Confirmation of Vehicle Financial Interest Agreement (Form ODT 6)

ODT 6
Government of Western Australia
Department of Transport
Confirmation of Vehicle Financial Interest Agreement
On-demand Transport
This form is used when an applicant for an Omnibus - Charter Vehicle or Regular Passenger Transport (RPT) Licence does not own the
vehicle that they wish to use, and provides confirmation that there is an arrangement with the vehicle owner to use the vehicle as an Omnibus.
VEHICLE INFORMATION
CURRENT PLATE NUMBER
AGREEMENT DETAILS
START DATE
HAVE THE REGISTERED OWNER AND THE OMNIBUS APPLICANT
AGREED THAT THE OMNIBUS APPLICANT MAY USE THE VEHICLE AS
AN OMNIBUS?
VIN/CHASSIS NUMBER
NO
YES
COMMENCEMENT DATE
MAKE
/
MODEL
/
COMPLETION DATE
/
VEHICLE REGISTERED OWNER DETAILS
/
IS THERE A CHARGE FOR THE USE OF THE VEHICLE?
DRIVER’S LICENCE NUMBER
NO
YES
IF YES, WHAT IS THE AMOUNT?
FAMILY NAME / COMPANY NAME
$
IS THERE A BOND FOR THE USE OF THE VEHICLE?
FIRST NAME
NO
YES
OTHER NAME / S
IF YES, WHAT IS THE AMOUNT?
RESIDENTIAL / COMPANY ADDRESS
$
WHAT IS THE PERIOD OF NOTICE FOR TERMINATION FROM THE
OWNER TO THE APPLICANT?
SUBURB
W A
STATE
POST CODE
WHAT IS THE PERIOD OF NOTICE FOR TERMINATION FROM THE
APPLICANT TO THE OWNER?
TELEPHONE NUMBER
VEHICLE REGISTERED OWNER DECLARATION
I declare that the information provided on this form is true and correct.
OMNIBUS APPLICANT DETAILS
DRIVER’S LICENCE NUMBER
FAMILY NAME / COMPANY NAME
I also consent to licensing information and other information identifying the
vehicle specified in this form being made available to the Omnibus Applicant
by the Department for the purposes connected with the Omnibus Licence
contemplated in this form.
VEHICLE REGISTERED OWNER NAME
VEHICLE REGISTERED OWNER SIGNATURE
FIRST NAME
DATE
OTHER NAME / S
/
/
OMNIBUS APPLICANT DECLARATION
RESIDENTIAL / COMPANY ADDRESS
I declare that the information provided on this form is true and correct.
OMNIBUS APPLICANT NAME
SUBURB
STATE
W A
TELEPHONE NUMBER
OMNIBUS APPLICANT SIGNATURE
POST CODE
DATE
/
/
Last updated: 21/07/2016