APPLICATION

Need a limited licence / work licence?

If you’ve been suspended or disqualified from driving, we can help you get back on the road. If you would like us to prepare your limited licence documentation, simply fill out our application form below.

Once you have submitted the form, we’ll review the information and contact you to talk about the next steps

If any of the following apply, you will not be eligible to apply for a limited licence:

Indefinitely disqualified from driving.
Disqualification is due to a conviction for driving while disqualified or driving while suspended.
Charged with driving contrary to the conditions of a limited licence.
Disqualification is due to drink driving while operating a transport service vehicle.
An excess breath alcohol reading of above 800 micrograms per litre of breath or 160 milligrams of alcohol per 100 millilitres of blood.

You cannot apply for a limited work licence if you have been convicted of any two of the following offences within 5 years:

Reckless, careless or dangerous driving causing injury or death.
Failing to stop after an accident.
Driving under the influence of alcohol or drugs.
Applying for or obtaining a driver licence while disqualified.

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APPLICANT DETAILS

Name(Required)

First Middle Last

Email(Required)

Phone(Required)

Gender(Required)

Date of Birth(Required)

DD slash MM slash YYYY

Address(Required)

Street Address Suburb City State / Province / Region ZIP / Postal Code Country

Driver Licence Type(Required)

Drivers Licence Number(Required)

Reason For Limited Licence Application(Required)

Briefly describe how you lost your licence on this occasion:(Required)

Disqualified By / Suspended By(Required)

How long are you disqualified / suspended from holding a licence?(Required)

What date did your disqualification / suspension start?(Required)

DD slash MM slash YYYY

Have you recieved a disqualification / suspension notice?(Required)

Yes

District Court location where you were sentenced / disqualified

If your disqualification is due to drink driving - what was the EBA level / reading?

Have you previously ever been disqualified for an EBA offence?(Required)

If yes, please specify date/s (month and year)

Have you ever been convicted of driving while disqualified or suspended?(Required)

Yes

Have you ever been convicted of any two of the following offences within the past 5 years (on two separate occasions)

Reckless, careless or dangerous driving

Reckless, careless or dangerous driving causing injury or death

Failing to stop after an accident

Drink driving or driving under the influence of drugs

Applying for or obtaining a driver licence while disqualified / suspended

None of the above

Choose all options that apply

If yes, please specify date/s (month and year)

Please list details and dates of any previous driving charges or convictions:

Other than disqualification/suspension, did you receive any other sentence?(Required)

Community service

Home detention

Reparation

None

Tick all that apply

Please give details(Required)

Did you receive a fine?(Required)

What was the fine amount?(Required)

Have you paid the fine or made a payment plan arrangement with the court?(Required)

EMPLOYMENT DETAILS

Employment Type:(Required)

Occupation:(Required)

Company Name:(Required)

Company Contact Person / Manager(Required)

Company Email(Required)

Company Phone(Required)

Company Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Reason for needing to drive(Required)

Employment Purposes

Other

What is your occupation? (Tick all that apply)(Required)

Self Employed

Manager / Supervisor

Truck Driver

Delivery Driver

Courier Driver

Tradesman

Mechanic / Panel Beater

Sales Professional

Other

What are your employment duties? (tick all that apply)(Required)

I need to drive to and from my workplace

Make deliveries

Visit and meet with customers

Visit and meet with suppliers

Visit work sites at various locations

Visit company branches and stores

Attend work related meetings

Test drive vehicles

Attend to emergency call outs

Which days of the week do you need to drive?(Required)

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Please Specify(Required)

Regular work hours:(Required)

What hours will you be driving between?(Required)

What is the maximum number of hours you would spend driving each day?(Required)

What is your daily commute time? (how long does it take you to get to and from work?)(Required)

VEHICLE DETAILS

Below, please enter the details of the private vehicles and any work vehicles you will be driving on your limited licence. Do not enter details of any vehicle that does NOT have a current WOF or Rego - These will NOT be accepted by Police.

Private Vehicles(Required)

Make & Model

Colour

Year

Registration Number

Registered Owner

Use the "+" button to add another vehicle

Work Vehicles

Make & Model

Colour

Year

Registration Number

Registered Owner

Use the "+" button to add another vehicle

DRIVING BOUNDARY

Below, please provide details of the boundary you need to drive within. Police require a driving boundary be imposed. You will not be permitted to drive outside that driving boundary at any time during your Limited Licence period.

North Boundary(Required)

East Boundary(Required)

South Boundary(Required)

West Boundary(Required)

HARDSHIP DETAILS

Below, please answer the questions relating to your personal and financial circumstances. The Court will want to know this information in order to assess your application.

Monthly income (after tax)(Required)

Monthly rent / mortgage payment(Required)

Monthly food costs(Required)

Monthly power costs(Required)

Monthly telephone costs(Required)

Monthly insurance costs

Monthly vehicle costs

Monthly fuel costs

Monthly loan, hire purchase, credit card payments

Total monthly expenses

Total leftover after expenses

Do you have access to any savings or funds to pay for a driver while you are suspended / disqualified?(Required)

Yes

Are there any suitable public transport options? If not, please explain why they are not suitable in your case.(Required)

Relationship Status:(Required)

Single

De Facto

Married

Civil Union

Number of dependent children:

What are your living arrangements?(Required)

How many people live at your address?(Required)

Do you have family members who rely on you for transport? If so, please explain the situation and why they rely on you.

Consent(Required)

I acknowledge, understand, and accept the terms and conditions

Confirmation(Required)

I confirm that the information I have provided in this form is true and correct

How did you hear about us?(Required)

Please Specify(Required)

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Contact

027 292 8720
info@limitedlicencesolutions.co.nz
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