Application for Enrolment - NSW Livestock Loading Scheme (NSWLLS)

1. Operator (Applicant) Details
Roads and Maritime sender name
Roads and Maritime Services customer number
Applicant's Name *

Company Individual
Please fill in the details *

First Name Surname
Please fill in the details *
(must be a legal entity, e.g company)
Trading Name *
(Name of partnership or Registered Business Name)
Australian Company Number (ACN) *
Name of any subsidiary companies
Registered office address or business address *

Address Line 1

Address Line 2

City State

Postcode
Nominated address is same as business address
Nominated address where compliance inspections may be conducted *

Address Line 1

Address Line 2

City State

Postcode
Compliance inspections postal address *

Compliance postal address is same as Business address Compliance postal address is same as Nominated address Other
*

Address Line 1

Address Line 2

City State

Postcode

2. Contact Details
Contact person *
(Must have authority to act on behalf of the company or business)
Title/Position *
Preferred contact method *

Business Phone Mobile Facsimile Email
Business phone number *
Mobile phone number *
Facsimile number *
Email Address *

3. Operator Declaration

I, the applicant, hereby agree to comply with the requirements of the NSW Livestock Loading Scheme (NSWLLS) and understand that non compliance with these requirements can result in penalties.

I authorise Roads and Maritime Services to disclose information and documentation relating to my enrolment.

I understand that giving false and misleading information is a serious offence and penalties apply.

I hereby declare that all details provided in this application are true and correct.
Applicant's signature *

Clear
Applicant's Name same as Contact person
Applicant's Name *
Title/Position *
Date Signed (day/month/year) *

Day Month Year
Privacy Statement *

The Roads and Maritime Services (Roads and Maritime) is subject to the Privacy and Personal Information Protections Act 1998, the Health Records and Information Privacy Act 2002 and the Privacy Act 1988 (Cth) which requires the Agency to comply with the Information Privacy Principals. Roads and Maritime is committed to protecting your privacy. We will only use your information for the purpose for which you have provided it and for directly related purposes. Roads and Maritime will not disclose your personal information to third parties, unless you consent or in other circumstances where such disclosure is required or authorised by law. Operators are responsible for obtaining the consent of the driver to provide information to the Agency.

4. Nominated Vehicle List

NOTE: All vehicles and trailers being removed must have had the NSWLLS labels removed.

Vehicles to be managed by operator but registered in the name of a different company or individual must be nominated as "Captured Vehicles" on the Nominated Vehicle List for the NSW Livestock Loading Scheme.

Click on the (+) Button to add multiple entries
All fields are mandatory *
Please note: Information must be provided for all vehicles to be added, details that are incorrect or omitted may result in delays or the application not being processed.

Catalogue No. 45071673 Form No. 1639 (10/2014) ABN 76 236 371 088

5. Changes to Nominated Captured Vehicles

Vehicles to be managed by operator but registered in the name of a different company or individual must be nominated as "Captured Vehicles" on the Nominated Vehicle List for the NSW Livestock Loading Scheme.

* Provide details of all captured vehicles below

Click on the (+) Button to add multiple entries
Please note: Information must be provided for all vehicles to be added, details that are incorrect or omitted may result in delays or the application not being processed.

Catalogue No. 45071673 Form No. 1639 (10/2014) ABN 76 236 371 088
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1. Operator (Applicant) Details