Written-Off Heavy Vehicles Register Notification

Written-Off Heavy Vehicles Register Notification

Use this notification to notify Transport for NSW about a written-off heavy vehicle for recording on the Written-Off Heavy Vehicles Register. This notification must be provided to Transport for NSW within 7 days after:

? the vehicle has been assessed as a write-off and before disposal of the vehicle ? the vehicle has been sold by a self-insurer to a vehicle recycler ? a vehicle recycler decides to dismantle or demolish the vehicle.

This notification is required under section 104J of the Road Transport Act 2013 (NSW) Written-off heavy vehicles must also have a written-off heavy vehicle warning label attached within the same 7 day period under section 104N of the Road Transport Act 2013 (NSW)

Written-off heavy vehicle warning labels are available on the Roads and Maritime website at rms..au

Note: Heavy vehicles are over 4.5 tonnes Gross Vehicle Mass. Special Purpose Vehicles and vehicles registered in the Conditional Registration Scheme are excluded from notification to Transport for NSW and from recording on the Written-Off Heavy Vehicles Register.

1. Vehicle details

Vehicle type (please tick) Truck Trailer

Prime Mover Bus

Family name Given name(s)

Registration number

State or Territory

Company name / business name (if applicable)

Make

ACN / ABN (if applicable)

Model VIN/chassis number (17 characters)

Address

Colour Variant Engine number

Vehicle shape Date built / Compliance date

Driver licence number Telephone number

Postcode

Customer number

Fax number

Engine capacity

Number of cylinders

Motive Power

Engine manufacturer

Tare weight

2. Assessor's details

Assessor's reference number

Type of assessor (please tick) Insurer Self-insurer

Vehicle dealer Vehicle recycler

Email address

3. Incident details

Date write-off decision made

//

day

month

year

Salvage condition (please tick) R - Repairable written-off heavy vehicle H - Hail Damage

S - Statutory written-off vehicle

4. Incident type

(please tick)

D - Dismantled/demolished

I - Impact

F - Fire

W - Water

H - Hail

M - Malicious / vandalism / stripped

Send this completed form to:

Transport for NSW Written-off Vehicle Unit PO Box 3035 Parramatta NSW 2124

F 02 8335 9445

E WOVR@rms..au

Catalogue No. 45065694 Form No. 5573 (06/2020)

UNCLASSIFIED SENSITIVE: PERSONAL

continued page 2 Page 1 of 5

5. Damage details

Damage location and damage severity codes Refer to the diagrams and list on page 4 and match an appropriate `damage severity code' to each location where the vehicle is damaged. Enter the `damage severity codes' against the numbered `damage locations' in the Incident Table below.

Damage location

Incident Table

Damage severity

Damage location

Damage severity

1

24

2

25

3

26

4

27

5

28

6

29

7

30

8

31

9

32

10 *

33

11 *

34

12 *

35

13 *

36

14

37

15

38

16

39

17

40

18

41

19

42

20

43

21

44

22

45

23

46

* Please note: Damage locations 10, 11, 12, 13 are for

motorbike, caravans and trailers only.

6. Declaration and privacy statement

Please read carefully before you sign. If you do not tell the truth you can be prosecuted.

(i) I declare that the details set out in this notification are true and correct. (ii) I have not been coerced or paid an inducement to assess the vehicle falsely or make this notification falsely. (iii) The vehicle specified in this notification has been assessed by or on the advice of a person who holds the relevant qualifications set out in clause 123J of the Road Transport (Vehicle Registration) Regulation 2017 (NSW). (iv) The vehicle specified in this notification has been damaged and assessed in accordance with the salvage, incident and damage details specified in this notification. (v) As required by law, I have kept a copy of this notification and the following assessment information for my records:

? vehicle identification details ? vehicle damage details ? details of the determination if the vehicle has suffered

damage of a type specified in the statutory write-off assessment criteria, including the date the determination was made ? the name of the person who made the assessment ? the reasons why the person was competent to make the assessment ? the sum for which the vehicle was insured ? the market value of the vehicle and the basis for determining that value ? the assessed repair cost and details of how the cost was determined, applying the relevant technical specifications ? the assessed salvage value of the vehicle and the basis for determining that value.

I acknowledge that I am required to keep these records for a period of seven (7) years from the date of issue. A copy of this notification and all other records associated with this notification and assessment will be produced upon request, to an officer of the NSW Police Force, or to Transport for NSW and/or NSW Fair Trading in the course of any investigation.

Personal Information Collection Notice: our Privacy Statement explains why we are collecting your Personal Information and how we will use and manage it in accordance with the Privacy and Personal Information Act 1998, and, where relevant, the Health Records and Information Privacy Act 2002. You can obtain a copy of our Privacy Statement at transport..au/privacystatement or call us on 13 22 13 to request a copy.

Signature

Date

/

/

Day

Month

Year

Catalogue No. 45065694 Form No. 5573 (06/2020)

UNCLASSIFIED SENSITIVE: PERSONAL

continued page 3 Page 2 of 5

Assessor's representative's details (if making this declaration and notifying on behalf of the assessor)

Family name

Given name(s)

Driver licence number

Customer number

Telephone number

TfNSW Office Use Only Details entered on the Written-Off Heavy Vehicle Register Data adjusted WOHVR updated Recording officers name

Staff number

Signature

Date

/

/

Day

Month

Year

Catalogue No. 45065694 Form No. 5573 (06/2020)

UNCLASSIFIED SENSITIVE: PERSONAL

Page 3 of 5

Damage severity and damage locations codes

Damage Severity Codes A Heavy panel

E Unrepairable

B Light panel

F Major damage

C Heavy structural

G Minor damage

D Light structural

H Major stripping

I Minor stripping J Major vandalism K Minor vandalism L Water (salt)

M Water (fresh) N Burnt/blistered O Smoke and heat P Minor smoke

1 Passenger front

6 Passenger side

5 Passenger rear

1 Passenger front

6 Passenger side

5 Passenger rear

Heavy Truck

7 Engine 8 Roof

9 Interior

Prime Mover

7 Engine

8 Roof

9 Interior

2 Driver front

3 Driver side

4 Driver rear

2 Driver front

3 Driver side

4 Driver rear

14 Whole vehicle 15 Floor pan (passenger front) 16 Fire wall 17 Chassis/structural rails (passenger) 18 Floor pan (driver rear) 19 Floor pan (driver front) 20 Floor pan (passenger rear) 21 Chassis/structural rails (driver) 22 A pillar passenger 23 A pillar driver 24 B pillar passenger 25 B pillar driver 26 C pillar passenger 27 C pillar driver 28 D pillar passenger 29 D pillar driver 30 Engine block (cracked, fractured)

14 Whole vehicle 15 Floor pan (passenger front) 16 Fire wall 17 Chassis/structural rails (passenger) 18 Floor pan (driver rear) 19 Floor pan (driver front) 20 Floor pan (passenger rear) 21 Chassis/structural rails (driver) 22 A pillar passenger 23 A pillar driver 24 B pillar passenger 25 B pillar driver 26 C pillar passenger 27 C pillar driver 28 D pillar passenger 29 D pillar driver 30 Engine block (cracked, fractured)

31 Transmission case 32 Differential case 33 Axle housing 34 Suspension (passenger front) 35 Suspension (driver front) 36 Suspension (passenger rear) 37 Suspension (driver rear) 38 Airbag front 39 Airbag side 40 Airbag curtain 41 Seat belt pre-tensioner 42 Battery pack 43 Tow Point (eg fifth wheel, turntable,

king pin, drawer bar, hook, eyelet) 44 Aux Equipment (eg crane, concrete

pump or mixer, tank, pump, garbage compactor) 45 Hydraulic or other Lifting Equipment (eg the ram on a tipping trailer)

31 Transmission case 32 Differential case 33 Axle housing 34 Suspension (passenger front) 35 Suspension (driver front) 36 Suspension (passenger rear) 37 Suspension (driver rear) 38 Airbag front 39 Airbag side 40 Airbag curtain 41 Seat belt pre-tensioner 42 Battery pack 43 Tow Point (eg fifth wheel, turntable,

king pin, drawer bar, hook, eyelet) 44 Aux Equipment (eg crane, concrete

pump or mixer, tank, pump, garbage compactor) 45 Hydraulic or other Lifting Equipment (eg the ram on a tipping trailer)

1 Passenger front

6 Passenger side

Trailer

8 Roof

2 Driver front

3 Driver side

10 Trailer front 11 Trailer rear 14 Whole vehicle 15 Floor pan (passenger front) 17 Chassis/structural rails (passenger) 18 Floor pan (driver rear) 19 Floor pan (driver front) 20 Floor pan (passenger rear) 21 Chassis/structural rails (driver)

33 Axle housing

34 Suspension (passenger front)

35 Suspension (driver front)

36 Suspension (passenger rear)

37 Suspension (driver rear)

43 Tow Point (eg fifth wheel, turntable, king pin, drawer bar, hook, eyelet)

44 Aux Equipment (eg crane, concrete pump or mixer, tank, pump, garbage compactor)

45 Hydraulic or other Lifting Equipment (eg the ram on a tipping trailer)

5 Passenger rear

9 Interior

4 Driver rear

Catalogue No. 45065694 Form No. 5573 (06/2020)

UNCLASSIFIED SENSITIVE: PERSONAL

Page 4 of 5

1 Passenger front

6 Passenger side

5 Passenger rear

Heavy Bus

7 Engine

8 Roof

9 Interior

2 Driver front 3 Driver side

4 Driver rear

14 Whole vehicle 15 Floor pan (passenger front) 16 Fire wall 17 Chassis/structural rails (passenger) 18 Floor pan (driver rear) 19 Floor pan (driver front) 20 Floor pan (passenger rear) 21 Chassis/structural rails (driver) 22 A pillar passenger 23 A pillar driver 24 B pillar passenger 25 B pillar driver 26 C pillar passenger 27 C pillar driver 28 D pillar passenger 29 D pillar driver 30 Engine block (cracked, fractured)

31 Transmission case

32 Differential case

33 Axle housing

34 Suspension (passenger front)

35 Suspension (driver front)

36 Suspension (passenger rear)

37 Suspension (driver rear)

38 Airbag front

39 Airbag side

40 Airbag curtain

41 Seat belt pre-tensioner

42 Battery pack 43 Tow Point (eg fifth wheel, turntable,

king pin, drawer bar, hook, eyelet) 44 Aux Equipment (eg crane, concrete

pump or mixer, tank, pump, garbage compactor) 45 Hydraulic or other Lifting Equipment (eg the ram on a tipping trailer) 46 Roll-over Protective Structure

Catalogue No. 45065694 Form No. 5573 (06/2020)

UNCLASSIFIED SENSITIVE: PERSONAL

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