F3000 Form – Fill Out and Use This PDF

Are you eligible for a Queensland (Qld) Driver Licence? To be eligible for a driver licence in Qld you must:

•prove your identity using original documents

•be a resident of Qld

•disclose medical conditions that may adversely affect your ability to drive safely.

You are not eligible to make this application if your licence is suspended or you are disqualified from driving in any Australian state

or territory or any other country.

The information you provide in this document must be true and correct otherwise the licence granted to you will be void and you may be prosecuted for providing false or misleading information.

If your application/renewal is approved, your licence will be mailed to you. This may take up to 2 weeks. You will receive a Driver Licence Receipt today which will allow you to drive until you receive your licence.

Please PRINT clearly in dark pen (do not use pencil or erasable ink)

1. Personal details

Family name

Given name/s

Date of birth

dd/ mm / yy

Gender: Male (M)

Female (F)

Town, state and country of birth

Residential address

Postcode

Postal address (if same as residential address, write ‘as above’)

Postcode

Daytime contact phone number

Email address

2. Previous name or aliases

Do you currently hold or have you ever been issued a Qld driver licence, industry authority, marine licence, adult proof of age card or vehicle/vessel registration, in any other name? (e.g. name at birth, maiden name, previous married names, adoptive name, or

3. Evidence of identity (EOI) and Qld residency

a.Can you show your Qld Driver Licence, Industry Authority, Marine Licence (with photo) or Adult Proof of Age card that is current or expired less than 2 years ago?

No

Yes

Licence/reference number

GO TO 4.

b.If you cannot show identification listed above, you must provide:

3 EOI documents + evidence of Qld residency. At least 1 EOI document must show your signature.

(For a full list of acceptable EOI documents please see Evidence of Identity Requirements for Individuals (form F4362) or visit www.qld.gov.au)

All EOI documents must be ORIGINAL and include:

1 category A + 2 category B OR 2 category A + 1 category B.

Category A (e.g. passport, birth certificate, Australian photo driver licence)

Document Type	Document number (e.g. X0100011)
	(e.g. C0100011)
Category B (e.g. Medicare card)
Document Type	Expiry date (if applicable)
Category A or B
Document Type	Document number or expiry date
	(do not give credit/debit card number)

Evidence of Qld residency address (e.g. bills for phone, electricity, rates)

Document Type

Issue date

dd / mm / yy

4.Is your name different from the name on your current driver licence or EOI documents above?

No

Yes

You must show an EOI change of name document

Change of name document (e.g. Australian change of name certificate)

Document Type	Document number		Issue date
		dd	/ mm / yy

5.Do you have a driver licence issued by another Australian state or territory or country?

No		Yes		Fill in details below. If you have a licence
				issued by another Australian state or territory,
				you must surrender it to be eligible for a Qld
				driver licence.

Licence/reference number				Effective date
				dd	/	mm	/	yy
State/territory/country of issue				Expiry date
				dd	/	mm	/	yy
Licence type (e.g. L/P/O)	Licence class/es (e.g. C/LR/MR)

6. Licence type and class

What type/class of licence(s) are you renewing or applying for?

other aliases)

No

Yes

Provide details below

Previous family name

Previous given name/s

Licence Type

Learner

P

P1

P2 Open

Licence Class

Car		C	Light Rigid		LR
Car (Automatic
		CA	Medium Rigid		MR
Condition)			Heavy Rigid
Learner Approved					HR
Motorbike		RE
			Heavy Combination		HC
Motorbike
		R	Multi-combination		MC

Note: An evidence of identity document linking your previous name and your current name may be required.

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Are you applying for a licence or class of licence that you held more than 5 years ago?

No

Yes

You must provide evidence of your previous licence

7. Medical Condition Reporting

You must report any medical condition/s that may adversely affect your ability to drive.

a.Do you need to wear glasses/contact lenses for driving?

No

Yes

S condition will be shown on your licence

b.Do you have any of the following conditions? Check each statement.

No Yes

Vision or eye disorder (other than wearing glasses or contact lenses) that may adversely affect your driving

Diabetes that requires treatment by tablet, insulin or other medication

Been diagnosed with epilepsy, experienced a seizure; or been required to take anti-epileptic medication after the age of 11

Any other medical condition/s that is likely to adversely affect your ability to drive safely

If you have answered Yes to any statement at 7b, you must provide a Medical Certificate for Motor Vehicle Driver (form F3712)

completed by your treating doctor.

8. Traffic history

a.Have you currently, or within the last 5 years, had your licence cancelled or been disqualified from driving or obtaining a driver licence by an Australian or overseas court?

No

Yes

Provide details below

Reason for cancellation/disqualification

State/territory/countryDuration

b.Is your licence currently suspended for any reason including speeding offences, demerit points, unpaid fines or any other reason?

No

Yes

Provide details below

Reason for suspension

State/territory/countryDuration

9. Court Orders - restricted licence

Have you been granted a current court order for any of the following? Check each statement.

	No				Yes		Code
A drink or drug driving conviction							X1
Special Hardship Order (SHO)							X3
An order allowing you to drive until your drink or							X4
drug driving charge is heard in court

If you have answered Yes to any of the above, you will need to show your court order/s. The relevant code will be shown on your licence. You must comply with the court order and carry it with you when driving.

Privacy statement: The Department of Transport and Main Roads (the department) collects this information under the provisions of the Transport Operations (Road Use Management) Act and Transport Planning and Coordination 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 department’s card production contractor will have controlled access to your information, digitised signature and digital photo to make your card. Information, including your digital photo or digitised signature, may be disclosed to an authorised agency if the information is connected to an application for its product. Your information will not be disclosed to any other third party without your consent, unless required or authorised by law.

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10. Applicant’s declaration

Sign only in the presence of an authorised person.

I declare that I have read the answers I have given to the questions in this application and that the answers are complete, true and correct in every detail.

If undertaking a practical driving test, I declare that I have the consent of the registered operator to use the vehicle for the test. I also declare that the registered operator has given consent for any Driving Examiner employed by the department or any Police

Officer, to drive the vehicle during or in connection with the test undertaken in the vehicle, if required.

I understand that if I have stated anything 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 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 or overseas licence holders.

I understand that by signing this declaration I agree to the surrender of my interstate driver licence.

I also consent to the department releasing information about my application for a Qld licence to the issuing authority or their agencies.

Applicant’s signature

Date

dd / mm / yy

It is an offence under the Transport Operations (Road Use Management) Act 1995 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 $7000.

Authorising person’s checklist

EOI sighted - address and details current on system

S or M conditions checked/added/amended

M condition reported - F3712 attached if required

Court orders/restrictions - sighted and copies attached, codes added

O/S - licence/documents sighted, copied and attached if required

O/S - translations of O/S document copied and attached if required Application Approved / Refused

Comments by authorising person

Authorising person’s declaration

I have witnessed the applicant’s signature and checked that it matches the applicant’s evidence of identity which I have sighted.

Authorising person’s name

Signature

Office stamp / date