Known User Statement

Use this form in the situation where you were not the driver or in control of the vehicle/trailer at the time of the offence and you are able to provide details of the person who was in control of the vehicle/trailer.

Your Details (Please use the details exactly as they appear on your licence)

The name of the company that owns the vehicle. Leave blank if vehicle is privately owned.
Please separate infringement numbers with a comma. ie 12345,12346,12347...
This is the name of the Council/Hospital/University that issued the infringement. This is never Bartels, Taylor & Associates.
Please be advised that only the registered owner of a vehicle or a person who has been nominated by the registered owner of a vehicle can provide a Known User Statement. It is an offence for anyone other than the registered owner of the vehicle or nominated person to submit a Known User Statement.

Details of person who had possession of the car / trailer

I state that at the time of the offence I believe that

Supporting Evidence and other attachments
Unlimited number of files can be uploaded to this field.
2 MB limit.
Allowed types: jpg png pdf doc docx.

I understand and acknowledge that:

  • This document is a digitally signed statement.
  • It is an offence to provide false or misleading information and a penalty may be imposed under the relevant acts.