Submitted by thomas.hanson@… on
Customer ID Image
Customer ID Individual Reference Number
Customer ID Given Name
Image Highlight
14.4%, 22.6%, 32.2%, 19.6%
Pattern
^[a-zA-Z]{1,20}$
Validation Message
Given name must contain only letters, maximum 20 characters
Field Description
Enter your first name as it appears on your license (letters only, max 20 characters)
Customer ID Middle Name
Image Highlight
14.4%, 25.1%, 32.4%, 17.6%
Pattern
^[a-zA-Z]{0,20}$
Validation Message
Enter your middle name if applicable (letters only, max 20 characters)
Field Description
Middle name must contain only letters, maximum 20 characters
Customer ID Family Name
Image Highlight
14.3%, 24.1%, 32.7%, 19.1%
Pattern
^[a-zA-Z]{1,40}$
Validation Message
Enter your surname as it appears on your license (letters only, max 40 characters)
Field Description
Family name must contain only letters, maximum 40 characters
Customer ID Full Name 1
Customer ID Full Name 2
Customer ID Full Name 3
Customer ID Full Name 4
Customer ID Birth Date
Include Day
On
Customer ID Gender
Customer ID Travel Document Number
Customer ID Expiry Date
Include Day
On
Customer ID Licence Number
Image Highlight
14.3%, 40.2%, 30.1%, 16.6%
Pattern
^\d{1,10}$
Validation Message
License number must be numbers only (up to 10 digits)
Field Description
Enter up to 10 digits only
Customer ID Card Number
Image Highlight
71.8%, 80.4%, 19.5%, 16.6%
Pattern
^\d{6,8}$
Validation Message
Card number must be 6-8 digits only
Field Description
Enter 6-8 digits only on back of card
Customer ID Card Expiry
Include Day
On
Customer ID Document Type
Driver's Licence
Customer ID State of Issue
Northern Territory