Driving Experience Declaration

Transport Operations (Road Use Management) Act 1995

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Page 1 of 2 TRB Forms F4464 ES V01 Jun 2014
Important information
This form may be used if you have completed 100 hours supervised driving experience (including 10 hours night driving).
You must
be at least 17 years of age before you can sign this declaration
sign this declaration in the presence of a verifying person, who holds a valid Queensland (Qld) open licence.
Lodging your learner logbook and declaration does not guarantee that you will be automatically eligible to take your practical driving test to apply
for a P1 provisional licence. You will be notified as soon as your logbook has been assessed.
You must sign this section in the presence of a verifying person. The verifying person must hold a valid Qld open licence.
You must not sign this declaration unless you are at least 17 years of age.
Section 1 - Learner drivers details
Qld learner licence number Family name Given name/s
Residential address
Postcode
Daytime contact phone number
2. Do you hold, or have you ever held, a learner licence issued by another Australian state, territory or country?
Licence number Expiry date State/Territory/Country of issue Licence class/es
No Yes
Date of birth
Postal address (if same as residential, write AS ABOVE)
Postcode
Mobile phone number Email address
3. Please indicate how your 100 hours (including 10 hours night driving) supervised driving experience was gained (tick one box only)
Driving experience with a supervisor (other than an accredited driver trainer) recorded in a Qld learner logbook
A combination of driving experience with a supervisor and an accredited driver trainer recorded in a Qld learner logbook
A combination of prior driving experience (maximum 50 hours while the holder of a foreign learner licence) recorded on the
Prior Driving Experience Application (form F4450) and driving experience on Australian roads recorded in a Qld learner
logbook
4. A total of at least 100 hours (including 10 hours night driving) of supervised driving is required prior to lodging this logbook and
declaration. Please list your total of on-road driving experience in minutes (e.g. 100 hours = 6000 minutes)
1. The Department of Transport and Main Roads (the department) will assess your logbook and notify you of the result. Please
indicate how you prefer to be notified (tick one box only)
Mail Phone Email SMS
Fill in your details below
minutes daytime driving
minutes night driving. Must be at least 600 minutes (10 hours)
minutes Total. Must be at least 6000 minutes (100 hours)
minutes driving experience with an accredited driver trainer. Record
as triple time (total minutes x 3) to a maximum 1800 minutes (30 hours)
minutes prior driving experience (if applicable)
Text
Page 2 of 2 TRB Forms F4464 ES V01 Jun 2014
Driving Experience Declaration continued... page 2 of 2
5. Learner drivers declaration
I declare that I am at least 17 years of age at the time of making this declaration.
I declare that I was the holder of a valid class C or CA Qld or equivalent non-Qld learner licence when learning to drive.
I understand that the department will check the correctness and accuracy of the information I have provided.
I declare that I have completed the number of supervised driving experience hours as detailed in this form.
I give permission for the department to access my driver licence record to confirm the information provided by me.
I give permission for the department to contact me for any further information considered necessary for the purpose of verifying information
I have provided.
I declare that the information I have provided in this form is complete, true and correct in every detail.
Learner drivers signature Date
Section 2 - Verifying persons details
This section must be completed by the person witnessing the learner drivers signature. The verifying person must hold a valid Qld
open licence.
Verifying persons signature Date
Qld driver licence number Family name Given name/s
Verifying persons declaration
I declare that the learner licence holder has signed the Driving Experience Declaration in my presence.
I declare that I hold a valid Qld open licence.
I give permission for the department to access my driver licence record to confirm the information provided by me.
I give permission for the authorised person to contact me for any further information considered necessary for the purpose of this declaration.
I declare that the information I have provided in this declaration is complete, true and correct in every detail.
Privacy Statement
The department provides this form under the Transport Operations (Road Use Management) Act to determine if the learner driver has completed the 100 hours supervised
driving experience requirement before being eligible to take the practical driving test for the granting of a Qld provisional licence. This form is also provided to determine
if the learner drivers signature has been verified by a person who holds a valid Qld open licence. The information collected in this form is accessible by authorised
departmental persons and some of this information may be disclosed to the Qld Police Service and interstate driver licensing authorities. The department will not disclose
your personal details to any other third parties without your consent unless authorised or required by law.
Residential address
Daytime contact phone number
Postcode