted as a result of this application may be deemed invalid.
Signature Applicant Name Date
Email completed form to: [email protected]
or Alternatively return completed forms to:
Heavy Vehicle Services Main Roads WA 525 Great Eastern Highway | REDCLIFFE | WA PO Box 374 | WELSHPOOL DC | WA 6986 | Telephone 138 HVO (486) | Fax (08) 9475 8455 www.mainroads.wa.gov.au
