Application for commercial operations licence commercial events

Size: px
Start display at page:

Download "Application for commercial operations licence commercial events"

Transcription

1 CONSERVATION AND LAND MANAGEMENT REGULATIONS 2002 (PART 7) Application for commercial operations licence commercial events CLM149E This application applies to persons or organisations commercially conducting events on reserves managed by the Department of Parks and Wildlife (DPaW). IMPORTANT This form needs to be completed if you are organising an event on CALM Land for reward or other consideration other than cost recovery of running the event. Approval will need to be obtained before you begin advertising the event if it will be carried out on CALM Land. If you are unsure whether your event is commercial or who should hold the licence, please contact DPaW s Licensing Officer on (08) for more information. APPLICATION FEE AND LICENCE CHARGE Licences are subject to a standard charge of $120, along with a $100 application fee. A higher licence charge may be applied by DPaW based on the scale of the event. These charges will be set by DPaW during the application process and may include administrative costs. Additional fees and charges may be applied where required. Please see the Commercial Operator Handbook for more details. If fees or charges in excess of the standard charge are required, you will be invoiced for these during the application process. Send the completed application, together with the licence charge above (refundable if your application is unsuccessful) plus the nonrefundable application fee of $100 to: Policy and Tourism Branch, Department of Parks and Wildlife, Locked Bag 104, BENTLEY DELIVERY CENTRE, WA, Fundraising or charity events run by registered charities may be eligible for a fee waiver. Please contact DPaW s Licensing Officer on (08) for more information. Definitions: CALM Land land, or land and waters, to which the Conservation and Land Management Act 1984 and Regulations 2002 apply, and includes caves and parts of caves on or under that land. Director General means the chief executive officer (CEO*) of DPaW (the department assisting the Minister in the administration of the Act), or a delegate of the CEO. Claims includes claims, demands, actions, suits, and proceedings (whether under the law of contract, tort, a written law or otherwise). Commercial operation the selling of any product or service by any person, partnership, company or other organisation for reward or other consideration. This includes the supply of transport, information, instruction or supervision, or a business organising an event that is contracted by, or on behalf of, a not-for-profit organisation (e.g. XYZ Marketing Pty Ltd organising a Surf Carnival for the Surf Life Saving Association Inc). Costs include damages, liabilities, losses, costs (including legal costs) and expenses (howsoever caused). Event an organised group activity that occurs at a certain place at a particular time which is deliberately staged or promoted to encourage public spectators and/or participants (e.g. car rallies, mountain bike competition etc). Licence a Commercial Operations Licence granted by the Director General under the Conservation and Land Management Regulations 2002 and which Licence incorporates the conditions set out in the Commercial Operator Handbook. Non-commercial activities an activity undertaken or organised without intent of gaining profit, reward or other consideration other than the cost recovery of undertaking the activity (e.g. local trail bike club operating a competition and run by volunteers). Operations the commercial operations which may be undertaken by an Operator pursuant to the licence. Operator a person (includes incorporated bodies) who holds a licence (e.g. XYZ Marketing Pty Ltd). Participant those persons participating in the Event. Please note: A fundraising or charity event may still be classified as a commercial operation depending on how it is organised. Please contact the Licensing Officer on (08) for more information. For additional information about commercial events and conditions that may apply if a licence is issued, please refer to the Commercial Operator Handbook which can be viewed from Page 1

2 APPLICANT DETAILS of applicant (person/company/incorporated body only) In association with or on behalf of (This may be a sporting group or peak body) Note: The application must be made by one person or company proposing to undertake the activity (activities) for which permission is sought. The application cannot be made using a trading/business name. If the application is by a company please provide the Australian Company Number (ACN) and address of directors and secretaries All applicants Please provide the Australian Business Number (ABN) Trading/Business name Is/are the name(s) registered? Yes No If yes, please provide the registered name(s) and the registration number(s) Postal address of applicant Note: If the applicant is a company the registered office of the company is to be provided. of contact Website Fax Phone 1 Phone 2 EVENT DETAILS Please attach a map of the area(s) at a scale of 1:50,000 (as a COG map wherever possible) indicating the proposed locations, routes, spectator points, and camping sites. The map(s) must also include any mustering, changeover or transition points within CALM Land and a further A3 or A4 detailed layout of these areas must be attached indicating possible vehicle overflow areas for the maximum expected numbers. Accurate and detailed maps and layouts assist in the assessment of your application (COG maps may be purchased from DPaW; phone (08) for more information). of event Please attach a detailed itinerary and any proposed advertising material for the event. Date and time of event DPaW needs to know which parks you would like to access during your event and which activities you propose to undertake in each park. The Commercial Operator Handbooks (terrestrial and marine) indicate which activities are permitted in each park and the conditions that apply to conducting the activities. Please ensure you have read and accepted the conditions before submitting this application form. The Commercial Operator Handbooks are available to download from Please list the parks (terrestrial and/or marine) where this event is proposed to occur. Please attach a detailed itinerary as well. Park (terrestrial and/or marine) Activities (Specify which sites, locations, routes, tracks and camping sites you intend to use as well as specific activities e.g. running, cycling, horse riding etc.) Page 2

3 EVENT MANAGEMENT Please attach a copy of the safety, emergency response and traffic plans as well as the environmental policy for your organisation if available. Number of participants expected Number of spectators expected Number of officials Number of support vehicles/vessels Will the media be involved? Please detail: Will any structures, facilities, signs or markers be erected on CALM Land or waters for the purpose of the event? Please detail: Will food or other supply vendors be hired or contracted to operate on CALM Land during the event? Please detail: Please list any special equipment, facilities or materials required to conduct the proposed activity or event. Will portable toilets and/or showers be provided? If so, please indicate the number of units that will be provided and the proposed method of effluent and waste water disposal? Please provide the proposed strategy for rubbish removal. Page 3

4 Please detail if other agencies, local government representatives, community groups or local committees been consulted and all the necessary approvals gained regarding this event?: Have you developed emergency response plans and notified the Local Emergency Management Committee (LEMC)? If so, please provide details. If not, you will need to provide prior to the event. Please provide any other information that may be relevant to your application, which may include any sustainability or eco-tourism initiatives such as reducing carbon emissions and ecological footprint, or partnerships benefiting the local community and the environment. VEHICLE/VESSEL DETAILS Please attach a copy of the survey certificates for each vessel that will be used while on CALM Land during the event which is owned by the applicant, to ensure currency. Vehicles: (please tick appropriate box) Hired from another organisation or business Owned by this business/organisation (please complete the table below) Vehicle Type (4WD, minibus, coach etc) Seating Capacity Registration No. Registration Expiry Transport Licence no. (for vehicles not registered in Western Australia) Vessels: Where canoes and kayaks used during an event on CALM Land are supplied by the operator, the crafts must have a hire and drive registration with the Department of Transport. Vessel Type(s) (canoe, kayak, dinghy, charter vessel etc) Nominated vessel(s) spv no/reg. No/Hire and Drive reg no size of vessel (m) Number of craft Please indicate the names of your intended skipper(s), if applicable, and their certification. Page 4

5 ABSEILING AND CLIMBING ACTIVITIES: Application for commercial operations licence commercial events ACTIVITY-SPECIFIC INFORMATION REQUIRED Please attach copies of the NOLRS registration for each stated leader. Abseiling and climbing activities will only be permitted at certain sign-posted CALM Land sites. Please contact the local DPaW district office to discuss which sites are acceptable. Any abseiling or climbing activities on CALM Land will need to comply with the Climbers Association of Western Australia Code of Ethics (available at and Outdoors WA Code of Conduct (available at DPaW requires all leaders for abseiling to be registered with National Outdoor Leader Registration Scheme (NOLRS) and to have the appropriate ratio of leaders to participants according to the current standards. Please contact Outdoors WA on (08) for more information regarding the registration scheme and for the current activity standards. It is important that you attach copies of the NOLRS registration for each of your stated leaders to ensure currency. If you are not yet registered with NOLRS, please make a note below and send the details as soon as possible. A licence for these activities will not be issued until DPaW is supplied with these details. Leader NOLRS registration no. Expiry date BIBBULMUN TRACK/MUNDA BIDDI TRAIL: If all or part of the or is included in the route for your event, please complete the and application form on page eight. If you intend on accessing these tracks during the event, it is important that you read the licence conditions in Section 18 of the Commercial Operator Handbook Terrestrial. It is also advised to contact the DPaW Recreation and Trails Unit to inform them of your intent to use these trails for an event. The Recreation and Trails Unit is also able to give advice on the best locations for access, information on the most suitable locations for your activities, and the latest news about track conditions. Please phone (08) for more information. PRE-EVENT TRAINING Please attach a map of the area(s) at a scale of 1:50,000 (as a COG map wherever possible) indicating the proposed locations, routes, and camping sites for the training exercises. The map(s) must also include any mustering, changeover or transition points within CALM Land. Accurate and detailed maps and layouts assist in the assessment of your application (COG maps may be purchased from DPaW; phone (08) for more information). DPaW is aware that some events need access to CALM Land before the event date to allow participants to train in similar terrain to that of the event. As these activities are associated with the event, you will need lawful authority to access CALM Land for these purposes. It is expected that spectators will not be invited or encouraged to these training exercises. Date of pre-event training Please list which parks (terrestrial and/or marine) and activities are proposed for the pre-event training. Specify which sites, locations, routes, tracks and camping sites you intend to use within the park. Park (terrestrial and/or marine) Activities (Specify which sites, locations, routes, tracks and camping sites you intend to use) Number of participants expected Number of officials Number of support vehicles/vessels Page 5

6 LICENCE CHARGE AND APPLICATION FEE PMENT DETAILS Payment: Cheque enclosed Mastercard Visa Card number Amount $: Expiry date / Signature on card (as it appears on the card) PMENT OF OTHER FEES AND CHARGES Please note that should higher licence charges or other payments such as supervision fees or a bond (as per section 7.10 of the Commercial Operator Handbook Terrestrial) be required then these will be invoiced to you. Invoices will need to be paid prior to a licence being issued. Park fees such as camping fees may apply for some events. To find out if your event requires payment of other park fees, please contact DPaW s Policy and Tourism Branch on (08) For information on which parks have entry and camping fees, please refer to Section 19 and 20 of the Commercial Operator Handbook Terrestrial available for download from INSURANCE Please attach a copy of the Certificate of Currency for your public liability insurance. Applicants are reminded that the General Licence Conditions in the Commercial Operator Handbook states as follows: 5.12 INSURANCE (a) The Operator shall at all times during the period of the Licence maintain a policy of public liability insurance, that covers the areas and operations allowed under the Licence, in the names of the Operator and the Director General to the extent of their respective rights and interests for the sum of not less than $10 million ($10,000,000.00) per event. (b) The Operator shall provide the Director General proof of the existence and currency of such insurance policy whenever requested by the Director General during the term of the licence. (c) The Operator shall pay all premiums of the public liability insurance policy when they are due, comply with all of the terms of that insurance policy and shall make the insurer aware of the licence, these conditions and the indemnity given to the Director General. If you have any queries please contact DPaW s Policy and Tourism Branch on: Phone: (08) Fax: (08) licensing@dpaw.wa.gov.au More information regarding commercial event licensing can be found at DPaW s website: Page 6

7 DEED/POLL I / We: (Full name of organisation / Person) hereby apply for a licence to enter upon and use the waters and land within the areas specified in this application in order to conduct the activities specified in this application. I understand and agree that the licence if granted will be subject to the provisions of the Conservation and Land Management Act 1984 (CALM Act) and all regulations and subsidiary legislation made under it. I certify to the best of my knowledge that the information provided within this application is true and correct in every detail. I understand that the licence if granted will not be transferable and may not be automatically renewed. I have read, understood and agree to abide by the general, operation specific, area specific, issues and extra conditions contained within the Department of Parks and Wildlife (DPaW) s Commercial Operator Handbook Terrestrial and Marine, as amended from time to time, and I understand that further conditions relevant to the areas and activities proposed in this application may be imposed. I hereby agree to release and indemnify, and keep indemnified, the State of Western Australia (State), the Chief Executive Officer of DPaW (CEO), and each of the employees, contractors and agents of the State or DPaW (Indemnified Parties) from and against all Claims and Costs which may be made or brought against, suffered or incurred by any of the Indemnified Parties arising in any way from, or in connection with the conduct of the applicant or any of its employees, agents, contractors, or attendees of the event the subject of this application: on any lands to which the CALM Act applies; or in relation to the event and activities the subject of this application. I certify that the applicant s public liability insurer is aware of the conditions that would apply to this licence and the indemnity granted above. I confirm that the applicant s public liability policy also covers the event and activities that are specified in this application form. Executed as a deed on:... Date (please select the appropriate box for your situation only): Natural person (check box) Signature Witness... Company Pty Ltd (executed in accordance with section 127(1) of the Corporations Act 2001 (Cth)) (check box) Signature of director or secretary... Signature of director Witness Incorporated Association (executed in accordance with section 14(1) (b) of the Associations Incorporation Act 1987 (WA)) Signature of person with authority to bind the Incorporated Association... (check box) Witness Page 7

8 YES (tick box) N/A (Not applicable) Where no tick box is available you must attach or have completed (these plans will be required prior to the event taking place) Application for commercial operations licence commercial events APPLICATION CHECKLIST Have you completed the online training? You are required to complete the online training before applying. The training can be accessed via Please attach a copy of the certificate? Have you included maps of the area(s) at a scale of 1:50,000 (as a COG map whereever possilble) indicating the proposed locations, routes, specator points, and camping sites as well as mustering, changeover or transition points and vehicle overflow areas.? Have you included a detailed itinerary detailing the areas and activities you wish to conduct the event in? Have you included details of the vehicles/vessels you plan to use for the operation and provided survey certificates for any vessels? Have you included a copy of your public liability insurance policy with $10,000,000 coverage, covering all proposed activities and locations and made your insurer aware of the conditions and indemnity? Have you included an event management plan which includes safety, emergency response and traffic plans as well as the environmental policy for the event? Have you signed the application? Have you enclosed the licence charge and the application/renewal fee totalling $220? If you re intending to conduct activities on the or, have you completed the Bibbulmun track and application form on page 9? If you intend to conduct abseiling and rock climbing activities, have you registered with NOLRS (National Outdoor Leader Registration Scheme) or equivalent and provided proof of your registration? Page 8

9 Application for commercial operations licence commercial events, and Cape To Cape Track Application Form NN WA AD RO NORTHAM O ER HW O HIG WANNEROO Y DYA TOO N ER ST EA D ROA YORK AT MIDLAND GRE PERTH Rottnest Island KALAMUNDA FREMANTLE WESTERN AUSTRALIA BEVERLEY KELMSCOTT Garden Island BR HIGHW OO Map 1 KT Cape to Cape Track ON JARRAHDALE HI Lands Managed by the Department of Parks and Wildlife, June 2011 GH WA Y WESTERN National Park Nature Reserve Map 1 SO UT H Conservation Park Section 5(1)(g) and 5(1)(h) Reserve NORTH BANNISTER BA NY Map 2 HI GH WAROONA OCEAN W 0 Scale km N Map 2 WILLIAMS NAME OF APPLICANT: TRADING NAME: CONTACT DETAILS: HARVEY COALFIEL COLLIE Y DONNYBROOK Map 1: Darling Range - Kalamunda to North Bannister Map 2: Dwellingup - North Bannister to Harvey - Quindanning Road Map 3: Collie - Harvey - Quindanning Road to Mumballup BUSSELTON GREA T KATANNING Map 4: Blackwood - Mumballup to Brockman Highway KIRUP Map 6: Northcliffe - Middleton Road to Broke Inlet Road BALINGUP Map 7: Walpole - Broke Inlet Road to William Bay Map 8: Denmark/AlbanyKOJONUP - William Bay to Albany SE SOU VAS JARRAHWOOD TH MARGARET RIVER Cape to Cape Track Map 1 MUNDA BIDDI TRAIL Map 1: Mundaring to Jarrahdale BRIDGETOWN NANNUP WES HW HIG BROCKMAN HW Map 4 BUS Map 5: Pemberton - Brockman Highway to Middleton Road HIG SELL BIBBULMUN TRACK RN Map 3 MUMBALLUP THE BOYANUP SOU ROAD HW Camping DS Map 3 BUNBURY Cycling INDIAN State Forest AL DWELLINGUP Bushwalking MANDURAH TER WHEATLEY N Donnelly Mill Holiday Village Map 2: Jarrahdale to Nanga Map 3: Nanga to Collie Map 4 Map 4: Collie to Jarrahwood Map 5: Jarrahwood to Manjimup Map 5 Map 7: Northcliffe to Walpole Map 8: Walpole to Denmark HIG HIGHW Map 9: Denmark to Albany HW AUGUSTA Cape to Cape Track Map 2 Map 6: Manjimup to Northcliffe MANJIMUP MUIRS CAPE TO CAPE TRACK Map 1: Cape Naturaliste to Prevelly ROCKY GULLY ANY Map 2: Prevelly to Cape Leeuwin Map 5 ALB PEMBERTON HIGH GISB: _b W Produced by Geographic Information Services Branch, February 2013 Map 6 MT BARKER NORTHCLIFFE W HIGH Map 8 SOUTHERN OCEAN Map 6 WALPOLE Map 9 DENMARK SO UT H COAST HWY ALBANY Map 7 Page 9 Map 7 Map 8

10 Notes PDF Page 10

The South African Tour Operator Licence Application - A Checklist for Success

The South African Tour Operator Licence Application - A Checklist for Success Commercial Tour Operator Licence Application/Renewal South Australia This form is for use by organisations or individuals proposing to undertake activities of a commercial nature within lands or waters

More information

MAJOR EVENT APPlication

MAJOR EVENT APPlication City of Victor Harbor MAJOR EVENT APPlication NAME OF THE EVENT Location of Event: Applicant s Name: Organisation (if applicable) Postal Address: Phone, Fax, E-mail and Mobile: Website Address (if applicable)

More information

Development Approvals

Development Approvals Development Approvals EVENT APPLICATION Please complete the enclosed form and return to:- By Mail: In Person: Via Email: Chief Executive Officer City of Perth GPO Box C120 PERTH WA 6839 Facsimile: (08)

More information

1. APPLICANT S DETAILS 2. PLEASE COMPLETE THIS SECTION FOR PUBLIC LIABILITY

1. APPLICANT S DETAILS 2. PLEASE COMPLETE THIS SECTION FOR PUBLIC LIABILITY PUBLIC LIABILITY/PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM FOR SWIM TEACHER/COACH PLEASE USE BLOCK LETTERS l ALL SECTIONS MUST ME COMPLETED Please ensure you have read and understood the Important

More information

NSW MARINE PARKS PERMIT APPLICATION FORM

NSW MARINE PARKS PERMIT APPLICATION FORM NSW MARINE PARKS PERMIT APPLICATION FORM QUESTION 1: Permit Applicant: If the applicant is a Registered Company/Business/Corporation/Organisation or Association Name:.. If the applicant is an individual

More information

Application for registration Building contractor (company)

Application for registration Building contractor (company) 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.

More information

HOME BASED BUSINESS PROPERTY INSURANCE APPLICATION FORM

HOME BASED BUSINESS PROPERTY INSURANCE APPLICATION FORM HOME BASED BUSINESS PROPERTY INSURANCE APPLICATION FORM IMPORTANT NOTICE: PLEASE READ & RETAIN IN YOUR FILE This is a generic form, not all of the above policies may be included in your current coverage

More information

CHILDCARE PROPERTY OWNERS INSURANCE APPLICATION FORM

CHILDCARE PROPERTY OWNERS INSURANCE APPLICATION FORM CHILDCARE PROPERTY OWNERS INSURANCE APPLICATION FORM Public & Products Liability and Professional Indemnity Insurance and Property Insurance. IMPORTANT NOTICE: PLEASE READ & RETAIN IN YOUR FILE This is

More information

Self-Managed Superannuation Fund (SMSF) Application

Self-Managed Superannuation Fund (SMSF) Application Self-Managed Superannuation Fund (SMSF) Application Section 1 Applicant of Self-Managed Superannuation Fund SMSF ABN Please provide a certified copy of your Self-Managed Superannuation Fund Trust Deed.

More information

THE SOUTH WEST SETTLEMENT QUESTIONS AND ANSWERS

THE SOUTH WEST SETTLEMENT QUESTIONS AND ANSWERS THE SOUTH WEST SETTLEMENT QUESTIONS AND ANSWERS FEBRUARY 2014 QUESTIONS AND ANSWERS 1. Why has the Government of Western Australia entered into these negotiations? All native title claims are filed in

More information

Water Services Operating Licence

Water Services Operating Licence Water Services Operating Licence Water Corporation WL32, Version 13, 13 February 2014 Water Corporation, WL32, 13, Error! Reference source not found. WATER SERVICES ACT 2012 Licensee Name: Water Corporation

More information

This application, together with all other necessary documentation must be submitted at least eight weeks prior to the event to:

This application, together with all other necessary documentation must be submitted at least eight weeks prior to the event to: Please be prepared to answer the following questions in order to apply to hire a park, open space or property owned by Wiltshire Council. If successful, formal consent will be issued which incorporates

More information

Renewal of registration Building surveying contractor (individual) Form 63

Renewal of registration Building surveying contractor (individual) Form 63 Government of Western Australia Department of Commerce Renewal of registration Building surveying contractor (individual) Form 63 Use of this form This form is to be used by building surveyors who are

More information

Insurance. Not-for-profit Organisations Public and Products Liability Insurance Application Form

Insurance. Not-for-profit Organisations Public and Products Liability Insurance Application Form Insurance Not-for-profit Organisations Public and Products Liability Insurance Application Form Important Notices It is very important that You read the information below and are satisfied You understand

More information

Application for an Electrical Contractor s Licence

Application for an Electrical Contractor s Licence Application for an Electrical Contractor s Licence 303 Sevenoaks Street (entrance Grose Ave) Cannington WA 6107 Postal Address: Locked Bag 14 Cloisters Square WA 6850 Telephone: (08) 6251 2000 Email enquires

More information

Licence Application Form COMPANY

Licence Application Form COMPANY Licence Application Form COMPANY Completing this form Use BLACK pen only Print clearly in BLOCK LETTERS DO T use correction fluid any amendments should be crossed out and initialled 1. COMPANY DETAILS

More information

Application Form Mining Minimum Impact Activities

Application Form Mining Minimum Impact Activities Application Form Mining Minimum Impact Activities We recommend that you contact the Hokitika Permissions team to discuss the application prior to completing the application forms: Permissions Advisor (Support)

More information

Liability Package for Associations and Non-profit Organisations

Liability Package for Associations and Non-profit Organisations Liability Package for Associations and n-profit Organisations Answer all questions. Blanks or dashes, or answers known to underwriters or brokers or N/A are unacceptable & will delay consideration of this

More information

Mutual Recognition. Who can apply? Build better.

Mutual Recognition. Who can apply? Build better. Build better. Mutual Recognition Mutual Recognition is a process whereby an individual who holds a licence in one state, territory or New Zealand is entitled to be licensed in another state, territory

More information

Combined Professional Indemnity and Public Liability Insurance Proposal Form

Combined Professional Indemnity and Public Liability Insurance Proposal Form Combined Professional Indemnity and Public Liability Insurance Proposal Form Australian Institute of Landscape Designers and Managers Ltd and Australian Institute of Horticulture Inc Important Notice Relating

More information

TOURISM LIABILITY APPLICATION FORM TOUR OPERATORS

TOURISM LIABILITY APPLICATION FORM TOUR OPERATORS BUSINESS DETAILS TOURISM LIABILITY APPLICATION FORM TOUR OPERATORS Legal Entity: Trading Name: ABN: Number of years you have operated this business: (If less than 3 years please provide details or previous

More information

Proposal Form Tourism & Tour Operators

Proposal Form Tourism & Tour Operators Proposal Form Tourism & Tour Operators TM Arranged through ASR Underwriting Agencies Pty Ltd Underwritten by Certain Underwriters at Lloyd s IMPORTANT NOTES PLEASE READ THESE GUIDANCE NOTES BEFORE COMPLETING

More information

Form 18 Application for a Queensland electrical contractor licence

Form 18 Application for a Queensland electrical contractor licence Electrical Safety Office Form 18 Application for a Queensland electrical contractor licence V17.06-2014 Electrical Safety Act 2002 INSTRUCTIONS: Read the guidelines when completing this application form.

More information

Subordinate Local Law No. 1.12 (Operation of Temporary Entertainment Events) 2015

Subordinate Local Law No. 1.12 (Operation of Temporary Entertainment Events) 2015 Redland City Council Subordinate Local Law No. 1.12 (Operation of Temporary Entertainment Events) 2015 Redland City Council Subordinate Local Law No. 1.12 (Operation of Temporary Entertainment Events)

More information

Shotgun Coaching Workshop Registration and Information Package

Shotgun Coaching Workshop Registration and Information Package Shotgun Coaching Workshop Registration and Information Package Edmonton Conservation Education Centre for Excellence #88, 4003 98 th Street Edmonton, Alberta, Canada T6E 6M8 Phone: (780) 466-6682 or Toll

More information

Low Rise Multi Unit Development Project Application Form RBUA Builder Warranty Insurance (South Australia and Western Australia)

Low Rise Multi Unit Development Project Application Form RBUA Builder Warranty Insurance (South Australia and Western Australia) Low Rise Multi Unit Development Project Application Form RBUA Builder Warranty Insurance (South Australia and Western Australia) About the Insurer This insurance is underwritten by Great Lakes Reinsurance

More information

Dental Practitioner Proposal for Dental Indemnity Policy Support Protect Promote

Dental Practitioner Proposal for Dental Indemnity Policy Support Protect Promote Support Protect Promote Dental Practitioner Proposal for Dental Indemnity Policy Support Protect Promote This is a proposal for a Dental Indemnity Policy underwritten by MDA National Insurance Pty Ltd

More information

Seniors Week 2015 Community Grants Program - Review

Seniors Week 2015 Community Grants Program - Review Seniors Week 2015 Community Grants Program Proudly presented by Issued 16 June 2015 Supported by: Page 1 of 13 1 Introduction Seniors Week 2015 is a special time of celebration for Western Australian seniors.

More information

Community Event Application

Community Event Application Community Event Application The Shire of Kalamunda s Events Team provides friendly, helpful guidance to organisers of community and public events. Your first point of contact for all event proposals, applications

More information

Property Professionals Professional Indemnity Insurance Proposal Form

Property Professionals Professional Indemnity Insurance Proposal Form Property Professionals Professional Indemnity Insurance Proposal Form This proposal is for: Valuers Real Estate Agents Business Brokers Related Property Professionals Important Information Answering the

More information

Professional Indemnity Insurance and optional Public & Products Liability

Professional Indemnity Insurance and optional Public & Products Liability Advantedge Members (Incorporating PLAN, FAST and CHOICE Members) Professional Indemnity Insurance and optional Public & Products Liability Proposal form 2014-2015 Please return completed proposal form

More information

Event Permit Application

Event Permit Application District Council of Loxton Waikerie Principal Office: 29 East Terrace, Loxton ~ Telephone (08) 8584 8000 Fax: (08) 8584 6622 Branch Office: Strangman Road, Waikerie Telephone (08) 8541 0700 Fax: (08) 8541

More information

ACCOUNT OPENING FORM. CUSTOMER INFORMATION (Please fill in where applicable) Customer Name Registration N BRN: Registration Date

ACCOUNT OPENING FORM. CUSTOMER INFORMATION (Please fill in where applicable) Customer Name Registration N BRN: Registration Date ACCOUNT OPENING FORM Domestic Company Global Business / International Company / Investment Fund Parastatal Body Club / Association Societe / Partnership FOR OFFICE USE ONLY CIF NO. ACCOUNT NUMBER/S CUSTOMER

More information

Professional Indemnity Insurance Proposal Form for Engineers and Construction Professionals

Professional Indemnity Insurance Proposal Form for Engineers and Construction Professionals Professional Indemnity Insurance Proposal Form for Engineers and Construction Professionals Answer all questions. Blanks &/or dashes, or answers known to underwriters or brokers or N/A are not acceptable

More information

ALPA Members Professional Indemnity Insurance Proposal Form

ALPA Members Professional Indemnity Insurance Proposal Form ALPA Members Professional Indemnity Insurance Proposal Form Insurance Cover May Include: Fidelity sub limit of up to $100,000 Cost exclusive excess Franchisor Liability Extension Bodily injury/property

More information

Proposal Form Australian Institute of Horticulture Professional Indemnity Insurance

Proposal Form Australian Institute of Horticulture Professional Indemnity Insurance Proposal Form Australian Institute of Horticulture Professional Indemnity Insurance Important Notice Relating to this Proposal PLEASE READ THE FOLLOWING ADVICE BEFORE PROCEEDING TO COMPLETE THIS PROPOSAL

More information

Professional Indemnity Proposal Form. for. Financial Planners

Professional Indemnity Proposal Form. for. Financial Planners Professional Indemnity Proposal Form for Financial Planners Address: 5/3352 Pacific Highway Postal: PO Box 976 Springwood QLD 4127 Springwood QLD 4127 Phone: 07 3387 2800 Fax: 07 3208 2200 Email: pidirect@pidirect.com.au

More information

ENTERTAINMENT & EVENTS LIABILITY INSURANCE

ENTERTAINMENT & EVENTS LIABILITY INSURANCE Arena Underwriting Pty Ltd ABN: 26 125 869 481 AFS: 317617 Suite 8, 12 Alma Road, New Lambton NSW 2305 Tel: 02 4952 4477 Fax: 02 4915 5376 www.arenaunderwriting.com.au ENTERTAINMENT & EVENTS LIABILITY

More information

Product Disclosure Statement

Product Disclosure Statement MTA Insurance Limited Equity Plus Insurance Product Disclosure Statement This document must be read in conjunction with the Application/Certificate of Insurance for MTA Equity Plus Insurance. Together

More information

Professional indemnity insurance

Professional indemnity insurance Professional indemnity insurance 2014 mini policy for CPA Australia members What is CPA Australia s mini policy? Fenton Green & Co. has arranged a professional indemnity insurance (Pll) mini policy (mini

More information

Local Sport Grant Program. Guidelines 2015/16

Local Sport Grant Program. Guidelines 2015/16 Local Sport Grant Program Guidelines 2015/16 Opening date: 26 November 2015 Closing date: 11 February 2016 CONTENTS 1. INTRODUCTION... 3 2. ABOUT THE PROGRAM... 3 3. PROGRAM OBJECTIVES... 3 4. FUNDING

More information

Hobsons Bay City Council Special Events Application

Hobsons Bay City Council Special Events Application Special Events Application EVENT NAME:-------------------------------------------------------- EVENT DATE:--------------------------------------------------------- EVENT MANAGER:--------------------------------------------------

More information

Claims Made Policy (applies to Professional Indemnity only) Your Duty of Disclosure. Excess. Your Legal Liability. Waiver of Rights.

Claims Made Policy (applies to Professional Indemnity only) Your Duty of Disclosure. Excess. Your Legal Liability. Waiver of Rights. Proposal Form Professional Indemnity & Public Liability Insurance for Swimming Pool Inspectors Arranged through ASR Underwriting Agencies Pty Ltd Underwritten by Certain Underwriters at Lloyd s IMPORTANT

More information

Application For Permit Vending On Local Government Land.Doc

Application For Permit Vending On Local Government Land.Doc Application for Permit Vending on Local Government Land Application Number: Receipt Number: Received By: Please complete this form in BLOCK LETTERS and return to: Compliance Section, City of Charles Sturt,

More information

South Australian Registered Conveyancers Professional Indemnity Master Contract of Insurance

South Australian Registered Conveyancers Professional Indemnity Master Contract of Insurance South Australian Registered Conveyancers Professional Indemnity Master Contract of Insurance South Australian Registered Conveyancers Professional Indemnity Master Contract of Insurance An important note

More information

EVENTS GRANTS FOR EVENT ORGANISERS & PROMOTERS

EVENTS GRANTS FOR EVENT ORGANISERS & PROMOTERS EVENTS GRANTS FOR EVENT ORGANISERS & PROMOTERS Closing Date for Applications: 4pm, Thursday, 31 March 2016 All new applicants are encouraged to contact the Community Development Team on (08) 9771 7777

More information

District Address: Address: PO Box 950, Strawberry Hills NSW 2012

District Address: Address: PO Box 950, Strawberry Hills NSW 2012 This form to be used per background definition below for casual & regular hire up to 1 year LICENSE AGREEMENT is between and Reserve Trust No: R (power to lease under s102 Crown Lands Act 1989) District

More information

How To Film On Council Land

How To Film On Council Land BYRON SHIRE COUNCIL POLICY NO 3.41 FILMING ON COUNCIL OWNED AND CONTROLLED LAND #916396 INFORMATION ABOUT THIS DOCUMENT (INTERNAL USE ONLY) Date Adopted by Council 19 November 2002 Resolution No. 02-1235

More information

LABOUR FORCE PROFESSIONAL LIABILITY INSURANCE PROPOSAL FORM

LABOUR FORCE PROFESSIONAL LIABILITY INSURANCE PROPOSAL FORM SURA LABOUR HIRE PTY LTD SUITE 1.04 29 31 LEXINGTON DRIVE BELLA VISTA NSW 2153 TELEPHONE. 02 9672 6088 SURA.COM.AU LABOUR FORCE PROFESSIONAL LIABILITY INSURANCE PROPOSAL FORM IMPORTANT NOTICES The information

More information

Professional Indemnity Proposal Form. for. Finance & Mortgage Brokers

Professional Indemnity Proposal Form. for. Finance & Mortgage Brokers Professional Indemnity Proposal Form for Finance & Mortgage Brokers Address: 5/3352 Pacific Highway Postal: PO Box 976 Springwood QLD 4127 Springwood QLD 4127 Phone: 07 3387 2800 Fax: 07 3208 2200 Email:

More information

Paul Donnelly Insurance Brokers

Paul Donnelly Insurance Brokers Paul Donnelly Insurance Brokers Pty Ltd www.pauldonnellybrokers.com.au Suite 1, Jubilee Towers, 107 Pacfic Hwy Hornsby NSW 2077 PO BOX 97, Berowa, NSW 2081 Phone: (02) 9482 7422 Fax: (02) 9482 7462 Email:

More information

Receivables Purchase Deed

Receivables Purchase Deed Deed Execution version Eastern Goldfields Regional Prison Redevelopment Project Receivables Purchase Deed The State of Western Australia represented by the Minister for Works, a body corporate constituted

More information

2016 Shitbox Rally Terms and Conditions

2016 Shitbox Rally Terms and Conditions 2016 Shitbox Rally Terms and Conditions Definitions Cancer Council means Cancer Council NSW ABN 51 116 463 846. Shitbox Rally means the outback car rally planned to commence on or about 7 th May 2016 and

More information

Claim Form TRAVEL INSURANCE

Claim Form TRAVEL INSURANCE ACCIDENT & HEALTH INTERNATIONAL Claim Form TRAVEL INSURANCE Sydney Level 4, 33 York Street Sydney NSW 2000 GPO Box 4213, Sydney, NSW, 2001 T: +61 2 9251 8700 F: +61 2 9252 4385 ABN: 26 053 335 952 AFS

More information

Medical Practitioner Application and Proposal

Medical Practitioner Application and Proposal Support Protect Promote Medical Practitioner Application and Proposal Application for Membership of MDA National Limited Proposal for Professional Indemnity Insurance Support Protect Promote Thank you

More information

Fair Trading will aim to make a decision on your application within 6 weeks after receiving all relevant information from you and other agencies.

Fair Trading will aim to make a decision on your application within 6 weeks after receiving all relevant information from you and other agencies. Application No. OFFICE USE ONLY Form PL-21 ABN 81 913 830 179 Property, Stock and Business Agents Act 2002 Application for a CERTIFICATE OF REGISTRATION FEE: $129.00 - applicable from 1 July 2015 to 30

More information

WA Food Regulation: Temporary and Mobile Food Businesses

WA Food Regulation: Temporary and Mobile Food Businesses WA Food Regulation: Temporary and Mobile Food Businesses This document contains information on the application of the Food Act 2008 (the Act) in relation to temporary and mobile food businesses. It is

More information

CONSTRUCTION ROAD CLOSURE APPLICATION

CONSTRUCTION ROAD CLOSURE APPLICATION Please return completed application form to: Secretary, Development Services City of Penticton, 2 nd Floor 171 Main Street, Penticton, BC V2A 5A9 Phone: (250) 490-2501 Fax: (250) 490-2502 CONSTRUCTION

More information

COMMUNITY FACILITIES HIRE AGREEMENT EAST RINGWOOD HALL

COMMUNITY FACILITIES HIRE AGREEMENT EAST RINGWOOD HALL COMMUNITY FACILITIES HIRE AGREEMENT EAST RINGWOOD HALL Please complete all relevant information CONTACT DETAILS Applicants Name: Organisation Name: Position: Phone Number: B/H A/H MBL Fax Number: Email:

More information

YACHTING AUSTRALIA INC. OVERSEAS TRANSIT AND RACING INSURANCE PROPOSAL FORM

YACHTING AUSTRALIA INC. OVERSEAS TRANSIT AND RACING INSURANCE PROPOSAL FORM YACHTING AUSTRALIA INC. OVERSEAS TRANSIT AND RACING INSURANCE PROPOSAL FORM INSURER: NAUTILUS MARINE INSURANCE AGENCY PTY LTD (ABN 34 100 633 038) 1. INSURED(S): 28-32 George Street, Sandringham VIC 3191

More information

KOFM S UMBRELLA CONTESTING RULES AND CONDITIONS

KOFM S UMBRELLA CONTESTING RULES AND CONDITIONS KOFM S UMBRELLA CONTESTING RULES AND CONDITIONS The following terms and conditions apply for KOFM s Umbrella contesting, to be run between 5.30am and 7.00pm weekdays from Friday 17 February 2012 until

More information

Christmas Island National Park

Christmas Island National Park Christmas Island National Park Phone: 08 9164 8700 Permit application form for commercial tours Please contact the park office at the phone number shown above, to obtain further details and a copy of the

More information

Home indemnity insurance

Home indemnity insurance Home indemnity insurance October 2007 What is the law? If residential building work worth over $20,000 is to be undertaken, the law requires that a builder must take out indemnity insurance in the name

More information

Sportscover Australia Pty Ltd AFS Licence No. 230914 ACN: 006 637 903 ABN: 43 006 637 903. Sportscover Syndicate 3334 at Lloyds Underwriters

Sportscover Australia Pty Ltd AFS Licence No. 230914 ACN: 006 637 903 ABN: 43 006 637 903. Sportscover Syndicate 3334 at Lloyds Underwriters Type of Cover: Insurer: Underwritten by: Policy Form/Ref.: Policy Number: S U M M A R Y General Liability Insurance Policy Sportscover Australia Pty Ltd AFS Licence No. 230914 ACN: 006 637 903 ABN: 43

More information

Expiry Date. If you have selected Cheque please nominate payee

Expiry Date. If you have selected Cheque please nominate payee TRAVEL INSURANCE CLAIM FORM IMPORTANT: PLEASE READ BEFORE YOU COMPLETE THIS FORM 1. Please answer all questions and provide all relevant documentation to avoid delays with your We are unable to process

More information

Marine Professional Negligence Insurance

Marine Professional Negligence Insurance Marine Professional Negligence Insurance PROPOSAL FORM for MarINE ProfESSIoNalS and logistics Details of applicant 1. Company name, address and contact details Postcode 2. Subsidiary, affiliated or associated

More information

DO NOT LEAVE ANY BLANKS. Name of Event:

DO NOT LEAVE ANY BLANKS. Name of Event: DO NOT LEAVE ANY BLANKS Special Event/Special Use Permit Application Summit County Government Date: A. Fill in the blanks Name of Event: Date(s) of Event: Time(s) of Event: Descriptions of Event/Scope

More information

NATIONAL POLICE HISTORY CHECK INFORMATION 2014. Western Australian Education and Training Sectors

NATIONAL POLICE HISTORY CHECK INFORMATION 2014. Western Australian Education and Training Sectors NATIONAL POLICE HISTORY CHECK INFORMATION 2014 Western Australian Education and Training Sectors HOW TO COMPLETE THE NATIONAL POLICE CHECKING SERVICE (NPCS) APPLICATION/CONSENT FORM Please read all information

More information

Public Event Application

Public Event Application Public Event Application Hire of Council Grounds Enquiries To: Sports & Reserves Administration Officer T: (08) 8256 0333 F: (08) 8256 0578 E: sportsfields@playford.sa.gov.au ORGANISATION/SCHOOL DETAILS

More information

ACCREDITATION PROCESS FOR ROADWORKS TRAFFIC MANAGERS MAIN ROADS WESTERN AUSTRALIA

ACCREDITATION PROCESS FOR ROADWORKS TRAFFIC MANAGERS MAIN ROADS WESTERN AUSTRALIA ACCREDITATION PROCESS FOR ROADWORKS TRAFFIC MANAGERS MAIN ROADS WESTERN AUSTRALIA 1. INTRODUCTION The Main Roads Western Australia Traffic Management for Works on Roads Code of Practice (the code) requires

More information

INTRODUCTION TO MARTIAL ARTS INSURANCE

INTRODUCTION TO MARTIAL ARTS INSURANCE INTRODUCTION TO MARTIAL ARTS INSURANCE Dear Instructor, Thank you for considering our group martial arts insurance packages, we have member and non-member rates however you will get a much better deals

More information

Business Perceptions. Results from a phone survey October 2013

Business Perceptions. Results from a phone survey October 2013 Business Perceptions Results from a phone survey October 2013 CATALYSE empowering decision makers 2013 Contents Strategic Insights 3 The Study 5 Business confidence 8 Business perspectives 10 Business

More information

NXFM S UMBRELLA CONTESTING RULES AND CONDITIONS

NXFM S UMBRELLA CONTESTING RULES AND CONDITIONS NXFM S UMBRELLA CONTESTING RULES AND CONDITIONS The following terms and conditions apply for NXFM s Umbrella contesting, to be run between 5.30am and 8.00pm weekdays from Friday 17 February 2012 until

More information

Letter of Engagement. Peter Vickers and Associates Pty Ltd Chartered Accountants ACN 003 466 813

Letter of Engagement. Peter Vickers and Associates Pty Ltd Chartered Accountants ACN 003 466 813 6 September 2013 Suite 2, 345 Pacific Highway Lindfield NSW 2070 t: (61-2) 9416 9266 f: (61-2) 9416 9149 e: services@pva.com.au www.vickersgroup.com.au Ms M Client Sydney Street NSW 2086 Dear Michele,

More information

Professional Indemnity Proposal form

Professional Indemnity Proposal form Important Information Please read this first Professional Indemnity Proposal form Important facts relating to this proposal form You should read the following advice before proceeding to complete this

More information

The Wheel. useful information for setting up a voluntary organisation

The Wheel. useful information for setting up a voluntary organisation The Wheel useful information for setting up a voluntary organisation Introduction When an organisation is starting up it is important for the members to consider the following points carefully: Whether

More information

Online Advertising Application Form

Online Advertising Application Form Online Advertising Application Form Section 1 - Business Details Save time. Apply online! Please Fax To (02) 4751 4720 Date Form Completed Registered Business/ Company Name Your business will be profiled

More information

Motor Vehicle Claim Form

Motor Vehicle Claim Form SSAA Insurance Brokers Pty Ltd Phone (08) 8332 0281 The Precinct Freecall 1800 808 608 Suite 14, 539 Greenhill Road Facsimile (08) 8332 0303 539 Greenhill Road Email insurance@ssaains.com.au Hazelwood

More information

IMPORTANT NOTICE PLEASE READ THE FOLLOWING ADVICE BEFORE PROCEEDING TO COMPLETE THIS PROPOSAL FORM

IMPORTANT NOTICE PLEASE READ THE FOLLOWING ADVICE BEFORE PROCEEDING TO COMPLETE THIS PROPOSAL FORM IMPORTANT NOTICE PLEASE READ THE FOLLOWING ADVICE BEFORE PROCEEDING TO COMPLETE THIS PROPOSAL FORM Your Professional Indemnity Insurance Policy is issued on a CLAIMS MADE basis. This means that this policy

More information

CLAIM FORM: AMATEUR SPORTS PERSONAL ACCIDENT INSURANCE THE ISSUE OF THIS FORM IS NOT AN ADMISSION OF LIABILITY PLEASE ENSURE

CLAIM FORM: AMATEUR SPORTS PERSONAL ACCIDENT INSURANCE THE ISSUE OF THIS FORM IS NOT AN ADMISSION OF LIABILITY PLEASE ENSURE CLAIM FORM: AMATEUR SPORTS PERSONAL ACCIDENT INSURANCE THE ISSUE OF THIS FORM IS NOT AN ADMISSION OF LIABILITY PLEASE ENSURE You fully complete every question before your doctor completes his statement.

More information

Professional Indemnity Insurance Proposal Form Miscellaneous

Professional Indemnity Insurance Proposal Form Miscellaneous Commercial & General Insurance Brokers (Aust) Pty Ltd Suite 4, 1016 Doncaster Road Doncaster East Victoria 3109 Phone: 1300 764 244 Fax: 03 8841 4299 Email: pi@cgib.com.au Web: www.cgib.com.au AFS License:

More information

Professional Indemnity

Professional Indemnity Professional Indemnity Proposal form New Business OR Renewal Policy number Intermediary Completion notes Please read the following before completing this document. Answer all questions in full. If you

More information

WESTERN AUSTRALIA HEAVY VEHICLE ACCREDITATION SCHEME (WAHVAS) BUSINESS RULES (DRAFT)

WESTERN AUSTRALIA HEAVY VEHICLE ACCREDITATION SCHEME (WAHVAS) BUSINESS RULES (DRAFT) WESTERN AUSTRALIA HEAVY VEHICLE ACCREDITATION SCHEME (WAHVAS) BUSINESS RULES (DRAFT) June 2015 DRAFT v1.3 Remove on final Contents 1. BUSINESS RULES OVERVIEW 3 1.1 Purpose 3 1.2 Legal Status of the Business

More information

PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM

PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM IMPORTANT TICES - `CLAIMS MADE CONTRACTS OF INSURANCE Please read the following carefully before completing this proposal form: Your professional indemnity

More information

Application for a Revised Certificate of Authorization for a Health Profession Corporation

Application for a Revised Certificate of Authorization for a Health Profession Corporation Application for a Revised Certificate of Authorization for a Health Profession Corporation Instructions and Checklist Application forms for a Revised Certificate of Authorization for a Health Profession

More information

Insurance Broking Terms of Reference

Insurance Broking Terms of Reference Insurance Broking Terms of Reference Effective 1 January 2009 These terms of reference apply to those members of the Financial Ombudsman Service Limited who have been designated as having the Insurance

More information

Rover Scout Motorsport Western Australia

Rover Scout Motorsport Western Australia Bush Baja 2015 Northam, WA. Rover Scout Motorsport Western Australia Event Entry Form Khanacross/Motorkhana Event Date: 29/5/15 1/6/15 Khanacross to be held under the International Sporting Code of the

More information

City of Markham - Contractors to Perform Tree Azin Injections

City of Markham - Contractors to Perform Tree Azin Injections Parks Department Forestry Section Agreement for Contractors to Perform TreeAzin Injections on City Property The City of Markham Boulevard Tree By-law 68-92 authorizes and regulates the planting, care,

More information

labour force professional liability insurance

labour force professional liability insurance labour force professional liability insurance application form Notices 1. Intermediary Acting as an Agent for Insurer In effecting this contract of insurance, Lawsons Underwriting Australasia Ltd ABN 35

More information

AFFINITY INSURANCE BROKERS Top Up Professional Indemnity Insurance APPLICATION FORM

AFFINITY INSURANCE BROKERS Top Up Professional Indemnity Insurance APPLICATION FORM AFFINITY INSURANCE BROKERS Top Up Professional Indemnity Insurance 1 July 2015 30 June 2016 APPLICATION FORM Completed Application Form to be returned to Affinity Insurance Brokers by 30 June 2015 Fax:

More information

Professional Indemnity Proposal Form

Professional Indemnity Proposal Form Professional Indemnity Proposal Form BuildSafe Insurance Brokers Pty Ltd ABN 84 109 623 976 AFSL 279367 5 Peninsula Boulevard, Seaford, Vic. 3198 Postal: P. O. Box 2294 Seaford, Vic. 3198 Phone: 1300 763

More information

Workers compensation insurance. Application

Workers compensation insurance. Application Workers compensation insurance Application Workers compensation insurance Please complete this application carefully to ensure that it meets your needs. How to complete this form 1. Read the important

More information

Contact Person: Position / Title: Phone: Fax: After Hours: Mobile: E-mail: Event Mobile: Event Times: Start: am / pm Finish: am / pm

Contact Person: Position / Title: Phone: Fax: After Hours: Mobile: E-mail: Event Mobile: Event Times: Start: am / pm Finish: am / pm MAJOR EVENT APPLICATION TEMPLATE Template No.: 4-5-216 GDS Category: Social, Cultural and Community Services Public Document? YES Date: June 2011 Page 1 of 13 Version: 1 Review Date: June 2013 * Must be

More information

A P P L I C A T I O N F O R T E N A N C Y

A P P L I C A T I O N F O R T E N A N C Y A P P L I C A T I O N F O R T E N A N C Y Property Applying For IMPORTANT IF YOU ARE SERIOUS ABOUT HAVING YOUR APPLICATION APPROVED, YOU MUST FILL IN ALL THE FIELDS REQUIRED. WHERE FIELDS DO NOT APPLY

More information

Given Name (in full): Surname (Family Name): Residential Address: (Number/Unit/Street/Suburb/State/Postcode) Town: State:

Given Name (in full): Surname (Family Name): Residential Address: (Number/Unit/Street/Suburb/State/Postcode) Town: State: Please tick appropriate course that you are applying for: RTO ID 40979 Shop C 60 Perry St Matraville NSW craig@r-training.com.au APPLICATION FORM CPP20212 Certificate II in Security CPP30411 Certificate

More information

Join GMHBA Transfer from an existing GMHBA membership Change my GMHBA cover

Join GMHBA Transfer from an existing GMHBA membership Change my GMHBA cover Application form September 2012 1. I wish to (please tick) Join GMHBA Transfer from an existing GMHBA membership Change my GMHBA cover GMHBA member number (existing members only) Cover or change of cover

More information

Event Application Form

Event Application Form Event Application Form Waipa District Council, Private Bag 2402, Te Awamutu 3840 Phone: 0800 924 723 Fax: 07 872 0033 Web: www.waipadc.govt.nz Email: events@waipadc.govt.nz If only a road closure is required,

More information

Application for superannuation benefits temporary residents departing Australia permanently

Application for superannuation benefits temporary residents departing Australia permanently GPO Box 89 Melbourne Vic 3001 VicSuper Member Centre 1300 366 216 vicsuper.com.au Application for superannuation benefits temporary residents departing Australia permanently * Indicates that providing

More information

Professional Indemnity Insurance Application Form for Eligible Midwives

Professional Indemnity Insurance Application Form for Eligible Midwives Professional Indemnity Insurance Application Form for Eligible Midwives This Form will be used by MIGA to consider your application for Professional Indemnity Insurance with MIGA and for your automatic

More information

PROFESSIONAL INDEMNITY INSURANCE GUIDELINES FOR B or C CLASS FINANCE BROKERS

PROFESSIONAL INDEMNITY INSURANCE GUIDELINES FOR B or C CLASS FINANCE BROKERS PROFESSIONAL INDEMNITY INSURANCE GUIDELINES FOR B or C CLASS FINANCE BROKERS Minimum requirements issued by the Commissioner for Consumer Protection ( the Commissioner ) 1. SCOPE OF COVER: 1.1 Cover (with

More information