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Mes Client / Licence Number Residential (Home)/ Business Address Number and Street Suburb / Town Postcode Suburb / Town Postcode Postal Address (if different to above address) 2. PLEASE COMPLETE THIS SECTION TO APPLY FOR A REPLACEMENT CERTIFICATE OR LABEL Make of Vehicle Body Type Plate Number (Please tick the appropriate boxes) I hereby apply for a: Replacement Label (heavy vehicles only) The original document has been: Lost Replacement Registration Details Certificate Replacement.

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