RMS Customer Number Application
Private customer
To get a Roads and Maritime Services (Roads and Maritime) Customer number you must prove your
identity. A copy of the brochure 'How to prove who you are' is available from your nearest motor
registry. You must attend the registry in person to complete this transaction.
Office Use
Customer number allocated
If you cannot provide an acceptable proof of identity document that shows your signature you must
complete the witness to applicant's signature section on page 2.
Attachments
If you cannot provide proof of residential address you must complete the reference section on page 1.
1
2
Customer details
Name
Do you hold or have you ever held a licence to drive or
ride in NSW, or a Roads and Maritime issued photo card
or conducted any business, such as registering a vehicle,
with Roads and Maritime that required the issue of a
customer number in the above name or in another name?
no
Residential address
yes
State
Postcode
Give details below
Licence number
Class of licence
Expiry date
Registration plate number
Mailing address (if different from residential address)
day
/
month
/
year
Other name
State
Postcode
What other business have you conducted?
Email address
3
Mobile number (please provide a mobile phone number if you
would like to receive communications from Roads and
Maritime this way)
Date of birth
day
Sex
/
month
/
year
male
female
Pensioner number (if applicable)
Customer declaration
Roads and Maritime Services (Roads and Maritime) is collecting
your personal information in order to create your Roads and
Maritime customer number. RMS may retain and use your personal
information for driver licensing, motor vehicle, road transport and
safety purposes.
Providing this information is voluntary but Roads and Maritime may
refuse your application unless you do so in which case you may not
be able to transact business with Roads and Maritime.
Roads and Maritime may disclose your personal information to
other driver licensing and vehicle registration agencies, to assess
your application or verify the information you provide, for inquiries
about motor accidents, to confirm compulsory third party (bodily
injury) insurance is current, to anyone proposing to acquire an
interest in your vehicle and in respect of inquiries relating to stolen
or abandoned vehicles.
Otherwise Roads and Maritime will not disclose your personal
information without your consent unless authorised by law.
Your personal information will be held by Roads and Maritime at
101 Miller Street, North Sydney NSW 2060. You have the right to
access and correct the information if you believe that it is incorrect.
You declare that the information on this form is true and complete.
Signature
Date
day
Catalogue No. 45071265, Form No.1411 (05/2012) ABN 76 236 371 088
/
month
/
year
Continued next page
Page 1 of 2
4
Reference
Required when you cannot provide proof of residential
address.
Position of witness - Employer / school principal / bank
manager / parent / guardian (cross out those not applicable)
To be completed by a person who has know you at least 12
months and holds a current NSW gold, silver or magenta
licence. RMS may contact the referee to verify information
in this application.
Date
Referee's full name (please print)
Business address of witness
day
Daytime contact phone
number of witness
/
month
/
year
(can be residential address of parent / guardian)
Referee's licence number
Referee's daytime contact
telephone number
State
Please note: If you do not tell the truth in your reference
statement, both you and the applicant can be fined.
I declare that I have known the applicant for at least 12 months and,
that to the best of my knowledge, the personal details given on
page 1 are correct.
I understand that my 'personal information' is being collected for
verification of the applicant's details. My supply of referee's
statement is voluntary.
RMS may disclose my 'personal
information' inside and outside of NSW to verify the contents of this
application.
Postcode
RMS office use only
Reason for establishment of customer
Proof of identity record
Stand-alone or primary proof
Signature
Passport / Visa date of issue or Expiry Date
Document number
Date
day
/
month
/
day
/
month
/
year
year
Secondary proof
5
Witness to applicant's signature
Required when you cannot provide an acceptable proof of
identity document that shows your signature.
If witnessed by a parent or guardian they must attend the
motor registry with you and show proof of their own identity.
Date of issue or expiry date
day
/
month
/
year
Name of applicant (block letters)
Proof of residential address
Type of proof
Signature of applicant
Parent or Guardian Proof of Identity
Witness declaration
Type of proof
I certify that the applicant, whose name and signature
appears on this form has signed in the signature box in my
presence.
My 'personal information' is being collected for verification of
the applicant's signature. My witnessing of the applicant's
signature is voluntary. My 'personal information' held by
RMS may be disclosed inside and outside NSW to verify the
contents of this application.
Name of witness (block letters)
Verified by
CSO's name
CSO's signature
Signature of witness
CSO's staff number
Catalogue No. 45071265, Form No.1411 (05/2012) ABN 76 236 371 088
Page 2 of 2
Cut here and hand to customer
Office Use Only
Customer name
RMS Customer number