RF1442A
UNREGISTERED / UNINSURED STATUTORY DECLARATION
WARNING:
WARNING:
The Oaths Act 1936 provides a maximum penalty of 4 years imprisonment for any person who knowingly makes
a Statutory Declaration which is untrue in any regard.
If this Statutory Declaration is not accepted by the issuing authority at any time, responsibility may return to you and
an enforcement warning notice may be issued to you – additional fees apply.
SEND COMPLETED DECLARATION to the Manager, Expiation Notice Branch,
GPO Box 2029, Adelaide SA 5001 (or facsimile number (08) 7322 3559)
DO NOT SEND OR MAKE PAYMENT
This Declaration may be completed by the person the notice is issued to if there is a defence to the alleged offence;
•
This declaration must be witnessed by a Justice of the Peace or a person proclaimed under Part V of the Oaths Act 1936
(e.g. a legal practitioner, a proclaimed police officer);
•
Responsibility for payment will remain with you if this Declaration is not properly completed and submitted to the Manager,
Expiation Notice Branch, before the due date for payment of the notice.
I,
Daytime Phone No.:
(Full Name)
of
(Address)
(Email)
authorised to speak for Company Name: (if applicable)
do solemnly and sincerely declare that at the time of the offence referred to in Expiation Notice No.:
issued to Motor Vehicle Registration Number:
State:
REGISTERED OWNER DECLARATION
DRIVER DECLARATION
I was the registered owner of the vehicle; and (7 Cross applicable)
I was not the owner of the vehicle; and (7 Cross applicable)
The vehicle was driven on a road with a permit allowing
it to be driven unregistered or with a trade plate fitted;
(write down the permit or trade plate details below)
I was driving the vehicle because I was required to drive
it by my employer during my employment and I did not know
that it was unregistered;
(explain the nature of the employment and the reasons why
you did not know that the vehicle was unregistered below)
I was not the driver of the vehicle and I had taken
reasonable steps to ensure that the driver was aware that
the vehicle was unregistered;
(write down the name, address, date of birth and licence
number of the driver and explain what you did to ensure that
the driver was aware that the vehicle was unregistered
below)
I was driving the vehicle whilst doing volunteer work for the
vehicle owner and I did not know that it was unregistered;
(explain the nature of the work and the reasons why you did
not know that the vehicle was unregistered below)
I was driving the vehicle whilst doing contract work for the
vehicle owner and I did not know that it was unregistered;
(explain the nature of the contract work and the reasons why
you did not know that the vehicle was unregistered below)
The vehicle was stolen or illegally used;
(explain when the vehicle was stolen or used without
permission, including any police report number and details
of the driver (if known) below)
I was driving the vehicle at the time of the alleged offence
and I did not know and could not reasonably have been
expected to have known that it was unregistered.
(explain why you were driving the vehicle and why you did
not know that the vehicle was unregistered below)
I was not the actual owner of the vehicle at the time
of the alleged offence.
(write down the name, address, date of birth and licence
number of the actual owner below)
Write details in this box
and I make this solemn declaration conscientiously believing the same to be true, and by virtue of the Oaths Act 1936.
Declared and subscribed at:
in the State of:
Signature: (person making declaration)
Justice of the Peace
Declared before: Name & ID:
Signature:
Proclaimed Police Officer
Date:
FOR OFFICE USE ONLY:
Revised: 10/03/2016
Page 1
/
/
Commissioner for taking affidavits