This form is to register a impromptu drive that you wish to register with the Mini Owners Club. Under the 404 licence (concessional and which requires mandatory reporting) you must register your intent to take your vehicle out for a non club event. Any official club events do not need to be registered.
Please note that taking your car to the petrol station (and any local driving) does not need to be recorded. It's only for long distance trips.
You can find more information at
https://www.transport.wa.gov.au/mediaFiles/licensing/LBU_VL_FAQ_VintageVeteranConcession.pdf