Exemption Application Form 120 Hours of Supervised Driving June2013

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120 hours of Supervised Driving Exemption Application

Version 3, June 2013

Road Safety (Drivers) Regulations 2009 regulation 20---------------------------------------------------------------------------------------

This form is to be used by a learner driver who is unable torecord the minimum supervised driving time in a LearnerLog Book due to undue hardship and wishes to apply for anexemption.

NO EXEMPTION IS REQUIRED from VicRoads if the learnerdriver obtained their learner permit prior to 1 July 2007 or if thelearner driver is 21 years and over. In these cases, the learnerdriver is not required to perform 120 hours of supervised drivingtime or maintain a Learner Log Book, it is recommended thatlearner drivers obtain at least 120 hours of supervised drivingtime, including 10 hours at night.

NOTE: If you are an interstate or overseas learner driverwhohas completed 120 hours of supervised driving but have notrecorded the driving experience in an interstate or overseaslog book, you are notrequired to complete this form or completea log book. In this case, the learner driver must provide astatutory declaration(s) to verify that he/she has completed 120hours of supervised driving (including at least 10 hours at night).In addition, a statutory declaration signed by a supervising driverconfirming the learner driver has completed 120 hours ofsupervised driving (including 10 hours at night) should beprovided.

Confirmation that an exemption has been granted byVicRoads must be obtained prior to making an appointmentto take a Victorian licence test.

What are the Learner Log Book requirements?What are the minimum supervised driving timerequirements for a learner?All learner drivers who obtained their learner permit on or after 1July 2007 and are under 21 years of age when applying for aprobationary licence must fill out an official Learner Log Book.The Log Book must contain a minimum of 120 hours ofsupervised driving experience (including 10 hours at night).

The learners driving experience must be recorded in the officialLeaner Log Book available from VicRoads. The Learner LogBook must be correctly completed according to specific rules, asdetailed at the front of the log book.

Who is eligible to apply for an exemption?To be eligible to apply for an exemption, you must have held acurrent and valid learner permit issued on or after 1 July 2007and be under the age of 21 at the time of application for aprobationary licence.

When should an exemption be applied for?

An application for an exemption should onlybe made when thelearner driver can demonstrate to VicRoads, by providingsupporting documentation, that he or she and/or their immediatefamily will suffer undue hardship as a result of completing theLearner Log Book requirements due to the nature of the learnersoccupation, employment or family circumstances. Please note itis your responsibility to make copies of your learner logbook as you go. You may not receive an exemption basedon a lost, stolen or destroyed log book.

What documentation must be provided?To support the application, the learner driver must provide:

documentation from, for example, an educational institution ifthe exemption is required due to hardship as a result ofoccupational circumstances; and/or

documentation from his or her employer verifying theemployment if the exemption is required due to hardship asa result of employment circumstances; and/or

documentation from a relevant authority (eg medicalpractitioner, parish priest etc) if the exemption is requireddue to hardship as a result of family circumstances.

The learner driver must also provide any documented evidenceof existing driving experience. This must be in the form ofphotocopies from the VicRoads Learner Log Book (if aVictorian learner driver) or a statutory declaration from thelearner driver and accompanying supervising drivers stating theamount of supervised driving experience the learner driver hasobtained (if an interstate or overseas learner driver). Ifphotocopies from the Learner Log Book are being provided,these must be certified by a relevant authority. See Section 7

for further details on providing documented evidence ofexisting driving experience.

Please ensure that the person supporting your applicationalso completes Section 11 of this form - Supportingpersons details.

This completed application must be mailed to:

VicRoadsExemptions53 61 Lansell StBENDIGO VIC 3550

VicRoads reserves the right to cancel your exemption ifyour driver licence is cancelled or suspended. A letter willbe sent to you to advise you of VicRoads intention tocancel the exemption, and you will be allowed anopportunity to show why you should be permitted to retainthe exemption. If you do not respond to the notice withinthe required time, the exemption will be cancelled withoutfurther notice.

VicRoads Learner Licence No:

NOTEThe personal information that you provide on this form willbe used by VicRoads to assess your application for anexemption under regulation 20(2), 20(3) of the Road Safety(Drivers) Regulations 2009. Failure to provide theinformation may result in your application not beingprocessed.

The personal information we collect from you inassociation with your application may be used only inaccordance with the Road Safety Act 1986 and associatedregulations or as otherwise required by law. Your personalinformation may be disclosed to contractors and agents ofVicRoads, law enforcement agencies or Courts authorisedto collect it.

For further information about our use of your personalinformation and your right of access to it, please see theVicRoads document Protecting Your Privacy or contactVicRoads on 13 11 71.





1. Learner Permit details

Learner Permit Number

2. Applicants details

Family name (please PRINT)

Given name/s (please PRINT)

Date of Birth

Residential address (please PRINT)

Postal address (if same as residential write AS ABOVE)

Daytime contact phone number

3. Employment travel details (Not self employed)

(To be completed if you need to drive to and from your place ofemployment, and as part of your employment duties)

Employers name (please PRINT)

Employers address (please PRINT)

ABN (Australian Business Number) Occupation

What are your start and finish times for each day of the weekand the days of the week that apply?(Please give an example of a typical working week)

Fromam/pm

Toam/pm

Days of the week

Note:A letter from the employer confirming these times andlocation must be provided.

What public transport or other means of travel is available to you fortravelling to and from your place of employment?

How many kilometres do you travel both waysto get to your place of employment?

4. Employment travel details (self employed)(To be completed if you are self employed and need to drive to

and from employment, and as part of your employment duties)

Entity/Tradingname (please PRINT)

ABN (Australian Business Number)

Entity/Trading address (please PRINT)

Occupation

What are your start and finish times for each day of the week andthe days of the week that apply?(Please give an example of a typical working week)

Fromam/pm

Toam/pm

Days of the week

Could you use public transport or other means of travel as part ofyour employment?

Yes No

What public transport or other means of travel is available to you fortravelling to and from your place of employment?

How many kilometres do you travel both waysto get to your place of employment?

kms





5. Occupational travel details(To be completed if you need to drive to and from certainlocations due to occupational circumstances)

Please explain the occupational circumstance which involvesyou having to drive the car.

What is the address to which you need to travel?

How often are you required to travel to this location? (daily,weekly etc)

What are the usual times at which you are required to travel toand/or from this location?(Please give an example of a typical week)

Times (am/pm)

Mon Tues Wed Thur Fri Sat Sun

Note:A letter from a relevant authority (e.g. educationalinstitution etc) confirming these times and location must beprovided.

What public transport or other means of travel is available fortravelling to get to this location?

How many kilometres do you travel one wayto get to this location?

6. Family travel details(To be completed if you need to drive to and from certain locationsdue to family circumstances)

Please explain the family circumstance which involves you havingto drive the car.

Does the circumstance require you to transport another or otherfamily members?

Yes No

If yes, how many other family members are you required totransport?

Number

What is (are) their relationship(s) to you?

What is the address to which you need to travel?

How often are you required to travel to this location? (daily, weeklyetc.)

What are the usual times at which you are required to travel toand/or from this location?(Please give an example of a typical week)

Times (am/pm)

Mon Tues Wed Thur Fri Sat Sun

Note:A letter from a relevant person (e.g. medical practitioner,parish priest etc) confirming these times and location must beprovided.

What public transport or other means of travel is available fortravelling to get to this location?

How many kilometres do you travel one wayto get to this location?

kms

km





7. Driving experience obtained(Must be completed to specify the amount of driving experienceyou have obtained)

How many supervised driving hours have you been able toobtain?

Please state the dates between which these supervised drivinghours were obtained.

How many of these supervised driving hours were obtained atnight (in hours)?

What supporting documentation do you have to support thissupervised driving experience? (please select)

Learner Log Book(photocopies only)

Signed statutory declarationfrombothlearner andsupervising driver

Note: All Victorian drivers must provide photocopies of theirVicRoads learner log book. The statutory declarations can onlybe provided by interstate or overseas applicants who are notrequired to complete log books or by learner drivers who havepartially completed the requirement interstate or overseas. At aminimum, the statutory declarations should state the number ofhours of supervised driving experience obtained by the learnerdriver and the driving conditions in which these were obtained.

Please ensure that supporting documentation is provided alongwith this application form to support your driving experience.Please only send through certified photocopies of Learner LogBook pages with this exemption form. Do not send through theoriginal Learner Log Book.

Certification of Learner Log Book documentationAll copied pages of the ORIGINAL Learner Log Book need to becertified as true copies by any individual approved to do so (seebelow).

The person who is authorised to certify documents must sight theoriginal and the copy and make sure both documents areidentical. The person must also make sure all pages have beencertified as true copies by writing or stamping certified true copyfollowed by their signature, printed name, qualification (e.g.Justice of the Peace, Australia Post employee etc) and date. Thefollowing can certify copies of the originals as true and correctcopies: a justice of the peace or a bail justice;

a public notary; an Australian lawyer (within the meaning of the Legal

Profession Act 2004); a clerk to an Australian lawyer;

the prothonotary or a deputy prothonotary of the SupremeCourt, the registrar or a deputy registrar of the CountyCourt, the principal registrar of the Magistrates Court or aregistrar or deputy registrar of the Magistrates Court;

the registrar of probates or an assistant registrar ofprobates;

the associate to a judge of the Supreme Court or of theCounty Court;

the secretary of a master of the Supreme Court or of the

County Court;

a person registered as a patent attorney under Chapter 20 ofthe Patents Act 1990 of the Commonwealth;

a member of the police force;

the sheriff or a deputy sheriff; a member or former member of either House of the Parliament

of Victoria;

a member or former member of either House of the Parliamentof the Commonwealth;

a councillor of a municipality;

a senior officer of a Council as defined in the LocalGovernment Act 1989;

a medical practitioner registered under the Health ProfessionsRegistration Act 2005;

a dentist registered under the Health Professions RegistrationAct 2005;

a veterinary practitioner;

a pharmacist;

a principal in the teaching service; the manager of an authorised deposit-taking institution;

a member of the Institute of Charted Accountants in Australiaor the Australian Society of Accountants or the National

Institute of Accountants; the secretary of a building society;

a minister of religion authorised to celebrate marriages;

a person employed under Part 3 of the Public AdministrationAct 2004 with a classification that is prescribed as aclassification to which this section applies or who holds officein a statutory authority with such a classification;

a fellow of the Institute of Legal Executives (Victoria).

Do you also require an exemption from the Learner Permit MinimumHolding Period Requirement?

Yes No

Note: This requirement stipulates that, when applying for a cardriver licence, a learner driver needs to have held their car learnerpermit for the following periods of times immediately beforeobtaining a car driver licence:

at least 12 months if the person is less than 21 years old; or

at least 6 months if the person is at least 21 years old butless than 25 years old; or

at least 3 months if the person is at least 25 years old.

If an exemption from this requirement is required, pleaseensure that the Minimum Time a Learner Permit must be heldExemption Form is completed and submitted along with thisapplication.





8. Affect on occupation/ employment/ family circumstancesand severe hardship that may be caused

Please outline below: how obtaining 120 hours of supervised driving would affect

occupation/ employment/ family circumstances

what severe hardship may be caused to you and yourfamily if this application is refused?(Attach a separate sheet if required)

9. Checklist

To ensure your application is processed promptly, please makesure that you have included the appropriate documents insupport of this application as outlined in this form under, Whatdocumentation must be provided?

10. Declaration

I declare that the information I have provided in this applicationis complete, true and correct in every detail. I understand thatfailure to provide complete, true and correct information in thisapplication may result in my application being refused.

I authorise VicRoads to make any enquiries considerednecessary for the purpose of this application.

Applicants signature

Date

11. Supporting persons details (eg employer, educationalinstitution, medical practitioner, parish priest etc) Accompanyingdocumentation must be provided by this person.

Full name (please PRINT)

Residential address (please PRINT)

Daytime contact number

Name of organisation (Business, educational institution, medicaltreatment provider, parish etc) (Please use stamp if available)

Supporting persons title (manager, registrar, treating doctor, parishpriest etc)

Do you have any other information about the applicantscircumstances that you consider important for VicRoads to

consider when assessing this application?

No Yes

If yes, please provide a signed statement on yourorganisations letterhead.

I give permission to VicRoads to contact me for furtherinformation considered necessary for the purpose of thisapplication.

I undertake to give any further information that VicRoads may askto verify any statements made by me in this application.

I declare that I support this application and that, to the best of myknowledge, the information given by the applicant is complete,

true and correct.

Supporting persons signature

Date





Office Use Only

Office Stamp/application received:

Decision

Document/File ID

Do you approve of this application?

No Yes

Reasons for decision

Delegated persons name

Position/ Title

Signature

Date

Exemption Application Form 120 Hours of Supervised Driving June2013

Documents

Transcript of Exemption Application Form 120 Hours of Supervised Driving June2013