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Government of Western Australia
Department of Transport
Driver and Vehicle Services
Statutory Declaration of Vehicle’s Dutiable Value
Oaths, Affidavits and Statutory Declarations Act 2005
STATUTORY DECLARATION
STATUTORY DECLARATION
ORGANISATION/COMPANY (CORPORATION)
(Please complete the NOMINATION OF AUTHORISED PERSON section)
FAMILY NAME
This declaration is true and I know that it is an offence to make a
declaration knowing that it is false in a material matter.
This declaration is made under Oaths, Affidavits and Statutory
Declarations Act 2005.
DECLARED AT
I,
FIRST NAME
/
DATE
/
SIGNATURE OF DECLARANT
OTHER NAME/S
IN THE PRESENCE OF:
PHONE NUMBER
Please see IMPORTANT INFORMATION (back page) section for
who can witness a statutory declaration.
FAMILY NAME
MOBILE NUMBER
FIRST NAME/S
EMAIL ADDRESS
OCCUPATION
ADDRESS
SIGNATURE
STATE
/
DATE
SUBURB
/
POST CODE
OCCUPATION
sincerely declare that vehicle detailed below:
NOMINATION OF AUTHORISED PERSON
Only to be completed if the vehicle is licensed or to be licensed in an
organisation or company (Corporation) name.
NUMBER PLATE
NAME OF OFFICER
being an officer of
I,
MAKE
NAME OF CORPORATION
as defined within
VIN/ CHASSIS NUMBER
Section 9 of the Corporations Act 2001 (Cwth), hereby appoint
NAME OF APPOINTED REPRESENTATIVE
at the time of application for the grant/transfer of a vehicle licence has
a dutiable value of:
DUTIABLE VALUE
as its representative in making this declaration.
SIGNATURE
$
PURCHASE PRICE
NAME AND NOMINATED OFFICER STATUS
$
Please refer to the GENERAL INFORMATION on the back of this
form.
DATE
/
/
Last Updated: 09/03/2016
IMPORTANT INFORMATION
This declaration must be made before any of the following persons
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Academic (post-secondary institution)
Accountant
Architect
Australian Consular Officer
Australian Diplomatic Officer
Bailiff
Bank Manager
Chartered Secretary
Chemist
Chiropractor
Company Auditor or Liquidator
Court Officer (Judge, Magistrate, Registrar or Clerk)
Defence Force Officer (Commissioned, Warrant or NCO with 5 years
continuous service)
Dentist
Doctor
Electorate Officer of a member of State Parliament
Engineer
Industrial Organisation Secretary
Insurance Broker
Justice of the Peace
Landgate Officer
Lawyer
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Local Government CEO or deputy CEO
Local Government Councillor
Loss Adjuster
Marriage Celebrant
Member of Parliament (State or Commonwealth)
Minister of Religion
Nurse
Optometrist
Patent Attorney
Physiotherapist
Podiatrist
Police Officer
Post Office Manager
Psychologist
Public Notary
Public Servant (State or Commonwealth)
Real Estate Agent
Settlement Agent
Sheriff or Deputy Sheriff
Surveyor
Teacher
Tribunal Officer
Veterinary Surgeon
or, any person before whom, under the Statutory Declarations Act 1959 of the Commonwealth, a statutory declaration may be made.
Or, any person before whom, under the Statutory Declarations
ActINFORMATION
1959 of the Commonwealth, a statutory declaration may be made.
GENERAL
WARNING: An applicant who understates the purchase price or current Dutiable Value of a vehicle or who provides
information which is false in a material particular (important details) commits an offence under the Duties Act 2008
and is liable to a penalty of $20,000.
The term ‘dutiable value’ is defined the Duties Act 2008.
New Vehicle:
For a new vehicle (which includes a demonstration model that has been used for that purpose for not more than 2 months)
that is a motor car, motor wagon, or motorcycle, the list price (see definition below), plus the price fixed by the manufacturer,
importer or principal distributor as the additional retail selling price in Western Australia for a particular type of transmission
fitted to the vehicle (For example, the set fee to upgrade a manual transmission to automatic).
Used Vehicle:
In relation to used vehicles - the amount for which the vehicle might reasonably be sold, free of encumbrance, in the open
market.
List Price:
List price means the price that has been fixed by the manufacturer, importer or principal distributor as the retail-selling price of
that vehicle in Western Australia.
NOTE: Vehicles which are transferred for no monetary gain need to have an amount provided for which the vehicle might
reasonably be sold free of encumbrances in the open market. (i.e. its dutiable value).
This form may be presented at the following Driver and Vehicle Services Centres:
METROPOLITANCOUNTRY
CANNINGTON
18C, 1480 Albany Highway
CITY WEST
Cnr Troode St & Plaistowe Mews
ALBANY178 Stirling Terrace
JOONDALUP
65 Boas AvenueBUNBURY
24 Wellington Street
KELMSCOTT
34 Gillam DriveCARNARVON
MANDURAH
Cnr Ranceby Avenue & Pinjarra Road
MIDLAND
Midland Gate Shopping Centre. Cale RoadKALGOORLIE
Suite 4, Anderson House, 35 Brookman Street
BROOME 9 Napier Terrace
13/1 Chesterfield Road, corner Mirrabooka AveKARRATHA
and Yirrigan DriveKUNUNURRA
MIRRABOOKA
Boat Harbour, Harbour Road
GERALDTON 65 Chapman Road
3-5 Welcome Road
Messmate Way
ROCKINGHAM 37 McNicholl Street Cnr McNicholl & Chalgrove
WILLAGEE
Cnr Stock Road and Leach Highway
For your nearest regional Department of Transport office or DVS agent, please visit our website at www.transport.wa.gov.au/dvs