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Application for Endorsement D, F, R, T, W

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Application for endorsement D, F, R, T, W DL19

Please read this before you start:

Check that you have all the relevant What to bring requirements from page 3 and ensure you have completed all questions - if not applicable write N/A.

1. What type of application are you making?

Applying for an endorsement for the first time

Applying to renew an endorsement

Reapplying because your endorsement has been expired for more than five years

2. What is your New Zealand driver licence number?

3. What is your name?

Surname

Full first name

Middle name(s)

4. Are the names you have shown on this application different from that shown on any of the supporting identification (including any driver licence)?

No

Yes My previous name was:

5. Are you?

Male    Female

6. Would you be willing to donate organs in the event of your death?

No    Yes

If you answer ‘yes’, in the event of your death your next-of-kin will be asked for their agreement to donate organs. Please let them know of your wishes.

7. What is your date of birth?

8. Where were you born?

Name of town/city

Name of country

9. Would you like your address printed on your licence?

No

Yes   OR   Physical address   Mailing address

10. Where do you live?

11. What is your mailing address? (if different from above)

12. What are your contact telephone numbers?

Home/mobile

Work

13. What type of endorsement(s) are you applying for?

D Dangerous goods endorsement

F Forklift endorsement

R Rollers endorsement

T Tracks endorsement

W Wheels endorsement

14. Medical fitness

have a medical condition that has affected your ability to drive safely in the last five years.

Please tick if you:

have never been aware of or told by a doctor that you have a medical condition that could affect your driving.

are aware of a medical condition but it has not affected your ability to drive safely in the past five years.

have supplied a medical certificate in the past five years that is of the same medical standards as the class for which you are currently applying, and:

• your medical condition has not worsened

• you have not been diagnosed with another medical condition that could affect your ability to drive safely.

15. Do you wear glasses or contact lenses for driving?

No    Yes

Declaration

I state that, to my best knowledge and belief, all the information I have given for this application is correct and I am not disqualified from obtaining or holding a driver licence or licence endorsement. I further declare that the medical fitness information provided above is true and correct.

Signature of applicant

Date

Office use only

Primary evidence of identity:

NZ photo driver licence

NZ passport

Other (specify below)

Supporting evidence of identity: (if applicable)

Evidence of name change: (if applicable)

Issue/effective date

Issue date

Expiry date

Reference number

Input

Chkd

Fee paid (GST included)

Date paid

Referee-verified image attached

Certificate of completion of course attached

Medical certificate attached

Eyesight certificate attached

Fit with lenses

Fit without lenses

Unfit

Agent stamp

Who should use this form?

Anyone who is applying for any of the following endorsements.

D Dangerous goods endorsement

F Forklift endorsement

R Rollers endorsement

T Tracks endorsement

W Wheels endorsement

What to bring

Your completed application form.

Medical certificate completed by your medical practitioner (if applicable, see medical certificate section on page 4).

Your glasses or contact lenses if you wear them for driving.

Certificate of completion of course (your D endorsement certificate must be no more than 60 days old).

Evidence of identity (must be original - no photocopies).

your New Zealand photographic licence (which can be current or expired up to two years), or

your current New Zealand passport.

If you do not have either of these documents you will need to provide two other acceptable forms of evidence of identity such as:

your New Zealand birth certificate and a student ID card or 18+ card, or

your New Zealand birth certificate and a utility bill (eg power account or rates bill) or bank statement.

If neither of the documents you provide has a photo, you will also need to provide a verified image (see Factsheet 20 Identification for driver licensing for further information and a full list of acceptable identity documents).

Cheque, cash or EFTPOS for paying the appropriate fee.

Evidence of name change (must be original - no photocopies).

your marriage or civil union certificate

your dissolution of marriage or civil union order

your certificate of annulment

your deed poll certificate, change of name certificate, or birth certificate showing both names

your statutory declaration confirming the change of name which has been registered with the Registrar of Births, Deaths and Marriages.

Where to apply

Take your completed form and all original documents to any driver licensing agent. These are selected branches of:

• New Zealand Automobile Association (NZAA)

• Vehicle Inspection New Zealand (VINZ)

• Vehicle Testing New Zealand (VTNZ).

Find your nearest driver licensing agent at www.nzta.govt.nz/agent. A customer services representative will process your application, check your identification, may take your photograph and a sample signature for your licence as well as check your eyesight. The appropriate fee will be payable at this time.

Warning

It is an offence to supply false or misleading information and may lead to court action. The consequences can include losing your licence and/or paying a fine.

If you do not supply all relevant information, your application may be delayed or declined.

Responsibilities

Driver licences make our roads safer for everyone and prove drivers are qualified and legally entitled to be behind the wheel. That’s why it is important you always carry your licence with you when you drive.

Your address will be recorded on the database and you should notify the Transport Agency at www.nzta.govt.nz/online if you change your address.

Medical certificate

You need to present a medical certificate with this application if:

• you have had a medical condition in the last five years that affects your ability to drive safely, and/or your medical condition has worsened, or a new condition has been diagnosed, since your last medical certificate was presented

• you are requested to by the NZ Transport Agency (regardless of when you last presented a medical certificate).

A medical certificate must be completed by a New Zealand registered medical practitioner and must not be more than 60 days old. The medical practitioner can be your usual doctor (GP), or if appropriate be a specialist or occupational therapist.

The medical certificate must state that you are fit to drive safely or indicate conditions under which you can drive safely.

Eyesight

You must prove that your eyesight meets the required standard.

• present a satisfactory eyesight certificate issued by a New Zealand registered optometrist (this certificate must not be more than 60 days old)

• present a satisfactory medical certificate issued by a New Zealand registered medical practitioner (this certificate must not be more than 60 days old)

• pass an eyesight screening check at a driver licensing agent.

More information

Your driver licensing agent has a range of factsheets which give more information on a wide range of driver licensing topics.

We use our forms and factsheets to provide useful, common-sense advice and information in a concise format. They can’t cover all aspects of a topic and should not be used instead of authoritative legal documents or legal advice.

More information is available on our website www.nzta.govt.nz/driver-licences, or call our contact centre on 0800 822 422.

Privacy information

The particulars you provide will become part of the Driver Licence Register. Collection, dissemination and release of this information is authorised by the Land Transport Act 1998 and part 11 of the Privacy Act 1993.

The Transport Agency may also use some of these particulars to provide you with information relating to driver licensing and driving, or to contact you for feedback on our services. We may also disclose some of the particulars to our agents and contractors in relation to the above purposes.

Under the Electoral Act 1993, s 263B, the Electoral Enrolment Centre operates an authorised information matching programme with the Transport Agency. The purpose of this programme is to assist in keeping the Electoral Roll up-to-date.

To keep the Driver Licence Register up-to-date the Transport Agency also operates an authorised information matching programme with Births, Deaths and Marriages. Please refer to the Privacy section of our website for more information.

The Privacy Act 1993 provides rights of access to, and correction of, any readily retrievable personal information held about you. Should you wish to exercise these rights please contact the NZ Transport Agency, Private Bag 11777, Palmerston North 4442 or email info@nzta.govt.nz.

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What the Application for Endorsement D, F, R, T, W Is and when it applies

The Application for Endorsement D, F, R, T, W is a structured U.S. administrative form used to request a specific endorsement category from a licensing or regulatory authority. It collects identifying information for the applicant, the endorsement type requested, supporting facts, and attestations required by the issuing agency. Agencies use this application to evaluate eligibility, confirm identity, and record the endorsement on an official license or file. Completing the form accurately and submitting supporting documentation is required for timely processing and to avoid administrative rejection or delay.

Who completes this endorsement application and why

Individuals and organizations file this application when they need an administrative endorsement tied to a professional, business, or regulatory credential.

  • Individual applicants: Professionals or licensees requesting a specific endorsement or specialty designation from a licensing board.
  • Employers or agents: Authorized company representatives submitting applications on behalf of employees or contractors when agency rules permit agent filing.
  • Legal and compliance teams: Attorneys or compliance staff preparing documentation and attestations to satisfy regulatory requirements and reduce risk.

Typical filers should confirm authority, required documentation, and any notarization or witness steps before starting to complete the application.

Sequential steps to complete and submit the application

Follow this step sequence to prepare, verify, sign, and file the Application for Endorsement D, F, R, T, W with minimal delay.

  • 01
    Prepare: Gather IDs, certificates, and contact details before opening the form.
  • 02
    Complete: Enter fields exactly; follow MM/DD/YYYY for dates and full legal names.
  • 03
    Authenticate: Add notarization or witness signatures if the issuing agency requires them.
  • 04
    Submit: Send to the agency by the accepted method and retain proof of transmission.

Typical processing flow for endorsement applications

A concise workflow shows who acts at each stage and what to expect from submission through final endorsement.

  • Document assembly: Compile form, attachments, and identity evidence.
  • Verification: Agency reviews eligibility, credentials, and completeness.
  • Decision: Agency approves, requests more info, or denies the endorsement.
  • Record update: Approved endorsements are recorded on the official license or file.

Online workflow settings to configure before eSubmission

Configure these workflow settings in your eSignature or document platform to ensure secure, auditable submissions.

Field Configuration
Signer Order Sequential signing when multiple approvers required
Authentication Level Email link, SMS code, or knowledge-based authentication
Conditional Fields Show or hide fields based on endorsement type selected
Retention Settings Automatic archiving and audit trail retention

Technical and integration considerations for eSubmission

Ensure your chosen eSignature provider supports required integrations, audit trails, and any necessary compliance addenda such as HIPAA or 21 CFR Part 11 when applicable.

  • Accepted Formats: PDF, DOCX
  • Authentication Options: Email, SMS, KBA
  • Integrations: Salesforce, Google Workspace, NetSuite

Core elements that make a professional endorsement application

A professional application is complete, verifiable, auditable, and aligned with the issuing agency's instructions so reviewers can make a quick, supported decision.

Clear identification

Applicant name, DOB, and government ID numbers presented consistently and matching attachments to avoid identity verification failure.

Precise endorsement code

Use the agency's exact endorsement letter (D, F, R, T, W) and follow the selection rules to prevent misclassification.

Supporting evidence

Attach transcripts, certifications, or affidavits and identify issuing authority and dates for each document submitted.

Signature and attestations

Signatures must match the stated signatory authority; include notarization or witness statements when required by the agency.

Contact information

Provide daytime phone, email, and mailing address for correspondence and to resolve any agency questions promptly.

Audit trail

Maintain records of submission, signer authentication details, and any resubmissions to support appeals or audits.

Security and compliance safeguards to consider

Encryption in transit: TLS 1.2/1.3
Encryption at rest: AES-256
Industry certifications: SOC 2 Type II
Privacy frameworks: GDPR, CCPA
Healthcare compliance: HIPAA (BAA required)
Regulated records: 21 CFR Part 11 support

Key risks and potential penalties from errors

False statements: Civil or criminal exposure
Incomplete filings: Administrative rejection
Late submission: Processing delays
Missing notarization: Invalid signature acceptance
Incorrect identity: Application denial
Recordkeeping gaps: Audit penalties

Common mistakes that delay endorsement processing

  • Submitting mismatched names between the form and supporting ID, which often triggers identity verification failures and requires re-submission.
  • Failing to include required attachments or failing to label them clearly so reviewers cannot confirm the claimed qualifications quickly.
  • Using informal date formats or omitting dates entirely, which can affect eligibility windows and background check timing.
  • Neglecting notarization or witness requirements stated by the issuing agency, causing the application to be returned or invalidated.

Timelines, expected processing, and agency deadlines

Timelines vary by issuing agency; confirm the agency's published processing times and any fast-track or priority options before filing.

Submission deadline:

Agency-specific; check instructions before filing

Processing estimate:

Ranges from days to several weeks depending on agency workload

Requests for more information:

Often a fixed response window, typically 10–30 days

Expedited options:

Availability varies; fees or proof may be required

Appeal period:

Agency rules set timelines for appeals or reconsideration

Comparing baseline eSignature pricing and capabilities

Overview of starting prices and common capability differences between signNow and other widely used vendors to inform vendor selection for endorsement application workflows.

signNow DocuSign Adobe Sign PandaDoc HelloSign
Starting Price $8/user/mo $15/user/mo $14/user/mo $19/user/mo $15/user/mo
Free Trial 7-day free trial Varies Varies Varies Varies
Bulk Send Yes Yes Yes Yes No
Audit Trail Yes Yes Yes Yes Yes
HIPAA Compliant Yes Yes Yes No No
Envelope Cap No envelope cap 100 envelopes/user/year Varies Varies Varies

Frequently asked questions about completing and filing the application

Answers to common questions about electronic execution, notarization, corrections, and processing expectations for this application.


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