QUEENSLAND POLICE SERVICE
APPLICATION FOR PERMIT
(Generally)
PT 31
09/03
5
Transport Operations (Road Use Management) Act 1995
TO:
THE SUPERINTENDENT OF TRAFFIC,
(Place)
I,
(Family name in BLOCK LETTERS)
(Given name(s) in BLOCK LETTERS)
of
(Address)
Hereby apply for a permit to
at
(Place)
on
the
(Day)
day of
(Date)
between the hours of
(Month)
(Year)
and
(Start time)
(Finish time)
I declare that the information and particulars set out herein are true and correct.
SIGNED AT
this
(Place)
(Witness to signature)
day of
(Date)
(Month)
(Year)
(Signature of applicant)
Privacy Collection Statement
The collection of this information is authorised by the Police Service Administration Act 1990 and the Transport Operations (Road
Use Management) Act 1995. The information will be used to assess your application for the specified permit. The QPS may disclose
some or all of this information to other State and Federal Government agencies as provided for by legislation or in accordance with
the Information Privacy Act 2009.
PT 31 Application for Permit (Generally)
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