Vehicle/recreational Ship Cancellation Of Registration Application (Page 2 of 2) in pdf

5. Stolen Vehicle/Ship

Was your vehicle/ship stolen?

Go to 6

Date theft reported to police

It will be necessary to have a police officer complete and stamp

Yes

the section below.

Has the vehicle/ship been recovered?

Yes

Date of recovery

Report or reference number

Were the number plates recovered (vehicles only)?

Yes

I hereby certify that the details shown are correct and the vehicle/ship details are consistent with the vehicle/ship reported stolen.

Police officer’s name

Rank and number

Station (place official stamp here)

Date

6. Statement

This section must be completed

I declare that the vehicle/recreational ship registration that I am cancelling was validly paid. All information provided in this document

is true to the best of my knowledge.

Signature/s of registered operator (In the case of joint registered operators at least one must sign)

Date

Signature/s of authorised company representative (if applicable)

Date

7. Statement

This statement must be completed if:

•

The reason for the cancellation is that the vehicle was written-off as a result of an accident or event and the cancellation date is to

be backdated. The statement below must indicate that the vehicle has not been driven on the road since the accident or event.

•

One or both plates cannot be surrendered (for example, lost, stolen or destroyed).

•

Plate/s have been taken by the Queensland Police Service as the vehicle is currently under a Number Plate Confiscation Notice.

I/We,

Signature of registered operator (in the case of joint registered operators at least one must sign)

Date

Note - when personalised plates are in joint names both signatures are required

It is an offence to give false or misleading information under the Transport Operations (Road Use Management) Act. Maximum

penalty may exceed $6000.

8. This question is to be completed for personalised plates only

1. Are vacant (plates not attached to a vehicle) personalised plates only to be

Privacy Statement: The department is collecting the information

cancelled?

on this form for the purposes of maintaining the department’s

vehicle/vessel registration register as required under the Transport

Yes

Surrender the personalised plates.

Operations (Road Use Management) Act. The department or its

agents/contractors may use your information in its communications

2. Are the personalised number plates and vehicle registration to be cancelled?

with you and where relevant, may give some of the information

to vehicle insurers, statutory entities, insolvency entities,

Yes

Surrender the personalised plates.

lawyers, person’s involved in vehicle incidents/accidents, vehicle

manufacturers, third parties who are involved in or intend to

3. Are the personalised plates to be attached to another vehicle immediately?

commence legal proceedings, tolling entities, law enforcement

agencies and interstate registering authorities. Your personal

Note - If the plate/s have been taken by the Queensland Police Service as the vehicle is

information will not be disclosed to any other third party without

currently under a Number Plate Confiscation Notice, you cannot attach these plate/s to

your consent, unless authorised or required to do so by law.

another vehicle during the confiscation period.

No further action

Yes

Complete an Application to Remove and/or Attach Personalised/Customised Plates (Form

required.

F2964)

Office use only

Is the vehicle currently under a CONF restriction? No

Number of plates surrendered?

Yes

0 plates required.

Have full requirements been met?

Initials ________________

Yes

Vehicle/Ship Registration cancelled from ____ /____ /____

Refund amount__________________

User Id ________________

Vehicle/recreational Ship Cancellation Of Registration Application Page 2

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