2. / Name of the activity (tick as applicable) / ☐Low Loader
☐Tracking Vehicle
☐Vehicle Mount
3. / Exemption sought from (tick as applicable) / ☐ Open Load Space
☐ Seat Belt
☐ Load Size & Projection
4. / Details of the contact person responsible for this activity (Producer / Production Manager) / Name / Click here to enter text.
Phone / Click here to enter text.
Postal address / Click here to enter text.
5. / Proposed duration of each day of the activity / Date:Click here to enter text. / Date:Click here to enter text. / Date:Click here to enter text.
Time:Click here to enter text. / Time:Click here to enter text. / Time:Click here to enter text.
6. / Location(s) of proposed activity (route) or attach a map / Click here to enter text.
7. / Details of vehicle towing Low Loader trailer / VIN / Click here to enter text.
Jurisdiction of registration / Click here to enter text.
8. / Details of Low Loader trailer / VIN / Click here to enter text.
Jurisdiction of registration / Click here to enter text.
9. / Details of Tracking Vehicle / VIN / Click here to enter text.
Jurisdiction of registration / Click here to enter text.
10. / Vehicle(s) which is/are to be loaded onto the back of the Low Loader / VIN / Click here to enter text.
Jurisdiction of registration / Click here to enter text.
11. / Method employed to restrain vehicle(s) on Low Loader / Click here to enter text.
12. / Number of people who will be traveling in the vehicle(s), that are to be loaded onto the back of the Low Loader / Click here to enter text.
13. / Number of film crew who will be traveling (harnessed) on the back of the Low Loader trailer / Click here to enter text.
14. / Estimated total weight of load that will be placed on Low Loader trailer / Click here to enter text.
15. / Number of film crew who will be travelling (harnessed) on the back of the Towing Vehicle / Click here to enter text.
16. / Number of film crew who will be travelling (harnessed) on the back of the Tracking Vehicle / Click here to enter text.
17. / Method used to restrain personnel riding on Low Loader &/or Towing Vehicle &/or Tracking Vehicle / Click here to enter text.
18. / Estimated total weight of load that will be placed on the Tracking Vehicle / Towing Vehicle / Click here to enter text.
19. / Dimensions of the Low Loader when it is in legal configuration / Click here to enter text.
20. / Dimensions of the low loader when it will be in an “over-width” configuration (if applicable) / Click here to enter text.
21. / Indicate form of Traffic Control to be implemented (TMP/Traffic Controllers, WA Police, Licensed Escort Pilots) / Click here to enter text.
22. / Confirm safe work practices will be adhered to as per WA Occupational Safety & Health Regulations 1996 and Film and Television Safety Guidance Notes (Producer / Production Manager signature required)
23. / Confirm vehicle(s) will drive at a speed that is safe & appropriate with consideration to the type of activity, rigging, number of persons travelling on board, location, road & weather conditions. / ☐
24. / Name & contact number of competent Person responsible for Low Loader / Tracking Vehicle / Vehicle Mount (Key Grip) operations (rigging, driving). / Click here to enter text.
25. / Name & contact number of film industry graded Safety Supervisor / Click here to enter text.
26. / Attach a copy of the public liability insurance certificate to cover this activity / ☐
27. / If the insurance issued is different from the activity organizers, please attach proof of the relationship between these two companies / ☐
I certify that all above filming activities will comply with Department of Transport requirements as outlined in the document, “Requirements for filming activities involving Low Loaders / Tracking Vehicles / Vehicle Mounts”.
Producer / Production Manager Name:
Sign: ______
Date: ______
Please note; Every successful applicant will have to pay $50.00 (Inclusive of GST) each time when asking for the exemption approval which is payable at any licensing center in WA (http://www.transport.wa.gov.au/licensing/20741.asp) or payable by a cheque addressed to “Department of Transport” or by credit card calling 13 11 56 and send the copy of the receipt to the officer concerned in Department of Transport.
Payment of $50.00 Exemptions Fee at the Licensing Centre. Ask for a General Revenue Receipt
Issued to: Company / Organisers Name
Transaction Type: Vehicle Standards Regulations Exemption Fee
Reason: Exemption from Road Traffic Code 2000 (Regulation 233 /234 /278)
Contact details of the Department of Transport :
Phone : 08 - 9216 3895 / Fax : 08 - 9216 3899 / Email :
Postal Address : Vehicle Safety and Standards, 21 Murray Road South, Welshpool WA 610
Vehicle Safety and Standards
21 Murray Road South
Page 2 of 2 Welshpool WA 6106
Facsimile (08) 9216 3899