Western Australian Repealed Regulations Western Australian Repealed RegulationsThis legislation has been repealed.
Forms
Form 1
Reg. 4(1)
No. ........................
............................ Court of Petty
Sessions
Western Australia
Justices Act (Extraordinary Licences) Regulations 1977
Road Traffic Act 1974 s.76(1)
APPLICATION FOR EXTRAORDINARY LICENCE
Application of:
Surname (block letters)
.......................................................................................................
Other names (in full)
...........................................................................................................
Date of Birth
.......................................................................................................................
Address
...............................................................................................................................
Occupation
..........................................................................................................................
Name and address of employer (if self-employed state so)
................................................
Date disqualified from
holding or obtaining a driver’s licence
..........................................
Period of disqualification
....................................................................................................
Reason for disqualification. (If on conviction state nature of offence and
specify court by which convicted and, in the case of an offence against
section 63, 64, 67 or 67A of the Road Traffic Act, state whether first,
second or subsequent conviction for such an offence. If not on conviction
state circumstances.)
............................................................
.............................................................................................................................................
.............................................................................................................................................
1. The abovenamed
person hereby applies for an Order of the Court directing the Director General
to issue him with an extraordinary licence under section 76 of the
Road Traffic Act 1974 .
2. The licence is
required in respect of vehicles of Class ................................
3. The localities,
times and purposes for which the licence is required are as follows:
........................................................................................................
.......................................................................................................................
.......................................................................................................................
.......................................................................................................................
4. The reasons why the
licence is needed, and the nature of the hardship and inconvenience which
would result if this application is refused, are as follows:
.........................................................................................................
.......................................................................................................................
.......................................................................................................................
.......................................................................................................................
5. (a)
The applicant has not been refused an
extraordinary licence by a court within the period of 6 months immediately
preceding the date of this application.
(a)
The applicant was refused an extraordinary licence
on a special application heard by the (specify Court)
...........................................
on the
..............................., 20 .............., but otherwise has not been
refused an extraordinary licence by a court within the period of 6 months
immediately preceding the date of this application.
(a)
Delete whichever is inapplicable.
For meaning of “special application” see s.76(12)
Road Traffic Act 1974 , or regulation 3.
6. A licence
suspension order made under the Fines, Penalties and Infringement Notices
Enforcement Act 1994 is not in force in respect of the applicant.
..........................
...............................................................................
Date
Applicant/Counsel/Solicitor for Applicant
______________________________________________________________________
COURT USE ONLY
This matter has been set down for hearing on
............................................................................
at the Court of Petty Sessions
.....................................................................................................
Form 2
Reg. 4(3)
No. ........................
............................. Court of Petty
Sessions
Western Australia
Justices Act (Extraordinary Licences) Regulations 1977
APPLICATION UNDER SECTION 76(7)(a) OF ROAD TRAFFIC ACT 1974
1.
.................................................................................................................................
of
......................................................................................
in the State of Western Australia being the holder of an extraordinary licence
issued as directed by an Order of the
................................................................. Court of
Petty Sessions made on the ................................. day of
.................................. 20 ............, which licence is subject
to the following limitations and
conditions.............................................................................
.............................................................................................................................................
.............................................................................................................................................
hereby applies to this Court for an Order
(a)
varying those limitations and conditions by
.................................................
.......................................................................................................................
.......................................................................................................................
(a)
cancelling those limitations and conditions and substituting the following
limitations and conditions:
...........................................................................
.......................................................................................................................
.......................................................................................................................
(a)
Delete whichever is inapplicable.
2. In support of this application the following
matters are brought to the attention of the Court:
(b)
.......................................................................................................................
.......................................................................................................................
.......................................................................................................................
(b)
State reasons why variation or substitution is necessary or justified (see
s.76(9)(a) Road Traffic Act 1974 ).
........................................................................
Applicant/Counsel/Solicitor for Applicant
______________________________________________________________________
COURT USE ONLY
This matter has been set down for hearing on
............................................................................
at ........................... o’clock in the
......................................, at the Court of Petty Sessions
..................................................
Form 3
Reg. 4(4)
No. ........................
............................. Court of Petty
Sessions
Western Australia
Justices Act (Extraordinary Licences) Regulations 1977
APPLICATION UNDER SECTION 76(7)(b) OF ROAD TRAFFIC ACT 1974
1. Whereas
...................................................................................................................
of
.........................................................................................................................................
in the State of Western Australia is the holder of an extraordinary licence
issued as directed by an Order of the ........................................
Court of Petty Sessions made on the ......................... day of
............................., 20 ..........., which licence is subject to the
following limitations and conditions:
.................................................................................
.............................................................................................................................................
.............................................................................................................................................
application is hereby made to this Court for an Order
(a)
varying those limitations and conditions by
.................................................
.......................................................................................................................
.......................................................................................................................
(a)
cancelling those limitations and conditions and substituting the following
limitations and conditions:
...........................................................................
.......................................................................................................................
.......................................................................................................................
(a)
cancelling that extraordinary licence.
(a) Delete those inapplicable.
2. In support of this application the following
matters are brought to the attention of the Court:
(b)
......................................................................................................................
......................................................................................................................
......................................................................................................................
......................................................................................................................
(b) State reason why
variation, substitution or cancellation is necessary (see s.76(9)(a) and (b)
Road Traffic Act 1974 ).
........................................................................
for
Director General
________________________________________________________________
COURT USE ONLY
This matter has been set down for hearing on
...........................................................................
at
......................... o’clock in the
.......................................at the Court of Petty Sessions
...................................................
Form 4
Reg. 9
No. ........................
............................. Court of Petty
Sessions
Western Australia
Justices Act (Extraordinary Licences) Regulations 1977
NOTICE OF RESULT OF HEARING
To: DIRECTOR GENERAL:
Take notice that on the hearing of an application under section 76
(a)
............................................... of the
Road Traffic Act 1974 , on the ........................... day of
........................................, 20 .............., the Court
(a)
Insert relevant provision.
(b) made
an Order in the following terms:
.......................................................................................................................
.......................................................................................................................
.......................................................................................................................
.......................................................................................................................
(b)
refused the application.
(b)
Delete whichever is inapplicable.
........................................................................
Clerk
of Petty Sessions
Form 5
Reg. 4(2)
No. ........................
............................ Court of Petty
Sessions
Western Australia
Justices Act (Extraordinary Licences) Regulations 1977
Road Traffic Act 1974 s.76(1) and (12)
SPECIAL APPLICATION FOR EXTRAORDINARY LICENCE
IMPORTANT — This form must be used when making a special
application under section 76(1) of the Road Traffic Act 1974 .
Application of:
Surname (block letters)
............................................................................................
Other names (in full)
...............................................................................................
Date of Birth
............................................................................................................
Address
....................................................................................................................
Occupation
...............................................................................................................
Name and address of employer (if self-employed state so)
....................................
..................................................................................................................................
Date disqualified from holding or obtaining a driver’s licence
...............................
Period of disqualification
........................................................................................
Disqualified on conviction for an offence under the following section of the
Road Traffic Act 1974 (specify one of the offences referred to in
section 76(12) of the Act):
..................................................................................................................................
Description of offence:
............................................................................................
..................................................................................................................................
1. The abovenamed person hereby applies for an
Order of the Court directing the Director General to issue him with an
extraordinary licence under section 76 of the Road Traffic Act 1974
.
2. The licence is required in respect of vehicles
of Class ...........................................
3. The localities, times and purposes for which
the licence is required are as follows:
...................................................................................................................
.................................................................................................................................
.................................................................................................................................
.................................................................................................................................
4. The reasons why the licence is needed, and the
nature of the extreme hardship which would result if this application is
refused, are as follows —
..................................................................................................................................
..................................................................................................................................
..................................................................................................................................
..................................................................................................................................
..................................................................................................................................
For meaning of “extreme hardship” see
s.76(3b) Road Traffic Act 1974 .
5. The applicant has not been refused an
extraordinary licence by any court in respect of the abovementioned period of
disqualification.
6. A licence suspension order made under the
Fines, Penalties and Infringement Notices Enforcement Act 1994 is not in
force in respect of the applicant.
.............................
.....................................................................................
Date
Applicant/Counsel/Solicitor for Applicant
________________________________________________________________
COURT USE ONLY
This matter has been set down for hearing on
.............................................., at the Court of Petty Sessions
....................................................................................
[Schedule amended in Gazette 26 February 1982
p.636; 4 December 1992 p.5887; 21 June 1996 p.2640;
31 January 1997 pp.675-6.]