INSTRUCTIONS

1. Read through this form carefully

2. Applicant/Individual to fill out' and sign where indicated.

3. Make payment and click submit to finish

A Record of Traffic Infringement Notices (RTINs) provides an individual with their record of traffic infringements issued by the WA Police Force in the preceding ten years. This record cannot be used to determine the number of demerit points against a licence. To find this information, please consult the WA Department of Transport “Driver’s Demerit Points Enquiry” online service.

STEP 1 - FILL OUT FORM

Authority to Release Record of Traffic Infringement Notices Form

Personal Details

Full Legal Name (as it appears on WA Drivers Licence)

Given names *

Surname *

Previous names (incl. changes by deed poll or marriage)

Place of birth *

Date of birth *

Daytime contact number *

Residential Address *

Street addressStreet address line 2

City

State

Postcode

WA Drivers Licence Number (if known)

Verify Email Address: *

Send code

STEP 2 - REASON FOR APPLICATION

State Reason

STEP 3 - UPLOAD PHOTO IDENTIFICATION

This application cannot be processed without a copy of an approved form of photo identification (passport, drivers licence, photo card). A photocopy is acceptable.

Choose your Identification type:

Drivers licencePassportOther

UPLOAD FRONT OF IDENTITY DOCUMENT *

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CONSENT LETTER

TO WHOM IT MAY CONCERN

I, the applicant, hereby authorise the Western Australia Police to provide details of all traffic infringement notices recorded against me in the last ten years.

My Representative Name: ANITA NOLAN

Organisation: ELITE SCREENING AUSTRALIA

Postal Address: P.O Box 636, Toowoomba City, QLD 4350

Individual’s Declaration and Warranty

I declare and warrant that:

I am the person referred to in this Authority to Release Information Consent Letter.
All the personal details are my personal details and are true and correct.
I agree for Elite Screening Australia to collect my personal information in accordance with their privacy policy.
I acknowledge and agree to Elite Screening Australia's terms of use.
I authorise Elite Screening Australia to submit my application for traffic infringement report form to the Western Australia Police on my behalf