Confirmation of Vehicle Financial Interest Agreement (Form ODT 6)

January 15, 2018 | Author: Anonymous | Category: N/A
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ODT 6

Government of Western Australia Department of Transport

Confirmation of Vehicle Financial Interest Agreement

On-demand Transport

This form is used when an applicant for an Omnibus - Charter Vehicle or Regular Passenger Transport (RPT) Licence does not own the vehicle that they wish to use, and provides confirmation that there is an arrangement with the vehicle owner to use the vehicle as an Omnibus.

VEHICLE INFORMATION CURRENT PLATE NUMBER

AGREEMENT DETAILS

START DATE HAVE THE REGISTERED OWNER AND THE OMNIBUS APPLICANT AGREED THAT THE OMNIBUS APPLICANT MAY USE THE VEHICLE AS AN OMNIBUS?

VIN/CHASSIS NUMBER

NO

YES COMMENCEMENT DATE

MAKE

/ MODEL

/

COMPLETION DATE

/ VEHICLE REGISTERED OWNER DETAILS

/

IS THERE A CHARGE FOR THE USE OF THE VEHICLE?

DRIVER’S LICENCE NUMBER

NO

YES

IF YES, WHAT IS THE AMOUNT?

FAMILY NAME / COMPANY NAME

$ IS THERE A BOND FOR THE USE OF THE VEHICLE?

FIRST NAME

NO

YES OTHER NAME / S

IF YES, WHAT IS THE AMOUNT?

RESIDENTIAL / COMPANY ADDRESS

$ WHAT IS THE PERIOD OF NOTICE FOR TERMINATION FROM THE OWNER TO THE APPLICANT?

SUBURB

W A

STATE

POST CODE

WHAT IS THE PERIOD OF NOTICE FOR TERMINATION FROM THE APPLICANT TO THE OWNER?

TELEPHONE NUMBER

VEHICLE REGISTERED OWNER DECLARATION I declare that the information provided on this form is true and correct.

OMNIBUS APPLICANT DETAILS DRIVER’S LICENCE NUMBER

FAMILY NAME / COMPANY NAME

I also consent to licensing information and other information identifying the vehicle specified in this form being made available to the Omnibus Applicant by the Department for the purposes connected with the Omnibus Licence contemplated in this form. VEHICLE REGISTERED OWNER NAME

VEHICLE REGISTERED OWNER SIGNATURE

FIRST NAME

DATE

OTHER NAME / S

/

/

OMNIBUS APPLICANT DECLARATION

RESIDENTIAL / COMPANY ADDRESS

I declare that the information provided on this form is true and correct. OMNIBUS APPLICANT NAME SUBURB STATE

W A

TELEPHONE NUMBER

OMNIBUS APPLICANT SIGNATURE POST CODE DATE

/

/ Last updated: 21/07/2016

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