Government of Western Australia
Department of Transport
PC1
Photo Card Application
Issued under the
Western Australian Photo Card Act 2014
Last updated: 09.02.2024
APPLICATION TYPE
ADDITIONAL CARD
CERTIFIED COPYREPLACEMENT CARD
NEW APPLICATION
REASON FOR REPLACEMENT/CERTIFIED COPY:
STOLEN
NOT PRODUCED
SURRENDERED
BUILD SLIM
MEDIUM SOLID
GENDER
MALE FEMALE X
HEIGHT CM
NATURAL HAIR COLOUR
EYE COLOUR
COUNTRY OF BIRTH
If you hold a concession, complete the section below and present your
concession card/s at the time of application.
The concession details will also be applied to your WA driver’s licence.
WA SENIORS CARD NUMBER
COMMONWEALTH SENIORS HEALTH CARD NUMBER
PENSIONER CONCESSION CARD NUMBER
FIRST NAME
OTHER NAME/S
FAMILY NAME
DECLARATION
I,
declare that the information provided in this application is true and correct.
DATE OF BIRTH
/ /
RESIDENTIAL ADDRESS (MUST BE IN WA)
SUBURB
POST CODESTATE
W A
POSTAL ADDRESS (IF DIFFERENT TO RESIDENTIAL ADDRESS)
SUBURB
POST CODESTATE
APPLICANT DETAILS
When applying for a Photo Card, you must attend a Driver and Vehicle Services (DVS) centre, regional Department of Transport (DoT) oce or regional
agent in person and provide relevant proof of identity (POI) documents. Visit www.transport.wa.gov.au/licensing for locations. The Photo Card is valid for
ve years. Applicants must be over the age of 16 to be eligible. Applicants should be aware that there is no obligation on an institution to accept the Photo
Card for POI purposes.
VETERANS’ AFFAIRS GOLD CARD - ENDORSED TPI OR EDA
VETERANS’ AFFAIRS PENSIONER CONCESSION CARD*
*Where the holder is of pension age a 100% concession will apply.
Where the holder is not of pension age a 50% concession will apply.
You must advise DoT in writing if your concessional entitlement is
reduced or withdrawn.
Written correspondence to be mailed to Driver and Vehicle Services,
GPO Box R1290 Perth WA 6844.
IF YES DETAIL YOUR PREVIOUS/OTHER NAME/S
HAVE YOU EVER BEEN KNOWN BY ANY OTHER NAME?
(e.g. name at birth, maiden name, previous married names, alias, adoptive
name or foster name)
YES
NO
CONCESSION DETAILS
When blank, this form is classed as OFFICIAL, when completed, this form is classed as OFFICIAL SENSITIVE
IF YES LIST SIBLING NAME/S
WA LICENCE NUMBER
ARE YOU A TWIN (or any other multiple birth
variation e.g. triplet, quadruplet)?
YES
NO
LOST
DAMAGED
Supporting documents required
when gender X is selected, refer
to the DoT website.
PERSONAL DETAILS
Contact Number
Mobile Phone
Email Address
RESIDENTIAL ADDRESS TO BE DISPLAYED ON CARD:
NOYES
PROOF OF IDENTITY
To be eligible for a Photo Card you are required to show POI. A combination
of ve original documents must be presented to verify your full name, date of
birth and current residential address. You must supply original documents;
certied copies will not be accepted. One document must show your signature.
Holders of an existing WA driver’s licence, WA learner’s permit or WA Photo
Card will not be required to provide full POI when applying for a photo card.
A full list of acceptable identication documents are available online at
www.transport.wa.gov.au/licensing.
Turn over to complete
PRIVACY STATEMENT AND DECLARATION
DECLARANT FIRST NAME
DECLARANT OTHER NAME/S
DECLARANT FAMILY NAME
I,
declare that
APPLICANT FIRST NAME
APPLICANT OTHER NAME/S
APPLICANT FAMILY NAME
is unable to provide a signature for use on the Photo Card due to a permanent
disability.
I declare that the information I have given on this form is true and correct and
I am aware that it is an oence to give a false or misleading statement under
the Western Australian Photo Card Act 2014.
DECLARANT SIGNATURE
DATE
/ /
SIGNATURE REQUIREMENTS DECLARATION
PRIVACY STATEMENT
Read carefully before you sign. It is an oence to knowingly give false
information.
• The Western Australian Photo Card Act 2014 (the Act) requires you to
provide specic information and evidence to establish your identity and
residential address, including a signature unless the applicant is unable
to sign because of a permanent disability. If you are unable to provide a
signature because of a permanent disability, the Signature Requirements
Declaration below must be completed by a person who is 18 or over.
• The Chief Executive Ocer (CEO) of DoT may need to disclose your
personal information to third parties to verify that it is correct, as permitted
by law.
• Information you provide must be true, correct and complete. Providing
information that you know to be false or misleading could result in criminal
proceedings and the cancellation of any WA Photo Card issued to you.
DECLARATION
I declare that the information provided in this form and supporting
documents is true, correct and complete. I understand the above
Privacy Statement and consent to the CEO of DoT collecting, using and
disclosing any personal information provided in accordance with
the Privacy Statement.
APPLICANT SIGNATURE
DATE
/ /
OFFICE USE ONLY
A
C C D D
OPTION 2
• 1 document from Category A
• 2 from Category C and
• 2 from Category D
OPTION 1
• 1 document from Category A
• 1 from Category B
• 2 from Category C and
• 1 from Category D (not DL69)
A
B C C D
PROOF OF IDENTITY REQUIREMENTS FOR AN INITIAL APPLICATION
MUST BE MET (WA driver’s licence/learners permit/Photo Card not held).
I have checked that the applicant has met the proof of identity requirements
and have attached copies of all relevant documents provided. The applicant’s
signature has also been veried.
Where an applicant provides a debit/credit card, DO NOT PHOTOCOPY.
DATE
/ /
SITE
OFFICER’S NAME
All other applicants must supply 1 document from Category A and C or 1
document from Category B.
A
C B
OR
Concession Code (A, P or S)
WA Seniors Card sighted
Concession Type (A, H or V)
Commonwealth Seniors Health Card sighted
Pensioner Concession Card sighted
Concession details entered on record
Photocopy of card(s) attached
SIGNATURE
CONDUCTED SEARCH FOR IDENTITY IN EXISTING
DEPARTMENTAL RECORD/S
YES
If the applicant is unable to sign the above declaration themselves due to a
permanent disability a declarant can complete the section below.