Effective Date: 28 May 2015 Page 1 of 4Form R11

R11

Application to Register a Vehicle in the NT Application to Transfer NT Registered Vehicle

SECTION 1 - REGISTERED OWNER DETAILS(see NOTES FOR GUIDANCE on the rear of this form)

Do you want your registration renewal notices to be sent to your email address? YES NOEmail Address

Details of Applicant 2 (joint owner)Surname

Postal Address

Postcode

Email Address

Given Name(s)

Mobile Telephone Telephone

Date of Birth

/ /

Residential / Street Address

Postcode

Details of Applicant 1 (sole owner)Surname

Postal Address

Postcode

Email Address

Given Name(s)

Mobile Telephone Telephone

Date of Birth

Male Female/ /

Residential / Street Address

Postcode

Body Corporate (e.g. Company) name (in full)

ABN or ARBNACN or Association Number

Body Corporate (e.g. Company) Details

Email AddressMobile Telephone Telephone

Principle Place of Business

Postcode

Postal Address

Postcode

The mailing address to use for the service of notices is: (Select one only)

Body Corporate (e.g. Company)

Applicant 2

Applicant 1 Other (complete address below - )

Postcode

Customer IDCVL No.

Registration No.Type

Motor Vehicle RegistryGPO Box 530, DARWIN NT 0801 Phone: 1300 654 628Fax: (08) 8999 3103 Email: mvr@nt.gov.au Website: www.mvr.nt.gov.au

Indeterminate/Male Female Indeterminate/

Effective Date: 28 May 2015 Page 2 of 4Form R11

I am attaching to this application the following evidence of acquisition / ownership of the above vehicle:

A bill of sale from a recognised auction house or a licensed motor vehicle dealer.

A copy of a will or probate, written advice from a solicitor, or letter from a public trustee, showing that the vehicle is bequeathed to the applicant.

Documents from a court of law proving ownership of a vehicle (e.g. a Court Order).

A letter or receipt from the person or organisation that last registered the vehicle, clearly identifying the seller, the vehicle, and the buyer. The document must include the registration number, VIN or chassis number, and engine number of the vehicle.

The Seller has completed and signed SECTION 7 of this form.

SECTION 4 - EVIDENCE OF ACQUISITION / OWNERSHIP

Heavy vehicles/Trailers over 4.5 tonnes GVM/ATM

Common Expiry Date (pre-approval required)6 months

9 months3 months

12 months

Light vehicles/Trailers 4.5 tonnes GVM/ATM and under

6 months 12 months

SECTION 5 - REQUESTED PERIOD OF REGISTRATION

Registration cannot be extended past the Roadworthy Inspection due date. Attach Inspection Report if required.

(see NOTES FOR GUIDANCE)

SECTION 2 - HEAVY VEHICLESThis section ONLY applies to heavy vehicles/trailers (over 4.5 tonnes GVM/ATM). See NOTES FOR GUIDANCE on rear of this form

Evidence of Garage Address must be supplied with application.

Applicant 2 Body Corporate (e.g. Company)Applicant 1 OTHER (complete Form R13 and attach)

Registered owners of all heavy vehicles registered in the Northern Territory must nominate an operator (Nominated Operator) as being responsible for the vehicle on the general road network.

Vehicle Garage Address (or Principal Base of Operations)

Postcode

NHV Code (e.g. SP2)

The Nominated Operator is:

Engine Number

Make (e.g. Ford, Holden)Year of Manufacture Model (e.g. Falcon, Commodore)

VIN / Chassis / Serial Number

A separate application is required for each registerable vehicle

State / TerritoryRegistration Number Date of Expiry

/ /

SECTION 3 - DETAILS OF VEHICLE

Effective Date: 28 May 2015 Page 3 of 4Form R11

Privacy StatementThe Registrar of Motor Vehicles is required to collect information for Registrations, Licenses and Permits under section 92 of the NT Motor Vehicles Act. The Registrar adheres to the Department’s Privacy Statement and the Information Act. Further information on privacy can be found at www.transport.nt.gov.au/mvr/about-us

Comments

Processed By User IDSupervisor USER ID

Evidence of Garage AddressInspection Report Evidence of AcquisitionEOI

EOR Concession applied

WARNING

Individual (85 Penalty Units for a Company) or imprisonment for 6 months under the Motor Vehicles Act. In addition (for vehicles over 4.5 tonnes GVM/

I/We declare that I/we am/are the owner/s, or have been given permission by the vehicle’s owner/s (written authority is attached) to obtain registration

the(day)

Declared at: day of(month) (year)

Signature of Owner(s) OR Authorised Representative/

Printed Name of Owner(s) OR Authorised Representative/

SECTION 7 - NOTICE OF DISPOSAL (TRANSFER OF NT REGISTERED VEHICLE)

SECTION 8 - DECLARATION OF APPLICANT

YES NOIs this vehicle to be offered for HIRE as a DRIVE YOURSELF vehicle?

NT Pensioner & Carer Concession Primary Producer NT Seniors Card

A Concession is subject to validation. The concession is not automatically granted on the basis of this nomination.

Form R26, Application for Primary Producer Registration Concession required.Card Number Card Number

Declaration by Seller (former owner/s)

Sale PriceSignature of Seller

This section is to be completed by the SELLER (FORMER OWNER/S)

YES NOWas the sale of this vehicle at “arm’s length”?See NOTES FOR GUIDANCE on the rear of this form for

of

I Date of Birth / /

Date

/ /Date of Sale

/ /

SECTION 6 - CONCESSIONS

This section is to be completed by the new owner/s of the vehic time in the Northern Territory or/and if transferring the registration from another jurisdiction, have not paid stamp duty previously on the vehicle noted in this application. Stamp Duty is payable at $3 per $100 or part thereof on the sale price or market value of the vehicle. See Notes for Guidance, section 8 page 4 of this application. The payable Stamp Duty value is in addition to normal registration fees and charges.

If an Exemption from Stamp Duty is claimed, the Stamp Duty Exemption form must be completed and submitted with this application.

Sale Price or Market ValueYES NOWas the purchase of this vehicle at “arm’s length”?

Date of Purchase

/ /

Under section 59 of the Stamp Duty Act, persons who falsely declare the sale price and or the market value of a vehicle are liable to a penalty not exceeding 50 penalty units.

YES NOIs this vehicle under a HIRE PURCHASE AGREEMENT?YES NOIs this vehicle under a LEASE AGREEMENT?

SECTION 2 - HEAVY VEHICLESThis section is only for vehicles and trailers over 4.5 tonnes GVM/A

then he/she should declare the fact to avoid the infringement penalty and any applicable demerit points.

VEHICLE ROADWORTHY INSPECTION: Vehicle Roadworthy Inspections for light vehicles (< 4.5 ton GVM/ATM) are required once the vehicle is 5 years old,

require a roadworthy inspection every year.

SECTION 5 - REQUESTED PERIOD OF REGISTRATION

COMPLIANCE CHECK:

Please note that the registration cannot be extended past the next Inspection Due date without passing a Roadworthy Inspection. If your vehicle is required to pass a Roadworthy Inspection, please attach the Inspection Report to this application.

SECTION 3 - DETAILS OF VEHICLEEnter the details of the vehicle for which registration is sought.

SECTION 6 - CONCESSIONSNT PENSIONER AND CARER CONCESSION and NT SENIORS CARD:

and recording purposes. If you have already presented your NT Pensioner and Carer Concession or NT Seniors Card to MVR, simply quote the number in the space provided.

PRIMARY PRODUCER CONCESSION:Application for Primary Producer Concession, is to be attached to this application.

SECTION 7 - NOTICE OF DISPOSAL (Transfer of NT Registered Vehicle)ARM’S LENGTH - As a general rule, an arm’s length transaction is a transaction made in good faith between parties with independent interests (e.g. between a motor vehicle dealer and the public). Typically, the parties would not be related or have any business connections.

NOTES FOR GUIDANCE

Effective Date: 28 May 2015Form R11 Page 4 of 4

SECTION 1 - REGISTERED OWNER DETAILS

IF YOU ARE NOT ALREADY A MOTOR VEHICLE REGISTRY (MVR) CUSTOMER, you will be required to provide Evidence of Identity and Evidence of Residency with this application.

POSTAL and RESIDENTIAL / STREET ADDRESS FOR SERVICE OF NOTICE: This is the address where your renewal notice and other correspondence will be sent. You can nominate one of the applicants by marking the appropriate box, or complete the details of the address for service.

REGISTRATION RENEWAL NOTICE SENT TO EMAIL ADDRESS: You may nominate to have your registration renewal notice sent to your email address. Renewal Notices are a courtesy notice provided within (6) weeks prior to your vehicle registration expiry date. It is your responsibility to advise MVR should your email address change.

BODY CORPORATE - means a Company or Association registered under the Corporations Act. A body corporate vehicle owner should be aware that when an

IF YOU ARE NOT THE APPLICANT, you will be required to provide a letter of authority from the Registered Owner of the vehicle.

INFRINGEMENT NOTICES:

MARKET VALUE - Is the greater value of the vehicles market value at the date of the transaction, OR the vehicle’s market value at the date of transfer.

DUTIABLE VALUE: In the case of a sale and purchase between parties who are at “arm’s length” the dutiable value is the sale price of the vehicle. In any other case, the dutiable value is the market value.

SALE PRICE - Is the total amount paid by the purchaser, including any deposit, trade-in allowance, dealer delivery charges, the amount paid for any accessories or other equipment added to the vehicle (i.e. bull bars, airconditioning, towbar, window tinting etc.), and includes GST.

SECTION 8 - DECLARATION OF APPLICANT

BODY CORPORATE - A body corporate that is in control of a vehicle being used under a hire or lease agreement (ie. self drive hire) should be aware that when an

SECTION 4 - EVIDENCE OF ACQUISITION/OWNERSHIPAll applications to register or to transfer a registration require evidence of acquisition/ownership of the vehicle before the registration/transfer can be processed.

Registration Renewal type notice, bearing the applicants name, as evidence of ownership.

If the applicant is not the last registered owner of the vehicle, other evidence of acquisition/ownership is required.

A Renewal Notice, or an Invitation to Renew Registration is acceptable for evidence of acquisition/ownership ONLY where the applicant is named as the registered owner, AND is for the upcoming period immediately after the expiry of the current registration.