Written-off Vehicle

Application to repair a written-off vehicle

Important information Use this form if you are seeking an Authorisation to Repair a written-off vehicle (car, motorbike, trailer or caravan). You must provide information to substantiate your claim under the category you have nominated on this form. Lodge this application by post only. Mail this form, together with the Vehicle Damage Declaration and any other required documents to the address shown at the bottom of this page If you require more information about this application please go to the Roads and Maritime Services (RMS) website on www.rms. nsw.gov.au/WOV or call RMS on 13 22 13. Please note: You should be aware that if you wish to repair and re-register your written-off vehicle, from 31 January 2013, the Certificate of Registration for that vehicle will state that the vehicle has been reported to the NSW Written-off Vehicle Register. RMS reference no.

1. Applicant details
Drivers licence number / Customer number

3. Vehicle details
Make

Surname

Model

Given names

VIN

Address

Engine number

Postcode

Compliance plate date

Day

Business phone

Fax number

Month

Year

Colour

Shape / body type

Mobile phone

4. Were you the registered operator of this vehicle when it

Email was damaged? Yes No Go to 5 complete below a) Have you inherited this vehicle after it was written-off? Yes Go to 5 No Trailer Caravan Other specify b) Has the vehicle been notified to the Roads and Maritime Services as a 'superficially-damaged motorbike' before 30 June 2013? Yes No c) Go to 5 refer to c) refer to b)

2. Type of vehicle
Car Motorbike

If you answered No to the above questions, you are not eligible for an Authorisation to Repair this vehicle. For more information, please contact RMS on 13 22 13.
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To lodge your application please post all documents to: Roads and Maritime Services, Vehicle Identification Inspection Unit (VIIU) PO Box 646 Botany NSW 1455 www.rms.nsw.gov.au 13 22 13
Catalogue No. 45071564 Form No. 1585 (01/2013) ABN 76 236 371 088

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5. Category of Exemption being sought

In addition to your Vehicle Damage Declaration you are required to nominate the exemption category for which you wish to apply. Please tick the box or boxes that best describe the reason for your exemption. Note: Please refer to the categories below which describe the evidence you must submit to support your application for exemption.
Please tick

5. Customer Declaration and Privacy Statement

Please read carefully before you sign. If you do not tell the truth you can be prosecuted. Roads and Maritime Services (RMS) is collecting your personal information in relation to this declaration and may retain and use it for driver licensing, motor vehicle, road transport and safety purposes. You are required to provide your personal information under road transport legislation and RMS may reject your declaration if you do not provide it. RMS may disclose your personal information to other driver licensing and vehicle registration agencies, to verify the information you provide, for the purpose of enquiring about motor accidents, to confirm currency of compulsory third party (bodily injury) insurance, advise anyone proposing to acquire an interest in your vehicle and in respect of enquiries relating to stolen or abandoned vehicles. Otherwise RMS will not disclose your personal information without your consent unless authorised by law. RMS is subject to the Privacy and Personal Information Protection Act 1998. Your personal information will be held by RMS at 101 Miller Street, North Sydney NSW 2060. You have the right to access and correct the information if you believe that it is incorrect. You declare that the information on this form is true and complete. Section 307C of the Crimes Act 1900 makes it an offence for you to provide false or misleading information. Customer signature

Hail damage Hail damaged vehicles will only be considered for an exemption if you were the registered operator at the time the vehicle was hail damaged. Inherited vehicle A written-off vehicle that was inherited by the person seeking an Authorisation to Repair. Same registered operator for at least 28 days Vehicle registered to the same operator at least 28 days prior to the vehicle sustaining the damage causing it to be written-off. Motorsport vehicle Vehicle will be used only for designated motorsport activities. Applications for exemptions under this category may be considered in combination with controlled, conditional registration. Checklist: (please indicate below that you have included the required documents with your application) Insurer vehicle damage declaration (originals to be submitted) Evidence to support your application for the particular category of exemption Important note: When original documents are requested you should make copies for your records

Date
Day

Month

Year

RMS Office Use Only Assessed by

Signature

Badge no.

Recommendation Approve Not approve Date

Day

Month

Year

Approved by

Signature

Date
Day

Month

Year

Catalogue No. 45071564 Form No. 1585 (01/2013) ABN 76 236 371 088

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