DL 26

Government of Western Australia

Application for Replacement/

Certified Copy of Drivers Licence and/or Learners Permit

Department of Transport
Driver and Vehicle Services

TO REGISTER YOUR INTENTION FOR ORGAN DONATION, PLEASE CALL MEDICARE AUSTRALIA ON FREECALL 1800 777 203.

LICENCE HOLDERS DETAILS

FAMILY NAME

DATE OF BIRTH

GIVEN NAMES

RESIDENTIAL
ADDRESS

SUBURB OR
TOWN

POSTCODE

POSTAL
ADDRESS

SUBURB OR
TOWN

POSTCODE

Lost

Original licence/permit:

Destroyed

Stolen (complete declaration below)

LICENCE/PERMIT NUMBER

Replacement required:

Drivers licence

Learners permit
DATE

SIGNATURE

WITNESS

DRIVER AND VEHICLE SERVICES CENTRE/AGENT

STOLEN DRIVERS LICENCES ONLY

A *free replacement licence will be issued if you complete the Statutory Declaration below AND provide a
Police Incident Report Number. *Does not apply to Learners Permits
STATUTORY DECLARATION
Oaths, Affidavits and Statutory Declarations Act 2005
I
(Full Name)

of
(Address)

do solemnly and sincerely declare that to the best of my knowledge my drivers licence has been stolen
and reported to the Western Australian Police Service.
Declared at

this

Declarant Signature:

day of

year

Police Incident Report Number:

Declared before authorised witness:

(See back of form for explanation)

(Surname)

(Qualification)

(Other names)

(Signature)

It is an offence to give false or misleading information.

PENALTIES WILL BE ENFORCED UNDER THE OATHS, AFFIDAVITS AND STATUTORY DECLARATIONS ACT 2005.

Department of Transport staff/agents ONLY to detach the below credit card authorisation slip from this form.

Credit card Authorisation form

* Required fields

CARDHOLDER NAME *

CARD NUMBER *

CREDIT CARD *

Visa

Mastercard

EXPIRATION DATE *

BILLING ADDRESS *

CITY *

STATE/ PROVINCE *

PHONE NUMBER *

EMAIL ADDRESS

POSTAL CODE *

COUNTRY *

I authorise the Department of Transport to charge my credit card in the amount of: $
PRINTED NAME *

SIGNATURE *

DATE *

Your credit card details will be securely destroyed once your payment has been processed.
Last updated: 02/09/2014

OFFICE USE ONLY

Proof of Identity Check
PRIMARY

Birth Cert.

Passport

Immigration Doc.

Citizenship

Naturalisation Doc.

Proof of Age Card

Old Licence

I.D. Document No.

SECONDARY
(Specify)
REPLACEMENT ISSUED:

DATE:

YES

SIGNATURE:

DRIVER & VEHICLE SERVICES CENTRE/ AGENT:

AUTHORISED WITNESS
The declaration on the front of this form must be made before any of the following persons:
1.

Academic (Post-Secondary Institution)

16.

Engineer
31.

Podiatrist

2.

Accountant

17.

Commonwealth Industrial Organisation

Secretary.

32.

Police Officer

3.

Architect
Australian Consular Officer

18.

Insurance Broker

33.

Post Office Manager

4.

Australian Diplomatic Officer

19.

Justice of the Peace

34.

Psychologist

5.

20.

Lawyer

35.

Public Notary

6.

Bailiff
21.

Local Government CEO or Deputy CEO

36.

Public Servant (State or Commonwealth)

7.

Bank Manager
22.

Local Government Councillor

37.

Real Estate Agent

8.

Chartered Secretary
23.

Loss Adjuster

38.

Settlement Agent

9.

Chemist
24.

Marriage Celebrant

39.

Sheriff or Deputy Sheriff

25.

Member of Parliament

40.

Surveyor

26.

Minister of Religion

41.

Teacher

27.

Nurse

42.

Tribunal Officer

28.

Optometrist

43.

Veterinary Surgeon

29.

Patent Attorney

44.

30.

Physiotherapist

Any other authorised person under the

Statutory Declarations Act 1959 of the
Commonwealth

10. Chiropractor
11.

Company Auditor or Liquidator

12. Court Officer

13. Defence Force Officer
14. Dentist
15. Doctor

FOR MORE INFORMATION

More information is available online at www.transport.wa.gov.au/dvs or by calling the Driver and Vehicle Services Call Centre on 13 11 56.
LODGING YOUR APPLICATION BY POST (GPO BOX R1290, Perth WA 6844)
If you wish to lodge your application by post you must also supply the following documents:
Certified copies of primary and secondary proof of identification (information on acceptable proof of identity documents can be
located online at www.transport.wa.gov.au/dvs )
Police incident report number - for stolen drivers licence documents only
Payment - for lost, damaged and replacement drivers licence documents only