Form F4101 Cfd - Conditional Vehicle Registration Transfer Application Page 2
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48. Excess dimension/mass
Gas Fuel Systems Certificate/
Issue date
Compliance Plate number
Is the vehicle excess dimension?
/
/
No
Yes
Vehicle is required to operate under the
relevant guideline or authority.
exemptions listed in Gas Certificate Exemptions
Is the vehicle excess mass?
Other Gas Fuel Systems Certificate/
Issue date
Compliance Plate number
No
Vehicle is required to operate under the
Yes
relevant guideline or authority.
/
/
9. Date of disposal
15. Registration category
/
/
Limited
Zone
Unrestricted
10. Purpose of use
access
access
access
16. Is someone lodging this application on your
Private
Commercial
Used for
non profit
behalf?
(Your representative will need to bring proof of
Rental (self
Farming
Driver training
their identification as well as proof of your identity, for
driver rental)
Emergency
or tuition
example, Queensland Driver Licence).
Public passenger
vehicles
service
No
11. Conditional vehicle registration duty
Representative’s details - name (in full)
Yes
Duty (if applicable) on conditional registration is charged at
a flat rate of $25.00.
Are you exempt from paying duty? For information about
Representative’s signature
Conditional Vehicle Registration Duty exemptions, please
refer to the Duty section on this form.
Go to 12
No
17. Declaration
(All acquirer/s must sign, however, future
Yes
Is a whole or part interest in a vehicle being
transactions will require only one signature).
transferred by way of a gift to a relative of the
registered operator/s?
I/We declare that the information provided is correct.
I We will not use or permit the use of this vehicle outside
What is the relationship to the previous
Yes
registered operator? (please tick one box
of the conditions for use applying to the vehicle stated
below)
in the Guideline for Conditionally Registered Vehicles in
Queensland (Form Number 17).
Partner by marriage
I/We consent to the department verifying my EOI
Partner in a de facto relationship
documents or information with the issuing authority or their
(provided the couple are living together
at the date of the transaction and have
agencies.
lived together for at least two years)
Acquirer/s signature/s
Partner in a registered relationship
prescribed under the Relationships
Act 2011
Date
Parent, grandparent or their spouse
/
/
Spouse’s parent, grandparent or their spouse
Disposer/s signature/s (if currently in joint names the
Child, stepchild, grandchild or their
signature of only one disposer is required)
spouse
Spouse’s child, stepchild, grandchild
or their spouse
Date
No
Enter other exemption type below (refer
/
/
to duty information section on this form)
It is an offence to give false or misleading information under
the Transport Operations (Road Use Management) Act.
12. Registration periods
Maximum penalty may exceed $7000.
Are you paying the renewal at the time of transfer?
Now complete Part B - Seller’s Copy
6 months
12 months
No
Yes
13. Compulsory Third Party (CTP) Insurance
Privacy Statement: The department is collecting the information on this form
for the purposes of maintaining the department’s vehicle/vessel registration
You may choose a new CTP insurer for the next registration
register as required under the Transport Operations (Road Use Management)
period. For a list of licensed insurers visit maic.qld.gov.au.
Act. The department or its agents/contractors may use your information in its
Do you wish to nominate a new CTP insurer?
communications with you and where relevant, may give some of the information
to vehicle insurers, statutory entities, insolvency entities, lawyers, persons
If yes, name of CTP insurer
No
Yes
involved in vehicle accidents/incidents, vehicle manufacturers, third parties
who are involved in or intend to commence legal proceedings, tolling entities,
law enforcement agencies and interstate registering authorities. Your personal
information will not be disclosed to any other third party without your consent
Only GST registered businesses may be able to claim an
unless authorised or required to do so by law.
Input Tax Credit (ITC). Is anyone entitled to claim the GST
component of the CTP insurance premium for the vehicle as
Office/Agency use only
an ITC? If unsure contact your tax adviser.
No
Yes
Identification sighted? Yes
14. Is the vehicle fitted with gas fuel systems or
Authorising person’s name
other gas systems?
No
Yes
You must present the relevant Gas
Certificate, Form PGR101/102 (fuel system)
Authorising person’s signature
Date
or Form PGA734 (cooking facilities), with
/
/
this application unless exempt. The issue
date of the certificate must not be more than
three months before the vehicle transfer.
Page 2 of 4 TRB Forms Area Form F4101 CFD V01 Nov 2015
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