Application for a Dangerous Goods Driver Licence - Western Australia

Page | 1 Application for a dangerous goods driver licence DGDL REV3

Application no. (office use only)

Application for a dangerous goods driver licence

Dangerous Goods Safety Act 2004

Dangerous Goods Safety (Road and Rail Transport of Non-explosives) Regulations 2007

ABN: 69 410 335 356

Refer to Dangerous goods driver licence – general information for guidance in completing this application.

1. Type of application (please tick applicable)

Phone no. (day) Mobile phone no.

Motor driver’s licence (MDL) State Expiry date DD / MM / YYYY

Residential address (must be a Western Australian address)

Unit no. Street no. Lot no. Street name Type e.g. St, Rd

Town / suburb State WA Postcode

Postal address (if different to residential)

Unit no. Street no. Lot no. Street name Type e.g. St, Rd

PO Box no. Town / suburb State Postcode

The following supporting evidence must be lodged with your application (if required)

The original medical certificate assessed against the standards in Assessing Fitness to Drive for Commercial and Private Vehicle

Drivers.

The medical certificate must be dated not more than six months before the day the application is lodged.

6. Western Australian (WA) driving record (N)

An original National Police Certificate and original Certified Copy of Traffic Infringements, regardless of whether you have, or have

not been issued with a WA MDL.

Dated not more than six months before the day the application is lodged.