Vehicle/Recreational Ship Cancellation of Registration Application

Vehicle/Recreational Ship Cancellation of Registration Application
Transport Operations (Road Use Management) Act 1995 Transport Operations (Marine Safety) Act 1994
1. Registered operators details

Family/Business/Company name Given name/s
Residential/Business/Company address Postcode Postal address (if same as above write as above) Postcode
If you are cancelling a vehicle, dealer plate or trailer trade plate go to Section 2 If you are cancelling a ship, go to Section 3 2. Vehicle details
Registration number Vehicle make/model (e.g. Ford Falcon) Body shape (e.g. sedan)
VIN/Chassis number
Vehicle registration label If the registration of the above vehicle is current and a refund of the unexpired portion of the registration is required, it will be necessary to ensure that the registration label is destroyed and the following statement is completed. Statement I/We declare that the current registration label issued to the above vehicle has been destroyed. Signature of person who destroyed the label Date / Reason for cancellation Acquired by a DSAL dealer for sale Stolen Dealer plate/ trailer trade plate no longer required STOL OREQ No
Please complete Form 4069 Written-off Vehicle Notication (Motor Vehicle and Motorcycle - Individual) or Form 4070 Written-off Vehicle Notication (Caravan/Trailer - Individual)
Vehicle re-registered in Queensland/Interstate Wrecked/Destroyed
RERG WREK
Owner request vehicle not OREQ currently used on the road Was the vehicle assessed by an insurer? Yes Insurer
Vehicle wrecked/destroyed - WREK Cancellation date may be backdated to the day after the accident only if: Documentation from an ofcial source (e.g. Insurer or Police) is provided conrming the date of the accident: and The statement in Section 6 is completed, conrming that the vhicle has not been used on a road since the accident; and Either a letter from an Insurer is provided conrming the status of the vehicle as written-off, or a Written-off Vehicle Notication is completed form 4096 Written-off Vehicle Notication (Motor Vehicle & Motorbike - Individual) or form 4070 Written-off Vehicle Notication (Caravan & Trailer - Individual). Surrender of number plates Both number plates (if applicable) must be surrendered at the time of cancellation. A refund of the unexpired registration fees may not be granted unless the number plates are surrendered. If one or both plates are lost, stolen or destroyed, section 6. Statement (overleaf) is required to be completed stating the circumstances of the loss, theft or destruction. Go to Section 4
3. Ship details
Registration number Ship manufacturer Engine make Engine number/s
Ship registration numbers/label It will be necessary to ensure that the ship registration numbers are removed, the registration label is destroyed and that the following declaration is completed. I/We declare that the registration numbers have been removed from the hull and the current registration label issued to the above ship has been destroyed. Signature of person who removed the registration number and/or destroyed the label Date / Reason for cancellation Wrecked/ Destroyed Ship re-registered in Queensland/Interstate Go to Section 4 /
WREK RERG
Operator has ceased use of the ship
OREQ
Ship unseaworthy
UNSE
Stolen
STOL
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SSA Mulitmedia Services
Form F3517 ES
V01 Oct 2010
4. Stolen Vehicle/Ship
Was your vehicle/ship stolen? No Yes Go to Section 5 It will be necessary to have a police ofcer complete and stamp the section below. Has the vehicle/ship been recovered? No Yes Date of recovery / / Report or reference no. Date theft reported to police / /
Were the number plates recovered (vehicles only)? No Yes I hereby certify that the details shown are correct and the vehicle/ship details are consistent with the vehicle/ship reported stolen. Police ofcers name Rank and number Station (place ofcial stamp here) Date / /
5. 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. I consent to Department of Transport and Main Roads verifying my evidence of identity documents or information with the issuing authority or their agencies.
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 / / /
6. Statement
This statement must be completed if: The reason for the cancellation is WREK due to the vehicle being written-off as a result of an accident and the cancellation date is to be backdated; or One or both plates cannot be surrendered (e.g. lost, stolen or destroyed).
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
7. This section is to be completed for personalised plates only

Note - No refund or part refund of the plate fee will be considered for the cancellation of personalised plates. A refund of registration fees (if applicable) will be paid if either - 1. Vehicle registration is cancelled and personalised plates are surrendered, OR 1. Are personalised plates only to be cancelled? 2. Vehicle registration is cancelled and personalised plates Complete an Application to Remove and/or are retained for attachment to another vehicle. No Yes Attach Personalised/Customised Plates (Form Privacy disclaimer - Department of Transport and Main Roads collects F2964) and surrender the personalised plates. information on this form under the Transport Operations (Road Use 2. Are the personalised number plates and vehicle registration to be cancelled? No Yes Surrender the personalised plates.
Management) Act 1995, Transport Operations (Marine Safety) Act 1994 and the Transport Operations (Passenger Transport) Act 1994 to manage the Department of Transport and Main Roads vehicle and vessel register. This information may be released by the department or its agents/contractors to parties such as vehicle/vessel insurers, statutory/insolvency entities, lawyers, persons involved in vehicle and/or vessel accidents/ incidents, vehicle/vessel manufacturers, tolling entities and to or through interstate registering authorities. The information is accessible by authorised departmental ofcers and your personal information will not be disclosed to other third parties without your consent unless authorised to do so by law.
3. Are the personalised plates to be attached to another vehicle immediately? No No further action required. Yes Complete an Application to Remove and/or Attach Personalised/Customised Plates (Form F2964)
Ofce use only

Number of plates surrendered? 1 Have full requirements been met? No Yes Ship registration surrendered from ____ /____ /____ Registration cancelled from ____ /____ /____ 2 Initials _______________

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Vehicle/Recreational Ship Cancellation of Registration Application

1. Registered operators details

Vehicle re-registered in Queensland/Interstate Wrecked/Destroyed

Operator has ceased use of the ship

continued over page...

SSA Mulitmedia Services

V01 Oct 2010

7. This section is to be completed for personalised plates only

Ofce use only

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