Section 24 exemption application
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- Matthew Owen
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1 Fr ffice use nly Auhrisain number: Secin 24 exempin applicain This frm is fr persns applying fr an exempin under secin 24 f he Plumbers, Gasfiers, and Drainlayers Ac This exempin auhrises a persn wh is regisered and licensed as a gasfier fix r unfix, r assis in fixing r unfixing: a gas waer heaer, r any pipe ha supplies, r is inended supply, waer a gas waer heaer r h waer frm a gas waer heaer any fiing r appliance. Befre cmpleing his applicain frm yu shuld read he Bard s secin exempins plicy available a PART 1 Applican s deails Firs name(s) : Las name(s) : Psal address: Physical address: Suburb: Ciy: Cunry: Pscde: Suburb: Ciy: Cunry: Pscde: Phne: Wrk: Trading name: Address: Hme: Mbile: Dae f birh: / / 1
2 1. Have yu previusly held an exempin fix r unfix a gas waer heaer r any pipe ha supplies, r is inended supply, waer a gas waer heaer r h waer frm a gas waer heaer any fiing r appliance? YES / NO If YES, when did yu las hld an exempin? If YES, wha was yur exempin number? PART 2 Exempin deails 2. Please sae he reasn why yu are applying fr he secin 24 exempin fr he fixing r unfixing f gas waer heaers: 3. Please lis any qualificains yu have ha are relevan he fixing r unfixing f gas waer heaers and he exen which hse qualificains wuld enable yu saisfy he cmpeencies (insfar as hey relae fixing and unfixing gas waer heaers and assciaed piping) ha are be demnsraed by an applican fr regisrain as a plumber: Please ne ha yu mus supply evidence f having achieved hese qualificains if yu are applying fr he firs ime r yu have updaed yur qualificains since yu las held an exempin. 2
3 4. Please lis any experience yu may have ha is relevan he fixing r unfixing f gas waer heaers and he exen which yur experience wuld enable yu : 5. Have yu passed any plumbing examinains r assessmens in New Zealand r verseas? If s, please lis hem: Please ne ha yu mus supply evidence f having passed any exam r assessmen if yu are applying fr he firs ime r yu have updaed yur qualificains since yu las held an exempin. 3
4 6. Please lis any frmal plumbing raining ha yu have underaken: 7. Please lis any plumbing cninuing prfessinal develpmen (CPD) prgrammes ha yu have underaken: 8. D yu uilise a qualiy managemen sysem and, if s, please prvide a brief descripin: Please ne ha yu mus supply evidence f his if yu are applying fr he firs ime. 4
5 9. Please uline yur knwledge f New Zealand cmpliance requiremens such as relevan sandards and cdes f pracice relaing he paricular plumbing wrk ha yu are applying fr: 10. Please deail any echnical suppr ha is available yu when underaking he paricular plumbing wrk ha yu are applying fr: Please aach a separae shee if yu require addiinal wriing space. 5
6 11. Please advise us abu yur safey and cmpliance recrd: 12. Please aach evidence f yur healh and safey plan his applicain. 6
7 PART 4 - Fee paymen Amun payable: $635.00* * Applicain fee fr an exempin graned under secin 24 please ne his fee is an applicain fee and is n refunded if an applicain is unsuccessful. Paymen mehd: Cheque is enclsed Please make cheque payable : Plumbers, Gasfiers, and Drainlayers Bard Debi/credi card Visa Masercard Full name f cardhlder: Card number: Expiry dae: / I auhrise he Plumbers, Gasfiers and Cardhlder s signaure: Drainlayers Bard charge he al amun my credi r debi card. PART 5 Cnfirmain f accuracy By signing his applicain yu verify ha all infrmain given is rue and crrec. a l a m u n Signaure f applican / /20 Dae a c r s s Privacy Ac 1993: The infrmain requesed in his frm is clleced by he Plumbers, Gasfiers and Drainlayers Bard fr he purpse f assessing yur applicain and adminisering yur exempin. Hwever, he Bard may use his infrmain fr any her purpses required r permied by he Plumbers, Gasfiers, and Drainlayers Ac 2006 and he Privacy Ac Yu have he righ under he Privacy Ac 1993 access and reques crrecin f any persnal infrmain held abu yu by he Bard. 7 m y c r e d i
8 Dcumenain checklis In rder fr he Bard prcess yur applicain yu mus prvide he fllwing: Cmpleed applicain frm Fee paymen f $ Cerified cpies f yur qualificain dcumens if yu are applying fr he firs ime r yu have updaed yur qualificains Cerified cpies f dcumens which prvide evidence f having passed any exam r assessmen if yu are applying fr he firs ime r yu have updaed yur qualificains since yu las held an exempin. Evidence f yur qualiy managemen sysem if applying fr he firs ime Evidence f yur healh and safey plan Send yur cmpleed applicain : PGDB PO Bx The Terrace Wellingn 6143 If yu have any quesins abu his frm please call he Technical Services Advisr n beween 8am and 5pm, Mnday Friday. 8
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