Optional plate application form

Optional Plate
Government of Western Australia
Department of Transport
Application Form
Driver and Vehicle Services
Character Selection
Vehicle Type
Material
Frangipani Series - no space permitted
Vehicles only
Aluminium
Letters
Plate Size
Normal
Slimline
Combination
Colour
Black
Numbers
Pink
Numbers
Letters
Letters
Numbers
Zodiac Series - no space permitted
Letters
Numbers
Numbers
Letters
Chinese Zodiac Series - no space permitted
Letters
Numbers
Numbers
Letters
Custom Series
Aluminium - If a space is required please mark
Cannot contain numbers only.
No leading space.
Acrylic - If a space is required please mark
Maximum of 9 characters for motor vehicles. Maximum of
7 characters for motorcycle size. Cannot contain numbers
only. No leading space.
Name Series
If a space is required please mark
Vehicles only
Select type
Aries
Aquarius
Cancer
Aluminium
Capricorn
Gemini
Leo
Vehicles only
Select type
Pig
Dog
Dragon
Normal
Slimline
Combination
Libra
Pisces
Sagittarius
Aluminium
Horse
Monkey
Ox
Motor vehicle
Trailer
Motorcycle
Scorpio
Taurus
Virgo
Black
Purple
Normal
Rabbit
Goat
Rat
Rooster
Snake
Tiger
Motor vehicle size
Normal
Slimline
Combination
1/2 size 1-3 characters
3/4 size 1-5 characters
Black
Motorcycle size
Normal 1-7 characters
Small 1-5 characters
BLACK ON WHITE
WHITE ON ORANGE
WHITE ON BLUE
GREEN ON WHITE
WHITE ON DARK BROWN
WHITE ON DARK BLUE
BLUE ON WHITE
WHITE ON OLIVE GREEN
WHITE ON BLACK
RED ON WHITE
WHITE ON DARK GREEN
WHITE ON PURPLE
WHITE ON PINK
WHITE ON GREY
BLUE ON BRAND WA
Brand WA only available in normal size. Not available for motorcycle, slimline, 1/2 or 3/4.
The colours displayed may vary from the actual plate.
Vehicles only
Acrylic
Normal only
Vehicles only
Aluminium
Slimline
Combination
Maximum 9 letters, including spaces no leading space.
Prestige Series - no space permitted
WHITE ON BLACK
BLACK ON WHITE
Letters
Numbers
Last updated 06/03/2015
Character Selection
Vehicle Type
Material
Plate Size
Colour
Euro Premium
Vehicles only
Aluminium
Euro size
Baby Euro
Combination
Euro Custom Plus - no space permitted
Vehicles only
Aluminium
Euro size
Baby Euro
Combination
Euro Custom - no space permitted
Vehicles only
Aluminium
Blue sash
Euro size
Baby Euro
Euro Combination
Vehicles only
Aluminium
Euro size
Aluminium
Motor vehicle size
Cannot contain numbers only
If a space is required please mark
Letters
2 letters and 3 numbers
Numbers
Euro Series - characters allocated
Letters
Blue sash
Numbers
Retro Series - Motor vehicles - no space permitted
X contains 3 letters, 3 numbers
Letters
Blue sash
Numbers
OR
Normal
Slimline
Combination
WHITE ON BLACK
BLACK ON WHITE
U contains 3 letters, 3 numbers.
Numbers
Letters
Retro Series - Motor cycles - no space permitted
Motorcycle size
Normal size only
X contains 2 letters, 3 numbers
Letters
Numbers
OR
U contains 2 letters, 4 numbers.
OR
2 letters, 3 numbers.
Letters
Numbers
Personalised If a space is required please mark
Motor vehicle
Trailer
Motorcycle
Aluminium
Normal size
Motor vehicle
Trailer
Aluminium
Normal size
Numbers
Letters
1, 2 or 3 Letters and 3 numbers.
World Rally Championships
If a space is required please mark
Up to 3 characters.
Pre determined
Design series - No spaces permitted
Vehicle type
Motor vehicle
Trailer
Motorcycle
contains 3 letters and 3 numbers
Plate size
Normal
Slimline - not available for motorcycles
Combination - not available for motorcycles or trailers
OR
Numbers
Letters
contains 3 numbers and 3 letters.
Letters
Numbers
Intense series - No spaces permitted
contains 2 letters and 4 numbers
Vehicle type
Motor vehicle
Trailer
Plate size
Normal
contains 3 letters and 2 numbers
contains 3 letters and 3 numbers
contains 4 letters and 2 numbers
BIZPLATE REMAKE
Size
Vehicle
Trailer
Top message
Bottom message
Numbers
Letters
Colour
Own logo/image
Background colour of library image
Yes
White
No
(If no, select library image below)
Black
Library Image
DECLARATION
I take full responsibility for the displaying of the approved plates and agree to abide by the terms and conditions overleaf:
Signature of applicant
Date
PLEASE TURN OVER
PLATE OWNER DETAILS (NAME IN WHICH PLATES ARE TO BE REGISTERED)
SURNAME
GIVEN NAME/S
DATE OF BIRTH
ADDRESS
POSTCODE
DAYTIME TELEPHONE
MOBILE
DRIVER’S LICENCE NO.
To assist Driver and Vehicle Services in assessing your optional plate application please provide a brief description for your chosen character combination
(nickname, pets name etc)
Correspondence to be directed to owner? Yes
No
(If no, complete below)
CONTACT DETAILS
SURNAME
GIVEN NAME/S
DATE OF BIRTH
ADDRESS
POSTCODE
DAYTIME TELEPHONE
MOBILE
DRIVER’S LICENCE NO.
COLLECTION DETAILS
COLLECTION SITE - Please nominate your preferred collection site:
*Please note identification will be required when collecting plates
REMAKE APPLICATION
Is this application for a remake of existing optional plates? Yes
No
Motor Vehicle
Plate
Sizes
Motorcycle
Normal
372mm x 134mm
Normal
254mm x 100mm
Slimline
372mm x 100mm
Small
190mm x 100mm
1/2 size
190mm x 134mm
3/4 size
315mm x 134mm
Combination
1 normal & 1 slimline
Euro
520mm x 111.8mm
Baby Euro
372mm x 100mm
Euro Combination
1 Euro & 1 Baby Euro
General Terms and Conditions - Optional Plates
The Applicant for Optional Plates agrees to the following terms and conditions:
•
Optional plates cannot be affixed to a taxi, omnibus or any other vehicle, which requires specific identifying number plates.
•
Payment in full is required on submission of the application.
•
The successful applicant will be issued with a Certificate of Right to Display and Trade. The plates however, always remain the property of the Chief
Executive Officer of Transport.
•
The person entitled to the Certificate of Right to Display and Trade the plates may sell that right. The vendor of the Certificate of the Right to Display and
Trade and the purchaser are obliged to complete a transfer form and notify the Chief Executive Officer of Transport of the sale of the right to display the
plates.
•
A sale can take place at any price to any individual or corporation, but the Certificate of Right to Display and Trade the plates must be transferred in
accordance with the Road Traffic (Vehicle) Regulations 2014. Failure to do so will constitute a breach of the regulations, for which there is a penalty.
•
The Department of Transport provides no guarantee that designs or design features will be available in the future.
•
Where design features are no longer available, remake applications will be produced in the design features currently available for that plate series.
•
Plates not attached to a Western Australian licensed vehicle must be stored at a Driver and Vehicle Services (DVS) Centre or DVS Agent on behalf of the
Chief Executive Officer, and a storage fee for each year or part thereof will be charged to the person entitled to the Right to Display and Trade the plates.
•
The Chief Executive Officer reserves the right to refuse any application he considers to be or may be perceived to be:
a. Offensive;
b. Contentious;
c. Of a sensitive nature;
d. In breach of any Trade mark; or
e. For any other reason.
•
The applicant warrants that the character combination applied for in no way infringes any third party’s intellectual property rights.
•
The applicant indemnifies the Chief Executive Officer and the State of Western Australia in the event of any third party claims for breach of trademark
arising from the use of the plate.
•
The Applicant agrees that in the event that the character combination does infringe any third party’s intellectual property rights or is found not to comply with
the Plate Committee Guidelines, pursuant to these terms and conditions, the Chief Executive Officer may require the return of the plates together with the
Certificate of the Right to Display and Trade, and the Applicant acknowledges and accepts that the Applicant has no further rights relating to those plates.