Instructions for Applicant

Step 1: Download the Traffic History Application Form below.

TRAFFIC HISTORY APPLICATION FORM

Step 2: Sign the Traffic History Application form and get your photo ID certified/endorsed by the Authorised Officer. What “certified/endorsed” means: The Authorised Officer checks your original photo ID, confirms it is genuine and that the photo is really you, then adds a statement, signature, and stamp to the copy.

Authorised Officers include:

• Police Officers

• Justices of the Peace

• Commissioners of Oaths

• NT Police, Fire and Emergency Services (NTPFES) employees

Step 3: Click the ‘Save and Complete Later’ link at the bottom of this form – this will send a link to your email so you can come back to this form and continue completing the steps 4 & 5.

Step 4: Open the link in your email to return to your form at any time and complete all required details.

- Upload your signed Traffic History Application Form & certified ID

- Sign the consent section

- Make payment

Step 5: Submit this form to Elite Screening Australia.

TO WHOM IT MAY CONCERN 

I, the applicant, hereby authorise the Northern Territory Police Information Access Team to provide details of all traffic history recorded against me. 

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:

1. I am the person referred to in this Authority to Release Information Consent Letter.

2. All the personal details are my personal details and are true and correct.

3. I agree for Elite Screening Australia to collect my personal information in accordance with their privacy policy.

4. I acknowledge and agree to Elite Screening Australia's terms of use.

5. I authorise Elite Screening Australia to submit my application for traffic infringement report form to the Northern Territory Information Access Team Police on my behalf

Need help filling out this form?

Please contact our customer service team at the details below:

Web: Contact | Elite Screening Australia

Email: admin@elitescreeningaustralia.com.au

Ph: 1300 959 214

ABN: 73 647 362 203