Quick Reference Guide Filling out a Special purpose vehicle permit application form

Transcription

1 February 2014 Quick Reference Guide Filling out a form Regulator Customer Number (RCN) (if known) If you are applying online do not complete Sections 1, 2 and 3. If you have an RCN do not complete Section 1. Section 1 Applicant Details Applicant s Name (must be Company or Individual) ❶ Regulator Customer Number (RCN) Unique identifier for applying for road access permits. You will receive your RCN when you register online, note your RCN to put in this section. If applying offline (i.e. mail, fax or post) you won t fill in this section for first application. Australian Company Number (ACN) (ACN is not required for Individuals) Trading As Name (if applicable) Registered Company Address (or Business Address for individuals) Postal Address (if same as Registered Company write As Above ) Postcode ❷ Section 1 Applicant details You can apply as either a company or individual. Postcode Billing Postal Address (if same as Postal write As Above ) Postcode Please note: Page 1 of 7 If applying online you do not have to complete Sections 1, 2 or 3. However you do have to complete all sections on page 3. Page 1 of 6

2 Filling out a form Section 2 Contact Person s Details Full Name Title/Position Phone Number Fax Number Mobile Phone Number ❸ Section 2 Contact person s details This does not have to be the person applying for the permit, but the person the NHVR would contact with any queries. Billing person s details This is the address that your invoice will be sent. Address Preferred Method of Contact (please select one only) Fax Post Phone Mobile Billing Person s Details Full Name Same as Contact Person Details Phone Number Fax Number Address Preferred Method for sending of Billing details (please select one only) Post Permit Details Preferred Method for sending of Permit (please select one only) Section 3 Applicant Declaration I hereby declare that all details provided in this application are true and correct. Knowingly making a false statement to the NHVR may attract significant penalties under section 701 of the Heavy Vehicle National Law. Applicant s Name Fax Post ❹ Section 3 Applicant declaration. When applying online you will need to provide an electronic signature or print and sign if applying offline. Title / Position Privacy ment The NHVR is collecting your personal information to process this special purpose vehicle pursuant to Chapter 4 of the Heavy Vehicle National Law Act. We are authorised under this Act to collect information we reasonably require to process your application. We may disclose protected information contained in your application for the purposes set out in section 727 of the Act to an entity (including a private or public sector entity) identified in that section. This can include disclosure to an authorised employee or agent of the entity. We may disclose protected information to a law enforcement agency, including a service provider authorised to enforce the Heavy Vehicle National Law nationally. A police agency may disclose protected information disclosed to or otherwise held by it to another police agency authorised to hold protected information. Applicant s Signature If providing an electronic signature please consent to the following: I accept the electronic signature has the same status as a signed signature. Date Signed D D M M Y Y Page 2 of 7 Page 2 of 6

3 Filling out a form Complete all sections on page 3. Section 4 Vehicle Details Mobile Crane Concrete Pump Drilling Rig Other: Are you enrolled in IAP? Yes: No Extra states (if applicable) Vehicle Dimensions Forward Projection (m) Width (m) Vehicle Registration Number Vehicle Registration Vehicle Identification Number (VIN/Chassis Number) if unregistered supply PLEASE DON T USE CAPS Rear Overhang (m) Vehicle Make Removed Parts (counter weight) Vehicle Model Length (m) Height (m) Total Mass (t) Load Sharing Suspension GVM/ GCM/ ATM Yes No Dolly/Jinker Registration Number (if used) Dolly/Jinker Dolly/Jinker of Number Registration of axles Page 3 of 7 ❺ ❻ ❼ Section 4 Vehicle details Select vehicle type if you are currently enrolled in IAP select yes and specify which state(s).ensure you specify if the vehicle has load sharing suspension. Registration details As per vehicle registration papers (for GCM/GVM/ATM Vehicle compliance plate, manufacturers ratings letter or vehicle registration papers.i.e. 120t GCM). If applying for multiple vehicle combinations, they must have the same vehicle particulars (mass and dimensions). Vehicle dimensions Dimensions and specifications Provide all dimensions and masses. Front projection The distance of the projection forward of the centre of the steering wheel. Rear overhang The distance between the rear of the vehicle and the rear overhang line of the vehicle. Removed parts Specify the items/components removed and their mass for on-road travel (e.g. 10t of counterweight). Total mass Specify total mass for on-road travel. Page 3 of 6

4 Filling out a form Section 4 (cont d...) Loaded Axle Mass and Spacings Using the table provide the following details (if additional space is required please attach the Additional Axle Mass and Spacings page with details) Unit Number Axle Number of tyres Steerable axle (select if applicable) Distance from previous axle (m) Tyre size (mm) Ground Contact Width (m) Axle mass requested (t) ❽ Section 4 (cont d...) Vehicle details Number of tyres Enter the number of tyres on each axle. Steerable axle Select y or n for applicable axles. Distance from previous axle Specify spacing between each consecutive axle in metres. The distance is measured from the centre of the axle wheel hub to the next axle wheel hub. Tyre size Specify section width in millimetres (mm). If tyre is labelled in inches multiply by 25.4 to find width in mm. Ground contact width Specify the distance between the outermost point of ground contact of the outside tyres on each end of the axle. Note: do not include any tyre bulge. Axle mass requested Provide axle mass required. Description of vehicle (e.g. 5 axle crane with boom reversered on to a 3 axle dolly) Page 4 of 7 Page 4 of 6

5 Filling out a form Section 5 Permit Type oversize only overmass only oversize and overmass Period Please indicate required period. Period from Period to / / / / Note Requested period cannot exceed 3 years Period Permit (only applicable to certain combinations) Single Trip ❾ Section 5 Permit type Select applicable permit type (one only). Period Specify permit period required. The requested period cannot exceed 3 years. Section 6 Route/Area Details Start Address (Full Address including street number) Destination Address (Full Address including street number) state postcode state postcode Journey ID and Version Number Do you require a return trip? Yes No Route/Area Description (certain vehicle configurations may be restricted to routes only) Third party consent You may be required under law to consult with one or more other entities and seek their approval in relation to your application. ❿ In this case, the relevant road manager/s may commence their decision making process, however the Regulator cannot grant your permit until you provide evidence that approval has been given by the third party/ies e.g. Rail Networks, Energy Providers, Telecommunication Networks. Please provide evidence of third party approvals with this application Tick if attached If you are unable to provide at time of submission please supply as soon as possible via , fax, post or mail clearly marked Access Management 3rd Party Approval Evidence quoting the case number and your RCN. Section 6 Route/area details Start address/destination address For Single Trip permits Journey ID If using NHVR Journey Planner just add your Journey ID and version number (no need to fill in any further details). Route/area details If you are not supplying a Journey ID, ensure you fill in the route/area details and route/area description. For a trip permit provide a turn by turn description including streets and suburbs. Period permits If operating under a zone or area list the name or description of the zone/area in route/area description. Third party consent If third party approvals are required please attach copies to application form and tick attached Page 5 of 7 Page 5 of 6

6 Filling out a form DO NOT COMPLETE THIS PAGE IF SUBMITTING ONLINE Payment Details Notes: Preferred payment is by credit card Payment Method (tick one) Credit Card Cheque (please make cheques payable to the ). A separate cheque is required for each application if choosing to pay be one of these types. Payment Amount $70 If you wish to pay the application fee by Credit Card, please complete the details below Card Type Visa MasterCard American Express Name on Credit Card (please print) Card Number Contact Details Send completed applications and supporting information with payment details by Mail or Fax to the details listed below. Mail Access Management PO Box 30 Virginia Business Hub Qld 4014 Fax To contact the Access team Phone Number 1300 MYNHVR ( ) Standard 1300 call charges apply Please check with your phone service provider Office Hours Website 7:00am - 7:00pm (AEDT) AccessForms@my.nhvr.gov.au Payment details Only complete this page if you are applying offline (via fax or mail). If you are filling out the application electronically you will need to provide an electronic signature or print and sign if applying offline. A payment can be made by credit card or cheque. A permit cannot be issued without full payment of the required fees. About the NHVR The (NHVR) is Australia s dedicated independent regulator for heavy vehicles over 4.5 tonnes gross vehicle mass. The NHVR was created to administer one set of rules for heavy vehicles under the Heavy Vehicle National Law (HVNL), improve safety and productivity, minimise the compliance burden on the heavy vehicle transport industry and reduce duplication and inconsistencies across state and territory borders. Card Expiry M M / Y Y Cardholder Signature CVV If providing an electronic signature please consent to the following: I accept the electronic signature has the same status as a signed signature. Date Signed D D M M Y Y Page 7 of 7 (2014) Please note: While every attempt has been made to ensure the accuracy of the content of this fact sheet, it should not be relied upon as legal advice. For more information subscribe /subscribe visit info@nhvr.gov.au fax post PO Box 492, Fortitude Valley Q 4006 tel 1300 MYNHVR* ( ) *Standard 1300 call charges apply. Please check with your phone provider. Page 6 of 6