Online Form - Nominate Another Driver

Driver Nomination Form

This form is a legal document and can be used as evidence in Court.

I (Title)*

First or Given Name*

Surname*

Of (insert address)*

Mobile Phone

Home Phone

E-mail address*

Hereby state that the person who was the:*

Vehicle Registration Number*

Infringement Number(s)*

On (Date of Infringement)*

was (title of driver)*

First or given name of driver*

Surname of driver*

Address of driver (Postal address of driver)*

Phone number of Driver

Evidence to Support Nomination

Car Hire or Car Sales companies must attach rental or sales agreements.

If you have evidence to support your nomination, please attach here.

Max File Size: 10.00 MB
Allowed File Types: .avi, .doc, .docx, .gif, .jpeg, .jpg, .mov, .mp3, .mp4, .mpeg, .mpg, .pdf, .png, .ppt, .pptx, .xls, .xlsx

I certify that the information I have submitted in this form is true and correct to the best of my knowledge, I am aware that it is an offence to provide false and misleading information.*

AgreeDo not Agree