Application for Duplicate Operating Licence, Permit or Decal

FORM 1D
PAGE 1
DEPARTMENT OF TRANSPORT
NATIONAL PUBLIC TRANSPORT REGULATOR / PROVINCIAL REGULATORY ENTITY / MUNICIPAL REGULATORY ENTITY
NATIONAL LAND TRANSPORT ACT, 2009 (ACT NO. 5 OF 2009)
APPLICATION FOR DUPLICATE OPERATING LICENCE, PERMIT OR DECAL
Request for duplicate (Check applicable box):
Operating licence
Permit
Decal
* Attach original operating licence, permit or decal.
* If you are no longer in possession of the operating licence, permit or decal an affidavit must be supplied with the application giving the reasons why you are unable to
submit it.
SECTION A
PARTICULARS OF APPLICANT
Name of company, partnership, corporation or other legal entity, or
sole proprietor.
First names, if sole proprietor (not more than 3)
Postal address and code
Postal Code
Street address (if different from postal address)
Domicilium citandi et executandi
Postal Code
Telephone number
Code
Facsimile number (if any)
Code
E-mail address (if any)
Number of operating licence or permit
Date of expiry of OL or permit
/
Y
Y
Y
Y
/
M
M
D
D
Board/Regulatory Entity that issued operating licence or permit
SECTION B (Compulsory for all application types)
DECLARATION
I, the undersigned (full name) ................................................................................................................................................................................................................................
certify that the information furnished in this application form is true and correct.
I accept that if information supplied in this application is found to be false, the application will be rejected and I may be disqualified from making an application for an
operating licence in the future.
...................................................................................................
Signature
...................................................................................................
Name of person
Name of legal entity (if applicable)
...................................................................................................
Date