Application for registration Building contractor (company)

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1 Government of Western Australia Department of Commerce Application for registration Building contractor (company) Refer to the application guidelines for assistance in completing this application form. Company / Body Corporate Details Applicant company / body corporate name: Australian Business Number (ABN): Australian Company Number (ACN): Business name: Business name number: (trading as) Date of Incorporation: Place of Incorporation: Principal Place of business address: (no PO or GPO Boxes) Registered Address: (address for service) Post Code: Post Code: Postal Address: Post Code: Telephone details: Office: Area Code ( ) Fax: Area Code ( ) A / /Contractor Form company Page 1

2 Management Board Details Provide the following information for the Directors and Company Secretary, if more space is needed put information on a separate sheet and provide as an attachment to this application. Full Name Date of Birth Postal Address Position(s) held (tick where appropriate) Director Secretary Provide an historical company extract from the Australian Securities and Investments Commission (ASIC). This extract cannot be more than one month old at time of lodging your application. ASIC historical company extract attached. Attached If the list you have provided above for your management board is different to your ASIC extract, provide a full explanation on a separate page and submit as part of the application package. A / /Contractor Form company Page 2

3 Business Profile Record the work intended to be undertaken and estimate the value of building services work to be undertaken in the next three years. The estimated value of building services work to be undertaken within each of the next three years is as follows Year 1 $ Year 2 $ Year 3 $ Business Plan Provide a business plan including the structure and management of the operation and operational and financial plans. Details on how to prepare this plan are available in the business plan guidance note in the Registered Building Contractor Application Guidelines. Business plan attached. Attached Management and Supervision Applicants must satisfy the Building Services Board that they have arrangements in place to ensure that building services to be carried out will be managed and supervised in a proficient manner. Please attach a written submission outlining the arrangements in place. For example, your submission could outline the following: number of staff employed, capacity of staff, roles and responsibilities, the role of the nominated supervisor, training, succession planning, OH&S, contracting procedures, quality control, client management, progress reporting etc. Statement of arrangements in place attached. Attached A / /Contractor Form company Page 3

4 Financials Has the company / body corporate previously applied for, or held a registration as a builder or building services contractor? Has the company / body corporate applied for and been refused any other licence required by law to carry on business or held any such licence which has been cancelled or suspended at any time during the past ten years? Is the applicant company / body corporate solvent? Has there been any material change in the financial position of the company / body corporate since the preparation of the last official balance sheet? Paid up share capital of the company / body corporate: The source of initial working capital will be from: YES NO YES NO YES NO YES NO $ Capital loan(s) (agreement documentation required) $ Bank overdraft (verification required) $ Other (detail and verification required) $ Copies of any loan agreements, paid up share capital,overdraft facilities etc. noted above will need to be supplied in verification and must be in the name of the applicant only. Please note, companies that have commenced trading in any capacity are required to provide special purpose financial statements. Please refer to the checklist at the end of this form. Credit facilities have been arranged with the following trade suppliers (verification required) Name Credit Limit Guarantees given The Company s financial statements will be prepared by Name of Accounting Firm or Practitioner The Company s Auditor (if appointed): Name of Accounting Firm or Practitioner A / /Contractor Form company Page 4

5 Nominated Supervisor Please complete a copy of this page for each nominated supervisor. Salutation Please circle correct title Mr Mrs Ms Other (list other title) Family Name First name Middle name(s) Building Practitioner Registration Number Confirm that the nominated supervisor is an employee, director or officer of the applicant company and not a contractor or sub-contractor to the company. Employment relationship Employee Director Other officer If other officer state the office held by the nominated supervisor Basis of employment Full time Part time Please attach a copy of the employment contract between the company and the proposed nominated supervisor (not required if the nominated supervisor is a director of the company). Please attach a copy nominated supervisor s job description outlining duties and responsibilities within the company. Hours per day to be spent on management and supervision for the applicant company. Is the proposed nominated supervisor also the nominated supervisor for another registered entity? Yes No If yes, how many hours per day are spent supervising for this entity? Signature of Nominated Supervisor Date: A / /Contractor Form company Page 5

6 Declaration by applicant False and misleading information Section 99 of the Building Services (Registration) Act 2011 provides for penalties of up to $25,000 where a person makes a false or misleading statement or provides false or misleading information or particulars as part of an application for registration or renewal of registration. Information for document execution This document is to be executed on behalf of the company by either: a. Two directors or one director and one secretary; or b. One director where that person is both sole director and sole secretary. I hereby authorises the Building Services Board, the Building Commission or persons acting on behalf of the Board or the Building Commission to make enquiries considered necessary to assess this application. My general consent includes the specific consent to the acquisition of copies of the criminal records and credit reports of the applicant s directors and officers. I agree that the Board can use any or all information received pursuant to this authority for the purposes of the assessment or audit of this application. Executed for and on behalf of: In accordance with Section 127 of the Corporations Act 2001 ACN Name of applicant Signature of director Signature of director (if applicable) or Signature of company secretary (being sole director/secretary of the company) Delete if not applicable Name of director (print) Name of director/secretary (print) Date Date SAT review of Board decisions If you are aggrieved by a decision of the Board refusing to grant your licence or imposing a condition on your licence you may apply to the State Administrative Tribunal for a review of the decision. A / /Contractor Form company Page 6

7 Checklist Use this checklist to show that you have completed all parts of your application and attached all necessary supporting documents. Management Board details Historical company extract from ASIC attached, if applicable Financial capacity completed Business profile completed Business plan attached Management and supervision statement of arrangement submission attached Nominated supervisor details and job description attached Employment agreement between nominated supervisor and company attached, if applicable Declaration signed and dated Payment made Companies that have been trading Special purpose financial reports in the name of the applicant company that have been compiled by an independent certified accountant dated within three months of this application date attached (refer to application guidelines for contents of special purpose financial reports) Special purpose financial reports in the name of the company, for the preceding two years attached Bank statements dated within three months of this application date which identify the applicant company as the accountholder attached Newly incorporated companies Financials in the name of the applicant company attached Proof of working capital attached i.e. gift, loan agreement, overdraft facility etc. Bank statements dated within three months of this application date which identify the applicant company as the accountholder attached An incomplete or inaccurate application cannot be processed. If you need help completing this form please call the Building Commission on and ask for the Licensing team. A / /Contractor Form company Page 7

8 Payment Application and Registration fee GST is not applicable $3, ($ application fee + $2, for 3 years registration). Payment method Cash Cheque Money order Credit card Card authorisation Building Commission ABN: Visa Mastercard Card number / / / Expiry date / Name on card Amount payable $ Cardholder s signature Date / / Cardholder s contact phone number Level 1, 303 Sevenoaks Street, Cannington, Western Australia 6107 Locked Bag 14, Cloisters Square, Western Australia 6850 Telephone : Facsimile: (08) A / /Contractor Form company Page 8

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