Fillable Printable Learning Driving Licence Form - Queensland
Fillable Printable Learning Driving Licence Form - Queensland
Learning Driving Licence Form - Queensland
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Driver Licence Application/Renewal
(Learner, P1, P2, P type and Open Licence)
Transport Operations (Road Use Management) Act 1995
Please use this form if you are applying for the grant or renewal of
a Queensland (Qld) driver licence. You are not eligible to make
this application if your licence is suspended or cancelled or you are
disqualified from holding or obtaining a driver licence in any Australian
state or territory, or any other country.
Evidence of Identity (EOI) Requirements
You must give evidence of your identity. You may do so by showing
your Qld driver licence, industry authority, marine licence indicator
(conditions apply) or adult proof of age (APA) card. All cards must
be current or expired by less than two years.
If you are unable to show one of the above you will need to present
three other acceptable EOI documents and evidence of your Qld
residential address.
For a full list of acceptable EOI, evidence of residential address
and change of name documents please refer to the Evidence of
Identity Requirements for Individuals (form F4362) or visit
www.qld.gov.au.
Medical Condition Reporting
You must tell the department of any medical condition that may
adversely affect your ability to drive safely. You may need a medical
certificate confirming your fitness to drive. Your health professional
may also recommend that your licence be subject to conditions.
Please visit www.qld.gov.au for further information.
Postal address (if same as residential, write as above)
Daytime contact phone number Date of birth
Town and country of birth
1. Personal details
Family name (please print)
Given name/s
Residential address
Male
Female
/ /
Day Month Year
Category B (please print)
Evidence of Qld residency address (please print)
Is your name different to the name/s on your EOI documents?4.
No
Yes
You are required to show a change of name document.
Please provide details of your document.
Do you have a driver licence issued to you by another
Australian state or territory, or country?
5.
No
Yes
Driver licence number (if known) Effective date
Note:If you have a driver licence issued by another Australian state
or territory, you are not eligible for the grant of a Qld driver
licence if you do not surrender this driver licence to the
department.
/ /
Day Month Year
Licence type
State/Territory/Country of issue
Category A or B (please print)
Change of name (please print)
Document number (do not
give credit/debit card number)
Document type
(for example, credit card)
Document numberDocument type
Issue date
(for example, 10/06/2010)
Document type
(for example, telephone account)
Registration year
(for example, 2010)
Document type (for example, Qld
BDM issued Marriage Certificate)
Document number
(for example, 001000)
Expiry date
/ /
Day Month Year
Eye colour Height Hair colour Complexion
cms
Licence class/es
6.
What type and class/es of licence are you applying for?
Postcode
Postcode
2. Have you ever held a Qld driver licence in another name?
No
Yes
Driver licence number (if known) Expiry date
/ /
Day Month Year
Family name (please print)
Given name/s
Motorbike
Car
Car (Automatic
Condition)
C
CA
R
*Note:
From 1 January 2014 specially constructed vehicles (excluding
mobile cranes of more than 4.5t)
may be driven under the authority
of a class C licence; class UD will not be issued to new applicants.
Can you show your Qld driver licence, industry authority,
marine licence indicator or APA card?
3.
Yes
No
You must show three EOI documents, one of which
must show your signature, and one evidence of
residential address document. Please provide details
of your documents.
Licence/authority/reference number
You must provide evidence of your previous licence if you are
applying for a type or class of licence you have not held for more
than five years. (Visit www.qld.gov.au for more information).
Licence type
Learner
P
P1
P2
Open
Licence class
*Specially
Constructed
Vehicle
Learner Approved
Motorbike
RE
UD
Heavy Rigid
Light Rigid
Medium Rigid
LR
MR
HR
Multi-
combination
Heavy
Combination
HC
MC
Category A (please print)
Document number
(for example, X0100011)
Document type
(for example, Qld BDM birth certificate)
Email address
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Page 1 of 2 TRB Forms Area F3000 CFD V01 Apr 2015
8. Are you currently or have you recently been disqualified
from holding or obtaining a Qld marine licence by an order
of an Australian or overseas court?
Length of disqualificationYes State/Territory/Country
9. Are you currently or have you recently been disqualified
from holding or obtaining a driver licence by an order of
an Australian or overseas court?
Length of disqualificationYes State/Territory/Country
13.
Do you need to wear glasses/contact lenses for driving?
No Yes S condition will be shown on your licence
No Yes
Note: An Optometrist or Ophthalmologist report may also be required to be
given to your treating doctor.
Medical certificate (form F3712) is required
No Yes
Medical certificate (form F3712)
is required (see Note 1*)
*Note 1: You and your treating doctor must also complete the Private and Commercial
Vehicle Drivers Health Assessment (form F3195) if you hold or are applying
for a licence to drive any of the following vehicles:
a vehicle that is more than 8t GVM (class MR, HR, HC, MC)
a public passenger vehicle (e.g. taxi, limousine, bus)
a vehicle carrying dangerous goods.
A specialist report may also be required to be given to your treating doctor.
15.
No Yes How is your diabetes controlled?
Diet only
Insulin or other
glucose-lowering agent
Medical certificate (form
F3712) is not required
Medical certificate (form
F3712) is required (see Note 1*)
Do you have diabetes?
12.
Is your driver licence currently suspended for any of the
following reasons?
State/Territory/Country Period
No YesSpeeding offence
Accumulation of
demerit points
Unpaid fines No Yes
No Yes
Give details below
Any other reasons No Yes
Applicants declaration
Sign only in the presence of a departmental person.
I declare that I have read all the answers I have given to the questions in this
application and that the answers given by me are complete, true and correct in
every detail. I understand that if I have stated anything in this application that is
false or misleading, the driver licence granted to me as a result of this application
will be absolutely void and have no legal effect whatsoever. I understand that I
may be prosecuted for giving or stating any false or misleading information or
documents. I also declare that the information I have given about my medical
fitness to drive, is to the best of my knowledge, true and correct. I consent to the
department taking, keeping and using my personal information, documents, digital
photo and digitised signature for the purposes associated with my application.
I consent to the department verifying my EOI or evidence of previous licence
provided by me with the issuing authority or their agencies.
Additional declaration by interstate licence holders
I understand that by signing this declaration I agree to the surrender of my interstate
driver licence.
Applicants signature Date
It is an offence under the Transport Operations (Road Use Management) Act to
state anything or give a document to an authorised person if you know it contains
false or misleading information. The maximum penalty may be more than $6000.
/ /
Day Month Year
Were glasses or contact lenses worn for
the test?
Office Use Only
Practical driving test results
Class tested Code/condition (if any)
Passed Failed
Examiners signature
Date
Day Month Year
/ /
Examiners number
Report number
Eyesight test (if required)
NoYes
Tick where applicable
Give refusal letter
Comments
Authorising persons declaration
Authorising persons name
Authorising persons signature Date
Day Month Year
/ /
Office Stamp
Right Left Both
Application not approved
6 / 6 / 6 /
I declare that I have witnessed the applicants signature. I am satisfied that the signature
accords satisfactorily with the signature appearing on the EOI document/s. I also
declare that I have sighted the EOI, evidence of Qld residency, change of name
documents and evidence of previous licence as required.
Privacy Statement: The department collects this information under the provisions
of the Transport Operations (Road Use Management) Act so that you may apply for
a Qld driver licence. The department may disclose this information to interstate and
foreign driver licensing authorities, and the Queensland Police Service (QPS). Your
digital photo may also be released to the QPS. The departments licence production
contractor will have controlled access to your information, digitised signature and
digital photo to make your licence. Your information will not be disclosed to any other
third party without your consent, unless required or authorised by law.
18.
Registered operators authorisation for test vehicle
I authorise any Driving Examiner employed by the department or any Police
Officer, to drive my motor vehicle during or in connection with any driving test
undertaken in my vehicle, if required.
19.
Registered operators signature Date
/ /
Day Month Year
Vehicle registration number
10. Have you been granted a court order for any of the following
reasons? (Please show your court order)
11. Has your licence been cancelled for any other reason?
Yes Reason for cancellation
PeriodState/Territory/Country
14. Do you have any other vision or eye disorder?
#Note 2:A Medical Certificate (form F3712) is required if your licence has a condition
code M and your doctor has indicated that you now meet the medical criteria
for an unconditional licence.
Application approved
1:1 match performed
Applicants EOI confirmed
Applicants details confirmed
in TRAILS/TICA
(a) Restricted licence order for a drink or drug driving conviction
No
Yes
Code X1 will be shown on your driver licence.
(b) Special Hardship Order (SHO)
No
Yes
Code X3 will be shown on your driver licence.
(c) s79E order for a drink or drug driving related offence
No
Yes
Code X4 will be shown on your driver licence.
16.
No
Yes
Have you been diagnosed with epilepsy or experienced a
seizure at any time?
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Have you experienced a seizure or been required to take
anti-epileptic medication after the age of 11?
No Yes
17. Do you have any other medical condition that is likely to
adversely affect your ability to drive safely?
Medical certificate (form F3712)
is required (see Note 1*)
(See Note 2#)
Returning driver-previous licence verified and recorded (if required)
7. Do you currently have a Qld marine licence?
No
Yes
What marine licence do you hold?
Recreational marine driver licence
Personal watercraft licence
PWCL
RMDL
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No
Go to 9
No
Go to 10
No
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Page 2 of 2 TRB Forms Area F3000 CFD V01 Apr 2015
