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P64 Government of Western Australia Department of Transport Change of Personal Details Driver and Vehicle Services The information you supply on this form may be disclosed to other government agencies where provided for in legislation. The Director General of the Department of Transport also releases aggregated statistical information to third parties. However your personal identifying information will not be released to these persons without your explicit consent. Postal Address GPO Box R1290 PERTH WA 6844 ORGANISATION CODE if applicable New Details certified documentary evidence supporting change of name must be provided SURNAME/COMPANY NAME GENDER OTHER NAMES IN FULL DATE OF BIRTH Male Female RESIDENTIAL ADDRESS DETAILS COMPULSORY POST CODE SUBURB OR TOWN POSTAL ADDRESS IF SAME AS ABOVE LEAVE BLANK CONTACT TELEPHONE NUMBER EMAIL ADDRESS Previous Details to be completed where name/DOB has changed or requires correcting DO YOU HOLD ANY OF THE FOLLOWING WA driver s licence learner s permit or Photo Card Yes No Number WA firearms licence WA recreational skipper s ticket card The following vehicles/trailers/boats/plates are licensed in my name PLATE NO. /BOAT REGISTRATION No* MAKE BODY TYPE eg sedan caravan SIGNATURE Date / / This form can be downloaded from www. transport. wa*gov*au/dvs. OFFICE USE ONLY - DOCUMENTS AND NUMBER SIGHTED PHOTOCOPIES OF DOCUMENTS MUST BE CERTIFIED Driver s licence/ Photo Card Passport Birth certificate Marriage certificate Deed poll Business Reg* Cert. Other specify document and number Receiving officer signature Branch/Office Replacement / Certified DL Issued YES / NO Receipt Details Dealing address updated IF A FIREARMS LICENCE NUMBER HAS BEEN PROVIDED ABOVE THIS FORM MUST BE SENT TO POLICE LICENSING SERVICES ON FAX NUMBER 08 9454 1522 OR A PHOTOCOPY POSTED TO LOCKED BAG 9 EAST PERTH WA 6892 OR IF A BOAT REGISTRATION OR SKIPPER S TICKET NUMBER HAS BEEN PROVIDED ABOVE THIS FORM MUST BE SENT TO MARINE SAFETY ON FAX NUMBER 08 9435 7817 OR A PHOTOCOPY POSTED TO PO BOX 402 FREMANTLE 6959. However your personal identifying information will not be released to these persons without your explicit consent. Postal Address GPO Box R1290 PERTH WA 6844 ORGANISATION CODE if applicable New Details certified documentary evidence supporting change of name must be provided SURNAME/COMPANY NAME GENDER OTHER NAMES IN FULL DATE OF BIRTH Male Female RESIDENTIAL ADDRESS DETAILS COMPULSORY POST CODE SUBURB OR TOWN POSTAL ADDRESS IF SAME AS ABOVE LEAVE BLANK CONTACT TELEPHONE NUMBER EMAIL ADDRESS Previous Details to be completed where name/DOB has changed or requires correcting DO YOU HOLD ANY OF THE FOLLOWING WA driver s licence learner s permit or Photo Card Yes No Number WA firearms licence WA recreational skipper s ticket card The following vehicles/trailers/boats/plates are licensed in my name PLATE NO. Postal Address GPO Box R1290 PERTH WA 6844 ORGANISATION CODE if applicable New Details certified documentary evidence supporting change of name must be provided SURNAME/COMPANY NAME GENDER OTHER NAMES IN FULL DATE OF BIRTH Male Female RESIDENTIAL ADDRESS DETAILS COMPULSORY POST CODE SUBURB OR TOWN POSTAL ADDRESS IF SAME AS ABOVE LEAVE BLANK CONTACT TELEPHONE NUMBER EMAIL ADDRESS Previous Details to be completed where name/DOB has changed or requires correcting DO YOU HOLD ANY OF THE FOLLOWING WA driver s licence learner s permit or Photo Card Yes No Number WA firearms licence WA recreational skipper s ticket card The following vehicles/trailers/boats/plates are licensed in my name PLATE NO. /BOAT REGISTRATION No* MAKE BODY TYPE eg sedan caravan SIGNATURE Date / / This form can be downloaded from www.