Adult Proof of Age Card
Application/Replacement
Adult Proof of Age Card Act 2008
This form is to be used if you are applying for the issue or
replacement of an Adult Proof of Age (APA) card. To apply, you
must be at least 17 years and 11 months of age and ordinarily
reside in Queensland (Qld). However, you must be at least 18
years of age before an APA card can be issued to you.
The lodgement of this application does not guarantee its
approval.
Important information about the delivery of your APA card
If you were aged 18 years or over when you made your
application, your APA card will be sent to your postal address
within 14 days.
If you were under 18 years of age when you made your
application, your APA card will be returned to the Department
of Transport and Main Roads licence issuing centre where you
made your application. You will be notified when your card will
be available for collection. You will not be able to collect your
APA card before you turn 18 years of age. When you return to
the centre, you must show evidence of identity.
Evidence of Identity (EOI) Requirements
You must give evidence of your identity. You may do so
by presenting your Qld driver licence. If you are unable to
present your Qld driver licence, your Qld industry authority,
marine licence indicator or APA card may be accepted
(conditions apply). If you are unable to present any of these
documents you will need to present three other acceptable
EOI documents.
One of the documents must include your signature. If your
Qld residential address is not shown on any EOI documents
provided you must also show an evidence of Qld residential
address document. All documents must be current or
expired less than two years. All documents must be original
documents. Photocopies and certified copies of original
documents are not acceptable.
If you have changed your name or the details of your name
are different on the documents provided, you must show
a change of name document from the relevant Australian
Registrar of Births, Deaths and Marriages.
Please refer to the Department of Transport and Main Roads’
website www.tmr.qld.gov.au or the Evidence of Identity
Requirements for Individuals (form F4362) for a full list of
acceptable EOI, evidence of Qld residential address and
change of name documents.
2. Can you show your Qld driver licence, industry
authority, marine licence indicator or APA card?
Yes
No
Licence/authority/reference number
You are required to show three EOI documents
(refer to Evidence of Identity Requirements for
Individuals (form F4362)). Please provide details
of your documents.
Category A (please PRINT)
Document type (for example, Document number
Australian passport)
(for example, X0100011)
Category B (please PRINT)
Document type (for example, Document number (do not
give credit/debit card number)
CBA credit card)
Category A or B (please PRINT)
Document type
Document number
Evidence of Qld residency address (please PRINT)
Document type (for example, Issue date
Telephone account)
(for example, 10/06/2010)
3. Is your name different to the name/s on your EOI
documents?
No
Yes
1. Personal details
Family name (please PRINT)
Male
Given name/s
Female
Residential address
You are required to show a change of
name document (refer to Evidence of
Identity Requirements for Individuals
(form F4362)). Please provide
details of your documents. A Change
Customer Details (form F4214) may
also be required.
Change of name (please PRINT)
Document type
Document number Registration year
(for example,
(for example,
(for example,
Qld BDM Issued
2001)
001000)
Marriage Certificate)
Postcode
Postal address (if same as residential, write ‘AS ABOVE’)
Postcode
Daytime contact phone number
Date of birth
/
4. Have you been previously issued an APA card in
Queensland?
No
Go to 6
Yes
/
Town and country of birth
Eye colour
Height
Hair colour
cms
Complexion
Continued over page...
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Corporate Forms Area
Form F4772 CFD
V01 Aug 2013
5. What is the reason for the replacement APA card?
(a) because my APA card is damaged, destroyed, lost or
stolen.
Please indicate the reason for
No
Yes
replacement.
Damaged
Destroyed
Lost
Stolen
(b) you have not received your APA card in the mail.
Please confirm your postal address
No
Yes
details.
Privacy Statement: The Department of Transport and Main Roads provides this
form under the Adult Proof of Age Card Act so that you may apply for an adult
proof of age card. The information or documents collected for the purpose of
this application will be accessible by authorised departmental persons and some
of this information may be disclosed to the Qld Police Service and interstate
agencies that issue adult proof of age cards as allowed under the Act. The
Department of Transport and Main Roads’ card contractor will have controlled
access to your information, digitised signature and digital photo to make your
card. Your information, documents and digital photo may be accessed by
authorised departmental persons or police exercising a power in relation to
this Act, or otherwise authorised under the Police Powers and Responsibilities
Act 2000. The Department of Transport and Main Roads will not disclose your
personal information, documents, digitised signature or digital photo to any other
third parties without your consent unless authorised by law.
Postcode
(c) your APA card is defective or faulty.
Please give details about the defect or
No
Yes
fault. Note: You must return your defective/
faulty APA card.
Office Use Only (tick where applicable)
(d) your photo image is no longer a true likeness.
Note: You must return your APA card.
No
Yes
Applicant’s EOI confirmed
(e) other reason
No
Yes
1:1 match performed
Please provide details.
Applicant’s details confirmed in TICA/TRAILS
Application approved
Application not approved
Comment
6. Applicant’s declaration
Sign only in the presence of a departmental person
I declare that I have read all the answers I have given to the
questions in this application and that the answers given by
me are complete, true and correct in every detail.
I understand that if I have stated anything in this application
that is false or misleading, the adult proof of age card
granted to me as a result of this application will be
cancelled.
I understand that I may be prosecuted for giving or stating
any false or misleading information or documents.
I consent to the Department of Transport and Main Roads
taking, keeping and using my information, documents, digital
photo and digitised signature for the purposes associated
with the grant or replacement of my adult proof of age
card as required under the Adult Proof of Age Card Act or
otherwise authorised by law.
I consent to the Department of Transport and Main Roads
verifying my EOI documents or information provided by me
with the issuing authority or their agencies.
Applicant’s signature
Authorising person’s declaration
I declare that I have witnessed the applicant’s signature. I
am satisfied that the signature accords satisfactorily with the
signature appearing on the EOI documents. I also declare that I
have sighted the EOI, Evidence of Qld residency and Change of
Name documents as required.
Authorising person’s name
Authorising person’s signature
Date
/
/
Office Stamp
Date
/
/
It is an offence under the Adult Proof of Age Card Act to
state anything or give a document to an authorised person
if you know it contains false or misleading information. The
maximum penalty may be more than $6000.
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Corporate Forms Area
Form F4772 CFD
V01 Aug 2013