MR 96
NOTICE OF DISPOSAL
BOTH PARTIES MUST SIGN THIS FORM
The seller must forward this section within 14 days of sale to Service SA, GPO Box 1533, Adelaide SA 5001 or lodge in person at
a Service SA Centre. This will ensure the new owner will be responsible for any future breaches arising from the use of this vehicle.
Selling Price
Time of Disposal
Date of Sale
On
/
:
am/pm
/
$
Make of Vehicle
Plate
Body Type
Number
Surname/Body Corporate Name
Given Names
Residential (Home) or
Business Address
Number and Street
Suburb or Town
CLIENT Number (if known)
Postcode
Registered Owner/
Operator
Surname/Body Corporate Name
Given Names
Residential (Home) or
Business Address
Number and Street
Suburb or Town
CLIENT Number (if known)
To The Following Person(s)
Surname/Body Corporate Name
Given Names
Driver’s Licence Number
:
am/pm
$
Body Type
Driver’s Licence Number
Date of Birth
/
Date of Birth
/
Number and Street
Postal Adress
CLIENT Number (if known)
Postcode
CLIENT Number (if known)
To The Following Person(s)
/
Other/Joint
Owner’s Name
Residential (Home)
or Business Address
/
Make of Vehicle
Number
Registered Owner/
Operator
New Owner’s
Name
Selling Price
Time of Disposal
On
/
Plate
06/10
BOTH PARTIES MUST SIGN THIS FORM
The seller must forward this section within 14 days of sale to Service SA, GPO Box 1533, Adelaide SA 5001 or lodge in person at
a Service SA Centre. This will ensure the new owner will be responsible for any future breaches arising from the use of this vehicle.
Date of Sale
MR 96
NOTICE OF DISPOSAL
06/10
New Owner’s
Name
Surname/Body Corporate Name
Given Names
Driver’s Licence Number
Date of Birth
/
Driver’s Licence Number
Other/Joint
Owner’s Name
/
Date of Birth
/
Suburb or Town
Postcode
Residential (Home)
or Business Address
Suburb or Town
Postcode
Postal Adress
(if different to above address)
Number and Street
Suburb or Town
Suburb or Town
Postcode
Date
Signature of
New Owner
/
Date
Signature of
New Owner
Signature of Registered
Owner/Operator
/
MR 96
NOTICE OF DISPOSAL
Selling Price
Time of Disposal
Date of Sale
/
:
am/pm
/
$
Make of Vehicle
Plate
Body Type
Number
Surname/Body Corporate Name
Given Names
Residential (Home) or
Business Address
Number and Street
Suburb or Town
CLIENT Number (if known)
/
:
am/pm
$
Make of Vehicle
Postcode
Registered Owner/
Operator
Surname/Body Corporate Name
Given Names
Residential (Home) or
Business Address
Number and Street
Suburb or Town
CLIENT Number (if known)
To The Following Person(s)
Given Names
Body Type
Driver’s Licence Number
Date of Birth
Driver’s Licence Number
/
Date of Birth
/
New Owner’s
Name
Surname/Body Corporate Name
Given Names
Postcode
Driver’s Licence Number
Date of Birth
/
Driver’s Licence Number
Other/Joint
Owner’s Name
/
Date of Birth
Suburb or Town
Residential (Home)
or Business Address
Suburb or Town
Postcode
Postal Adress
Number and Street
40976 mr96 03/09
pms363
/
Suburb or Town
Postcode
Suburb or Town
Postcode
(if different to above address)
Date
Signature of Registered
Owner/Operator
/
/
Postcode
(if different to above address)
CLIENT Number (if known)
CLIENT Number (if known)
To The Following Person(s)
/
Other/Joint
Owner’s Name
Postal Adress
Selling Price
Time of Disposal
Number
Registered Owner/
Operator
Number and Street
06/10
On
/
Surname/Body Corporate Name
MR 96
The seller must forward this section within 14 days of sale to Service SA, GPO Box 1533, Adelaide SA 5001 or lodge in person at
a Service SA Centre. This will ensure the new owner will be responsible for any future breaches arising from the use of this vehicle.
On
Plate
/
BOTH PARTIES MUST SIGN THIS FORM
The seller must forward this section within 14 days of sale to Service SA, GPO Box 1533, Adelaide SA 5001 or lodge in person at
a Service SA Centre. This will ensure the new owner will be responsible for any future breaches arising from the use of this vehicle.
Date of Sale
/
NOTICE OF DISPOSAL
06/10
BOTH PARTIES MUST SIGN THIS FORM
Residential (Home)
or Business Address
/
Postcode
(if different to above address)
Signature of Registered
Owner/Operator
New Owner’s
Name
/
Signature of
New Owner
/
Date
/
Signature of Registered
Owner/Operator
Signature of
New Owner
/
/