Office use only

Eyesight Test

  • Did the applicant wear corrective lenses during the vision test?

  • Name

  • Signature of Authorised Officer

  • Tester number

  • Date/time passed

  • Pass or Fail

Theory Test

  • Test type

  • KT4

  • KT5

  • Test attempts record

  • Tester name

  • Test date/time

  • KT No.

  • Score

  • Result

  • Signature of Authorised Officer

  • Date/Time Passed

  • Tester number

Practical Test

Practical Test

  • Test Type

  • Signature of Authorised Officer

  • Name

  • Tester number

  • Date Passed

Off-Road Competency

  • Off-Road Competency Tests

  • Off-Road Competency Test
  • Fail Date/Time

  • Assessor

On-Road Competency

  • On-Road Competency Tests

  • On-Road Competency Test
  • Fail Date/Time

  • Assessor

Evidence of Identity (Original documents only)

  • Primary Evidence

  • If 'Other' specify here

  • Origin (State/Country)

  • Document number

  • Expiry date

  • Secondary evidence sighted

  • Type of document

  • Reference number

  • Evidence of Residence sighted

  • Type of document

  • Signature of Authorised Officer

  • Name

  • User ID

Certificate of Competence

  • Name of Provider

  • Date of Issue

  • Test Location

  • Tester number

  • Certificate Number

  • Certificate Type

  • Cancelled CoC Numbers

  • Cancelled CoC Number
  • CoC number

Comments

  • Make notes here

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