Known User Statement

Use this form in the situation where you were not the driver or in control of the vehicle/trailer at the time of the offence and you are able to provide details of the person who was in control of the vehicle/trailer.

Your Details (Please use the details exactly as they appear on your licence)

First Name

Surname

Is this vehicle registered in a company name?

Company Name

The name of the company that owns the vehicle. Leave blank if vehicle is privately owned.

Position at company

Your position at the company that owns the vehicle. Leave blank if vehicle is privately owned.

Your Postal Address

Suburb

State

Post Code

Country

Infringement Number

Please separate infringement numbers with a comma. ie 12345,12346,12347...

Agency Name

This is the name of the Council/Hospital/University that issued the infringement. This is never Bartels, Taylor & Associates.

Vehicle Registration Number

Telephone Number

Your email address

Please be advised that only the registered owner of a vehicle or a person who has been nominated by the registered owner of a vehicle can provide a Known User Statement. It is an offence for anyone other than the registered owner of the vehicle or nominated person to submit a Known User Statement.

Is this vehicle registered in your name at VicRoads? Or have you been nominated by the owner?

Details of person who had possession of the car / trailer

First name

Surname

Address

Suburb

State

Post Code

Country

Email Address

Date of Birth

Licence Number

I state that at the time of the offence I believe that

I was not

I was not at the time of the offence driving, or had at the time of the offence possession or control of the motor vehicle or trailer or the motor vehicle to which the trailer was attached.

Above information to sufficiently identify and locate ?

I provide the above information to sufficiently identify and locate the person whom I last knew as having (before the offence) possession or control of the motor vehicle or trailer or of the motor vehicle to which the trailer was attached.

I provide the following reasons for my belief

Supporting Evidence and other attachments

Add a new file

Unlimited number of files can be uploaded to this field.
2 GB limit.
Allowed types: jpg png pdf doc docx.

Acknowledgement

I understand and acknowledge that:

This document is a digitally signed statement.
It is an offence to provide false or misleading information and a penalty may be imposed under the relevant acts.

I Agree