Photo Identication Card Act 2008; Transport Planning
and Coordination Act 1994
Photo Identication Card
Application/Replacement
Page 1 of 2 LTSR Forms Area Form F4772 CFD V01 Sep 2023
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Evidence of Identity (EOI) Requirements
You must give evidence of your identity. You may do so by
showing your Qld driver licence, industry authority, marine
licence indicator (conditions apply), APA or Photo ID card. All
cards must be current or expired by less than two years.
If you are unable to show one of the above you will need
to present three other acceptable EOI documents and
evidence of your Qld residential address. For a full list of
acceptable EOI, evidence of residential address and change
of name documents, please refer to the Evidence of Identity
Requirements for Individuals (form F4362) or visit
www.qld.gov.au.
Please use this form to apply for:
• the issue or replacement of a Photo Identication (Photo ID)
card
• a replacement Adult Proof of Age (APA) card (now known as
Photo ID card).
To apply for a Photo ID card you must be at least 15 years of
age and reside in Queensland (Qld).
Important information about the delivery of your Photo ID
card
If your application is approved, your Photo ID card will be mailed
to your postal address within 21 days.
1. Personal details
Family name (please print)
Given name/s
Residential address
Postcode
Category A (please print)
Evidence of Qld residential address (please print)
Category B (please print)
Category A or B (please print)
Document type
(for example Australian
passport)
Document number
(for example X0100011)
Document type
(for example telephone account)
Issue date
(for example 01/04/2019)
Document type
(for example Medicare card)
Expiry date
(if applicable)
Document type
Document number or expiry date
(do not give credit/debit card
number)
Postal address (if same as residential, write ‘as above’)
Postcode
Daytime contact phone number
Date of birth
/ /
Town, state and country of birth
Email address
4. Can you show your Qld driver licence, industry
authority, marine licence indicator, APA card or Photo
ID card?
2. Do you currently hold or have you ever been issued a
Qld driver licence, industry authority, marine licence,
APA card, Photo ID card or vehicle/vessel registration,
in any other name? (for example name at birth, maiden
name, previous married names, adoptive name, or other
aliases)
Yes
Yes
No
No
Licence/authority/reference number
Provide details below
You must show three EOI documents, one
of which must show your signature, and one
evidence of residential address document.
Please provide details of your documents.
Do you want your residential address displayed on the
reverse of your Photo ID card?
Would you like to get e-notices and e-reminders?
No
No
Yes
Yes
Male (M) Female (F)
Gender:
/ /
Previous family name/s
Previous given name/s
Note: an EOI document linking your previous name and
your current name may be required.
3. Are you surrendering your Qld driver licence?
Yes
No
Reason for surrender:
Medical
Voluntary (no longer wish
to drive)
Print Form
Reset Form
Privacy Statement: TMR collects this information under the Photo Identication
Card Act and the Transport Planning and Coordination Act so you may apply for a
Photo ID card. TMR may disclose this information to the Queensland Police Service
(QPS) and interstate agencies that issue proof of age or photo ID cards. Your digital
photo may also be released to the QPS. TMR’s card contractor will have controlled
access to your information, digitised signature and digital photo to make your card.
Information, including your digital photo or digitised signature, may be disclosed
to an authorised agency if the information is connected to an application for its
product. Your information will not be disclosed to any other third party without your
consent, unless authorised or required by law.
8. Applicant’s declaration
I declare that I have read the answers I have given to the
questions in this application and that the answers are
complete, true and correct in every detail.
I understand that if I have stated anything that is false or
misleading, the Photo ID card granted to me as a result of
this application will be cancelled.
I understand that I may be prosecuted for giving or stating
any false or misleading information or documents.
I consent to the Department of Transport and Main Roads
(TMR) taking, keeping and using my personal information,
documents, digital photo and digitised signature for the
purposes associated with my application.
I consent to TMR verifying my EOI documents or information
provided by me with the issuing authority or their agencies.
Applicant’s signature
Date
/ /
Authorising person’s declaration
I am satised the applicant’s signature matches the applicant’s
EOI documents which I have sighted.
Authorising person’s signature
Date
/ /
Authorising person’s name
Oce Stamp
It is an oence under the Photo Identication Card Act to
state anything or give a document to an authorised person
if you know it contains false or misleading information. The
maximum penalty may be more than $4700.
EOI sighted - address and details current on system
Applicant’s details conrmed in TICA/TRAILS
1:1 match performed
Application approved
Comment
Application not approved
Authorising person’s checklist (tick where applicable)
your photo image is no longer a true likeness.
Note: You must return your card.
other reason
Please provide details.
your card is faulty.
Please give details about the fault.
Note: You must return your faulty card.
you have not received your card in the mail.
Please conrm your postal address details.
Postcode
Change of name (please print)
Document type
(for example Qld BDM
issued Marriage
Certicate)
Document number
(for example
01000)
Registration
year
(for example
2001)
6. Have you been previously issued an APA or Photo ID
card?
No Go to 7
Yes
Damaged Destroyed
Lost Stolen
7. Please indicate the reason you require a replacement
card
your card is:
Page 2 of 2 LTSR Forms Area Form F4772 CFD V01 Sep 2023
5. Is your name dierent to the name/s on your EOI
documents?
No
Yes You must show an EOI change of name
document. Please provide details of your
documents.
Photo Identication Card Application/Replacement continued ... Page 2 of 2