Application for registered person name
(*see note 3)
Full name/Company name
Note: if your application
If company, please provide a contact nameis approved, the
information will be
emailed to you. If you
have not provided an
email address, the
information will be
posted to your mailing
Contact phone number
Please select the Applicant type that applies to you: (tick one)
Motor Vehicle Trader
Other (please specify)
NZ driver licence no.
NZ Transport Agency customer no.
(see note 4)
(see note 4)
Do you have the registered person’s consent to access information about them on the Motor Vehicle Register?
Please attach a copy of the registered person’s consent to this application form.
Note: please include any
Do you want the information for: (tick one)
as necessary in support of
What is the reason for requiring registered person name and address?
continue on a separate sheet if necessary...
*Note: if you are a
Have you ever applied to the Secretary of Transport for an authorisation under s 241 of the Land Transport Act
motor vehicle trader
to access personal information?
or a financial service
provider, you do not
Attach a copy of the approval or decline letter from the Secretary of Transport to
this application form*.
need to attach a copy
of the letter.
Will the information be disclosed to a third party?
Who will the information be disclosed to?
Will the information be retained?
How long will the information be retained for?
Will the information be re-used?
How often will the information be re-used?
I certify that the particulars given are correct and that the name and address of the registered person(s) will
not be used for any other purpose than that specified in this application.
Continued over the page
How would you like to pay the $15 application fee?
Please charge my credit card as below:
Note: this fee is non-
refundable, regardless of
whether your application is
approved or declined.
Name on card
See note 6.
I have enclosed a cheque for $15.Note: cheques should be made payable to the NZ Transport Agency
Send your completed application, payment and any supporting documentation to:
Customer Service Team, NZ Transport Agency, Private Bag 11777, Palmerston North 4442.
Applications for registered person name and address
are considered under section 237 of the Land Transport Act 1998 and against
the criteria contained in the Official Information Act, which requires the NZ Transport Agency (NZTA) to weigh up the public
interest in releasing the information sought against the privacy rights of the person concerned.
Public interest usually means for the common good or general welfare of all but is not limited in any way. Each case will be
determined on it’s own merits.
The particulars specified on the Application for registered person name and address
will be stored and/or form part of the Motor
Vehicle Register. Collection and dissemination of this information is authorised by Part 17 of the Land Transport Act 1998.
Under the Electoral Act 1993, s 263B, the NZ Transport Agency (NZTA) is authorised to release information for data matching
purposes to the Electoral Enrolment Centre.
The Privacy Act 1993 provides rights of access to, and correction of, any retrievable personal information held by the NZTA.
Should you wish to exercise these rights please contact the Transport Registry Centre, NZ Transport Agency, Private Bag 11777,
Palmerston North 4442 or email: [NZTA request email].
State the manufacturers designation (eg Corolla, Accord), not the vehicle year.
- Private individuals should enter their driver licence number. Customer number
- Corporate organisations (non-individual) and insurance companies may have an NZ Transport Agency
customer number allocated to them which is to be entered as identification. Other
- if a driver licence number is not available, then photocopies of documents providing proof of full name,
date of birth and signature (for example passport, firearms licence) must be provided with this completed form. Corporate organisation
- if a customer number has not been allocated then a photocopy of the Certificate of incorporation
must be provided with this completed form.
The NZTA may contact the individual concerned to seek their views on the release of their personal details.
If the name and address details of a registered person are disclosed to you in response to your application, then the NZTA must
supply to the registered person, on request, your name and the purpose of disclosing to you the registered person’s details.
The fee is non-refundable, regardless of whether your application is approved or declined. The fee contributes to the cost of
processing your application.
Please allow up to ten working days for your application to be processed.