Application to renew an interstate Licence to Perform High Risk Work
|
|
- Bethany Atkins
- 8 years ago
- Views:
Transcription
1 Workplace Health and Safety Queensland FORM 97 Application to renew an interstate Licence to Perform High Risk Work V This form is only to be completed for high risk work licences that were issued in a jurisdiction other than Queensland, and are due for renewal within the next three months. Please note: if the licence is an existing Queensland Certificate of Competency or Old Style Certificate (issued pre-march 1992), or equivalent interstate issued licence, or an interstate high risk work licence that is not due for renewal or has expired for more than 12 months, please call the department s Advisory Services on Applicant details Title ( Dr, Mr, Mrs, Miss, Ms) First given name Family name/surname Second given name (if applicable) Date of birth (DD/MM/YYYY) Identification type (please select one of the following and provide the identification number) Queensland driver s licence Adult proof of age card I do not hold either of these forms of identification 2. Contact details You must be a resident of Queensland, or can satisfy Workplace Health and Safety Queensland (WHSQ) that circumstances exist that justify the renewal of the licence in Queensland. For more information, please contact WHSQ prior to submitting your application as the application fee is non-refundable. Residential address (must be an Australian address and not a PO Box) Unit no./street no. Street name Suburb/ Locality State Postcode Phone number (please provide at least one contact phone number) Telephone Mobile address (if applicable) Postal address (must be an Australian address) Cross this box if your postal address is the same as your address above, or provide your postal address details below PO Box number GPO Box number Private Bag number Locked Bag number Suburb/ Locality State Postcode 3. Interstate licence details Please provide details of your interstate high risk work licences; if you hold more than three interstate licences please attach these separately. Select only those classes in which you have maintained competency. For a full list of relevant codes for classes of high risk work, please refer to Table 1.0 High risk work classes and codes (page 4). Interstate licence 1 Licence number State of issue Issue date (dd/mm/yyyy) Expiry date Endorsements held on this licence LF LO RS CB CD WP CN CP C2 C6 C1 CT CS BB BI BS BA C0 CV PB DG HP HM RB RI RA SB SI SA TO ES Great state. Great opportunity.
2 Interstate licence 2 Licence number State of issue Issue date (dd/mm/yyyy) Expiry date Endorsements held on this licence LF LO RS CB CD WP CN CP C2 C6 C1 CT CS BB BI BS BA C0 CV PB DG HP HM RB RI RA SB SI SA TO ES Interstate licence 3 Licence number State of issue Issue date (dd/mm/yyyy) Expiry date Endorsements held on this licence LF LO RS CB CD WP CN CP C2 C6 C1 CT CS BB BI BS BA C0 CV PB DG HP HM RB RI RA SB SI SA TO ES 4. Additional information Having a licence suspended or cancelled, entering into an enforceable undertaking, or having a disqualification or conviction does not automatically exclude you from renewing your licence. Each application will be assessed on the details provided. You may be contacted to supply further information. Have you ever been convicted or found guilty of any offence under the Work Health and Safety Act 2011 or Work Health and Safety Regulation 2011 or under the work health and safety law of another state, territory or the Commonwealth? This relates to offences under the WHS Act or Regulations or WHS Law only. This does not include offences such as driving infringements, criminal offences or breaches of other legislation. Have you entered into an enforceable undertaking under the WHS Act or the WHS law of another state, territory or the Commonwealth? Have you ever had an equivalent high risk work licence under the WHS Act or Regulations or the WHS law of another state, territory or the Commonwealth refused, suspended or cancelled? This relates to high risk work licences only, not any other type of licence. Are you or have you been disqualified from applying for a high risk work licence? 2/7
3 5. Declarations by applicant By signing this application form you are declaring that: you do not hold an equivalent high risk work licence granted by a work health and safety regulator in another state, territory or the Commonwealth, unless that licence is due for renewal. you consent to Workplace Health and Safety Queensland making enquiries and exchanging information with work health and safety regulators in other states, territories or the Commonwealth regarding any matter relevant to this application. you have maintained competency in all of the high risk work classes listed in this application. that the information supplied in this application is true and correct to the best of your knowledge. none of the information supplied by you in this application or in any documents attached to or submitted in support of this application is false or misleading in any material particular. in making this application you have not failed to provide any material information relating to the matters addressed above. you acknowledge that it is an offence under the Work Health and Safety Act 2011 to provide false and misleading information in this application or in any documents submitted in support of this application. Name in full (please print) Signature Date (dd/mm/yyyy) PRIVACY STATEMENT: The Department of Justice and Attorney-General is collecting your personal information in order to process your application to renew an interstate licence to perform high risk work in accordance with the Work Health and Safety Act It is the department s usual practice to disclose this information to the applicable Commonwealth, state or territory work health and safety regulator/s in order to obtain information relevant to making a decision on your application or as otherwise required by law. The government may also disclose your licence status to employers or prospective employers and members of the public who wish to check this status. The status of a licence refers to whether the licence is current or not, the expiry date and any conditions attached to the licence. 6. Checklist of documentation required to present to Courthouse Staff 100 points of identification. For details please refer to table 2.0 Points of Identification (page 4). 7. Checklist of documentation required to submit to Courthouse Staff 8. Fee Completed application form Passport quality photograph of yourself. For details please refer to table 3.0 Photograph requirements (page 5) In order for your application to be accepted, the form must be completed correctly and all supporting documentation must be provided. Please note that your application will not be processed by WHSQ until full payment has been received. The fastest way to make payment is to provide your credit card details below or attach a cheque/money order to your application. If required, BPay details can be provided after your application is received by WHSQ. Please allow up to 120 days for your application to be processed. If you have any further enquiries regarding your application, please contact Advisory Services on The relevant fee is $77.55 Applicants wishing to make payment by credit card or BPay will be contacted by a Processing Officer. Please provide contact details. I have enclosed a cheque or money order (cheques should be made out to Department of Justice and Attorney General), or I wish to pay by credit card, please call me on I wish to pay by BPay. An application summary including BPay details will be forwarded to you within 5-7 working days. Please cross this box if a receipt is required. Address receipt is to be sent to (if different to address stated in Section 1) Street number Street name Suburb State Postcode Submit your completed application, supporting documents and relevant fee to a Queensland Courthouse, QGAP or QGSC Counter. 3/7
4 Table 1.0 High risk work classes and codes Code Class Code Class LF Forklift truck not pedestrian operated RB Basic rigging LO Order picking forklift truck RI Intermediate rigging CB Bridge/gantry crane RA Advanced rigging CD Derrick crane SB Basic scaffolding WP Boom type elevating work platform SI Intermediate scaffolding CN Non-slewing mobile crane SA Advanced scaffolding CP Portal boom crane CT Tower crane C2 Slewing mobile crane 20 tonnes or less CS Self erecting tower crane C6 Slewing mobile crane 60 tonnes or less RS Reach stacker. C1 C0 CV PB DG HP HM Slewing mobile crane 100 tonnes or less Slewing mobile crane over 100 tonnes Vehicle loading crane 10m tonnes or more Concrete placing boom Dogging Material or personnel hoist Materials hoist with cantilever platform BB BI BS BA TO ES Basic boiler (Note: holders of this endorsement will be issued with a BS). Basic intermediate (Note: holders of this endorsement will be issued with a BS) Standard boiler operation Advanced boiler operation Turbine operation Reciprocating steam engine Table 2.0 Points of Identification Proof of identification Document type Primary You must use ONE primary document OR at least ONE secondary document which MUST contain a photograph Secondar Your initial secondary document will be awarded 40 points, any additional documents will be awarded 25 points each. Document Full Birth Certificate or Birth Card issued by the Registrar of Births, Deaths and 70 Marriages Australian Passport (current or expired within the last two years, but not 70 cancelled) Australian Citizenship Certificate 70 International Passport (current, NOT expired or cancelled) 70 Point value Australian Photo Drivers Licence 40 or 25 Australian Photo Firearm Licence 40 or 25 State or Federal Government Employee Photo Identity 40 or 25 Tertiary Education Institution Photo Identity 40 or 25 Australian Learner s Permit 40 or 25 Department of Veterans Affairs Card 40 or 25 Centrelink or Social Security Card 40 or 25 Proof of Age Card (issued by Queensland Transport) 40 or 25 Medicare Card 25 Council Rates Notice 25 Property Lease/Rental Agreement 25 Property Insurance Papers 25 Motor Vehicle Registration or Insurance Documents 25 Professional or Trade Association Card 25 Utility Bills (e.g. Telephone, Gas, Electricity, Water) 25 Credit/Account Card 25 Credit/Account Card or Bank Statement/Passbook 25 Only ONE of each document from this category can be used for the proof of identity points. 4/7
5 Table 3.0 Photograph requirements You must provide a recent colour passport size photograph of yourself with your application. Your photograph must be no more than six months old and must meet the conditions set out below. If your photo does not meet the required quality requirements, your application will not be accepted. To meet the requirements your photo must: 1. Be within 45-50mm high and 35-45mm wide. 2. Show your head and top of your shoulders close up so the measurement of the face from the bottom of the chin to the crown (i.e. top of head without hair) is between 32 and 36mm. 3. Be printed on high quality paper at high resolution. 4. Show natural skin tones and colours, no flash reflection and no red eye. 5. Show you with natural expression and mouth closed (i.e. not smiling). 6. Have a plain, light-coloured background (e.g. white, cream or pale blue). 7. Show you facing and looking directly at the camera. 8. Show you with no hair across your eyes. 9. Show both edges of your face clearly. 10. Not show you looking over one shoulder (portrait style) or with head tilted. 11. Not be manipulated in any way and must be a single photo of applicant. Passport quality photo 12. Show you without hat or head covering unless worn for religion reasons, in which case, facial features from bottom of chin to top of forehead and both edges of your face must be clearly shown. Min 32mm Max 36mm 13. Show your eyes open and clearly visible, and only with glasses if you regularly wear them. You do not have to wear glasses for your passport photo. But if you do, no dark lenses or flash reflections of the lenses, and frames cannot cover any part of your eyes. AEU 14/5166 5/7
6 CHECKLIST FORM 97 Application to renew an interstate Licence to Perform High Risk Work Courthouse staff use only Lodged at: Courthouse QGAP QGSC PLEASE SPECIFY Location: Applicant details: Name of applicant: Date and time of application: Signature of Courthouse officer: Checklist: Has the applicant completed the Licence to perform High Risk Work interstate renewal application? Has the photo of the applicant been verified? Has the interstate high risk work licence of the applicant been verified? Please ensure the licence was not issued in Queensland or interstate high risk work is expiring within 3 months and/or has not been expired for more than 12 months. Expiry date of interstate high risk work licence: Classes of high risk work listed on licence: Has the applicant displayed appropriate identification documents? Please use the table below to identify which documents were displayed. Proof of Identification Document type The applicant must use ONE primary document OR At least ONE secondary document which MUST contain a photograph The initial secondary document will be awarded 40 points; any additional documents will be awarded 25 points each. Document Primary Full Birth Certificate or Birth Card issued by the Registrar of Births, Deaths and Marriages Australian Passport (current or expired within the last two years, but not cancelled) 70 Australian Citizenship Certificate 70 International Passport (current, NOT expired or cancelled) 70 Secondary Point value Australian Photo Drivers Licence 40 or 25 Australian Photo Firearm Licence 40 or 25 State or Federal Government Employee Photo Identity 40 or 25 Tertiary Education Institution Photo Identity 40 or 25 Australian Learner s Permit 40 or 25 Department of Veterans Affairs Card 40 or 25 Centrelink or Social Security Card 40 or 25 Proof of Age Card (issued by Queensland Transport) 40 or 25 Medicare Card 25 Council Rates Notice 25 Property Lease/Rental Agreement 25 Property Insurance Papers 25 Motor Vehicle Registration or Insurance Documents 25 Professional or Trade Association Card 25 Utility Bills (e.g. Telephone, Gas, Electricity, Water) 25 Credit/Account Card Tick if document displayed 6/7
7 Only ONE of each document from this category can be used for the proof of identity points. Credit/Account Card or Bank Statement/Passbook 25 Applicant has provided an ID Waiver Letter from Licensing Services, Workplace, Health & Safety Has the applicant supplied the method of payment? Please specify: Cheque or money order included with the correct filing fee or contact details supplied for payment via credit card or Bpay AEU 14/5166 Applicant to retain the following section as evidence of application Workplace Health and Safety Queensland Work Health and Safety Regulation 2011 Application to Renew an interstate Licence to Perform High Risk Work Name of applicant: Date and time of application: Signature of Courthouse officer: 7/7
APPLICATION FOR A HIGH RISK WORK LICENCE Work Health and Safety Act 2011
APPLICATION FOR A HIGH RISK WORK LICENCE Work Health and Safety Act 2011 PURPOSE This form is to be used to apply for a high risk work licence under the Work Health and Safety Act 2011 (the Act). You can
More informationOverseas: NOTES. Application for an Australian Passport. Your checklist. Keep your passport safe at all times.
Application for an Australian Passport Overseas: NOTES Who can apply for an Australian passport? All Australian citizens can apply if you have any questions or doubts about your Australian citizenship,
More informationApplication to register a change of name (adult 18+ years)
Application to register a change of name (adult 18+ years) July 2014 Recognising the significance of life events Important information about your change of name application If you require access to a translation
More informationREGISTRATION OF INTEREST FOR EMPLOYMENT
REGISTRATION OF INTEREST FOR EMPLOYMENT Thank you for your registration of interest for employment with Global Resource Support! For your registration to be considered, please complete the entire document
More informationCERTIFICATION OF COMPETENCY (A copy of supporting documentation must be attached).
REGISTRATION OF INTEREST FOR EMPLOYMENT Thank you for your registration of interest for employment with United Industrial Solutions! For your registration to be considered, please complete the entire document
More informationApplication to register a change of name (adult 18 years or over)
Government of Western Australia Department of the Attorney General Registry of Births, Deaths & Marriages BDM400 Application to register a change of name (adult 18 years or over) Eligibility You must be
More informationApplication for a Certificate of Approval
Private Security Personnel Licensing Authority For more information visit www.pspla.govt.nz Application for a Certificate of Approval Under the Private Security Personnel and Private Investigators Act
More informationNATIONAL 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 informationCRIMINAL HISTORY CHECK APPLICATION
NORTHERN TERRITORY POLICE SAFE NT Phone 1800 723 368 (1800 SAFENT) Office Hours 8 30am 4 30pm Monday Thursday 9 30am 5 30pm Friday CRIMINAL HISTORY CHECK APPLICATION PF095 06/12 C APPLICATION FOR CRIMINAL
More informationAPPLICATION FOR A LICENCE Security & Related Activities (Control) Act 1996
WESTERN AUSTRALIA POLICE APPLICATION FOR A LICENCE Security & Related Activities (Control) Act 1996 Instructions to applicants follow all of these steps to complete your application You must carefully
More informationForm 20 Application for additional/change of qualified person for a contractor licence
Department of Justice and Attorney-General Electrical Safety Office Form 20 Application for additional/change of qualified person for a contractor licence V12.06-2014 Electrical Safety Act 2002 INSTRUCTIONS:
More informationForm 11 Application for electrical work licence/permit (other than apprentice)
Electrical Safety Office Form 11 Application for electrical work licence/permit (other than apprentice) V15.06-2014 Electrical Safety Act 2002 If you are applying for an additional electrical work training
More informationYour secure identity. Meeting proof of identity requirements
Your secure identity Meeting proof of identity requirements The Department of Transport (DoT) is committed to safeguarding your identity through secure information management and personal identification
More informationConsumer and Business Services
Consumer and Business Services Born in South Australia Register a Change of Name Application (child under 18) To change a child s name you must complete this form, pay the appropriate fee and provide documentation
More informationAPPLICATION FOR A LICENCE Security & Related Activities (Control) Act 1996
Security & Related Activities (Control) Act 1996 Instructions to applicants follow all of these steps to complete your application You must carefully complete all sections and attach all required documents.
More informationRenewal 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 informationApplication for a real estate salesperson registration certificate
New registration application Form 3 1 Notes Application for a real estate salesperson registration certificate Property Occupations Act 2014 This form is effective from 1 December 2014 ABN: 13 846 673
More informationApplication 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 informationAgents financial administration Form 4
Agents financial administration Form 4 Collection agent application for authority to open a trust account Agents Financial Administration Act 2014 Debt Collectors (Field Agents and Collection Agents) Act
More informationApplication for Department of Agriculture Approved Auditor
Application for Department of Agriculture Approved Auditor Export Control (Eggs and Egg Products) Orders 2005 Export Control (Fish and Fish Products) Orders 2005 Export Control (Meat and Meat Products)
More informationWHOLE BALANCE TRANSFER TO A KIWISAVER SCHEME
WHOLE BALANCE TRANSFER TO A KIWISAVER SCHEME Issued 1 November 2014 Please use this form to transfer your whole superannuation balance to a KiwiSaver scheme. Transferring only part of your superannuation
More informationAuthorised Signatory Form
Form Complete this form: to give a person other than your adviser the authority to act on your existing margin lending facility in all matters as if they were you (including but not limited to increasing
More informationFair 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 informationLAST NAME GIVEN NAME(S) DATE CEASED / / LAST NAME GIVEN NAME(S) DATE CEASED / /
Application by an INDIVIDUAL FOR A NSW SECURITY LICENCE under the Mutual Recognition Act 1992 and/or Trans-Tasman Mutual Recognition Act 1997 OFFICE USE ONLY Application No: - Receipt No: - Trim No: To
More informationASBESTOS REMOVAL LICENCE ASBESTOS NOTIFICATIONS
GUIDE FOR APPLICANTS ASBESTOS REMOVAL LICENCE ASBESTOS NOTIFICATIONS TABLE OF CONTENTS INTRODUCTION... 2 WHY YOU NEED A LICENCE... 2 WHY YOU NEED TO NOTIFY... 2 LICENCE TYPES... 2 SCOPE... 2 WHO MAY APPLY
More informationGuide for applicants for asbestos removal and asbestos assessor licences and notifications
Guide for applicants for asbestos removal and asbestos assessor licences and notifications of asbestos removal work, asbestos fibres and emergency demolition of structures containing asbestos March 2013
More informationAs an aged care worker, this incentive is for you to upgrade your qualifications and build your career in aged care.
Aged Care Education and Training Incentive Programme COMPLETION PAYMENT This application form is to be completed by applicants who have completed studies and have already received a commencement payment
More information20 Frequently Asked Questions
National Police Certificates Issued by Victoria Police 20 Frequently Asked Questions 1. Where can I obtain an application form? The Victoria Police website contains information on how to apply for a National
More informationForm 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 informationFIRST HOME OWNER RATE OF DUTY INDIAN OCEAN TERRITORIES
FIRST HOME OWNER RATE OF DUTY INDIAN OCEAN TERRITORIES SECTIONS 141 146 OF THE DUTIES ACT 2008 (WA)(CI) & (CKI) APPLICATION FORM AND LODGMENT GUIDE A first home owner who is not eligible for the First
More informationIdentification GETTING STARTED
Identification GETTING STARTED 3 This is Booklet 3 in the Getting Started Series. Getting Started is a guide for people leaving prison. Booklets 1 The First Week 2 Housing 3 Identification 4 Alcohol and
More informationApplication 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 informationInformation for temporary residents departing Australia
Information for temporary residents departing Australia MLC Superannuation What is a Departing Australia Superannuation Payment? The Departing Australia Superannuation Payment (DASP) is the payment of
More informationNATIONAL POLICE CHECKING SERVICE (NPCS) INFORMED CONSENT FORM
SECTION 1: PERSONAL INFORMATION Please select appropriate box only: Employee Contracr/Consultant Volunteer Individual Other (Please specify) Is this a renewal check? Yes No Names by which I am, or have
More informationAs an aged care worker, this incentive is for you to upgrade your qualifications and build your career in aged care.
Aged Care Education and Training Incentive Programme COMMENCEMENT PAYMENT This application form is to be completed by eligible aged care workers who have enrolled and commenced studies to enhance their
More informationHow to complete the AML/CTF Investor Identification Information Form
How to complete the AMLCTF Investor Identification Information Form The Australian government has introduced legislation called the Anti-Money Laundering and Counter Terrorism Financing Act 2006 which
More informationREQUEST FOR WITHDRAWAL
REQUEST FOR WITHDRAWAL If you need help For assistance call NGS Super Customer Service Team on 1300 133 177. Step 1. Complete your personal details Please print in black or blue pen, in uppercase, one
More informationIndividual Construction Occupations (Licensing) Act 2004, s128 and s17
Application to renew/issue an expired licence Construction Occupation licence Individual Construction Occupations (Licensing) Act 2004, s128 and s17 This form is to be used for individuals to: renew a
More informationApplication for Bond Loan and Rental Grant assistance
Office use only (application number) Bond Loan Rental Grant Application for Bond Loan and Rental Grant assistance The Department of Housing and Public Works provides Bond Loans and Rental Grants to people
More informationThree year term. (One licence category includes non-refundable application fee of $144.60 ) $1242.60 $2329.60 $144.60
New licence application Form 1 1 Notes Application for an individual s licence Real estate agent, property auctioneer, resident letting agent, motor dealer, chattel auctioneer Property Occupations Act
More informationMutual 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 informationA Hero rate or Zero fees at selected ATMs.
A Hero rate or Zero fees at selected ATMs. It s easy to open your Bankwest Hero Transaction account or Bankwest Zero Transaction account. Here s how: Now that you have downloaded the Bankwest Hero Transaction
More informationPayment of unclaimed superannuation money
Instructions and form for super fund members Payment of unclaimed superannuation money How to complete your Application for payment of unclaimed superannuation money individual. For information about unclaimed
More informationAPPLICATION FOR NEW CERTIFICATE OF COMPETENCE
APPLICATION FOR NEW CERTIFICATE OF COMPETENCE This is an application form for a certificate of competence under the Health and Safety in Employment (Mining Operations and Quarrying Operations) Regulations
More informationAdvantages: How it works:
Suncorp Wealth Cash Management Account Application Form Details Suncorp Wealth Cash Management Account offers competitive interest with no ongoing fees and charges. To conveniently settle your share purchases
More informationMedicare enrolment application
Medicare enrolment application When to use this form Use this form if you are: a migrant living in Australia applying for permanent residency and living in Australia a visitor to Australia an Australian
More informationAsbestos licensing and notification guide for applicants
Asbestos licensing and notification guide for applicants Use this guide if you are: applying for an asbestos removal work licence applying for an asbestos assessor licence notifying of asbestos removal
More informationAPPLICATION FOR REGISTRATION AS A BUILDING PRACTITIONER CERTIFYING ENGINEER - INDIVIDUAL
NORTHERN TERRITORY BUILDING PRACTITIONERS BOARD APPLICATION FOR REGISTRATION AS A BUILDING PRACTITIONER CERTIFYING ENGINEER - INDIVIDUAL SECTION 1 PERSONAL DETAILS FAMILY NAME (Surname) GIVEN NAME (First
More informationApplication Form for Millinium's Wholesale Fixed Income Fund Individual(s) / Sole Trader (Resident/Non Resident)
Before you sign this application form, we wish to give you a Information Memorandum ("IM") which is a summary of important information relating to Millinium's Wholesale Fixed Income Fund ("Fund"). The
More informationConditions of accreditation as an assessor for high risk work classes
Conditions of accreditation as an assessor for high risk work classes. Contents Section 1 - Purpose... 3 Section 2 - Conditions of accreditation... 3 General requirements... 4 Conduct as an assessor...
More informationAPPLICATION FOR Private Rental Assistance Ask if you need help with this form
ALL APPLICATIONS MUST INCLUDE PROOF OF IDENTIFICATION Housing SA APPLICATION FOR Private Rental Assistance Ask if you need help with this form The information you provide on this form will be used by Housing
More informationChild. Application for an Australian Passport. Your checklist
Application for an Australian Passport Child Appointments Only certain applicants should lodge their forms at a passport office in Australia. Appointments are essential. See notes for details. Protect
More informationCOMMONWEALTH CONSTRUCTION INDUCTION TRAINING CARDS. Guidance material
COMMONWEALTH CONSTRUCTION INDUCTION TRAINING CARDS Guidance material CONTENTS INTRODUCTION 3 WHAT IS GENERAL CONSTRUCTION INDUCTION TRAINING? 3 WHO CAN PROVIDE GENERAL CONSTRUCTION INDUCTION TRAINING?
More informationOwner Builder permit. Owner builder application. Company application. Lease agreements. Owner builder course. Build better.
Build better. Owner Builder permit Under the Queensland Building and Construction Commission Act 1991 you must obtain an Owner Builder permit before carrying out building work with a value of $11,000 or
More informationUNCLAIMED MONEY HOW TO CLAIM YOUR MONEY
UNCLAIMED MONEY HOW TO CLAIM YOUR MONEY Do not complete this form to claim funds where your search shows the Type of money as 'Banking', 'Life' or 'Company Gazette'; or if you are claiming funds listed
More informationApplication for Accreditation by Testing
Application for Accreditation by Testing OFFICE USE ONLY AUS NZ OS Please use blue or black ball point pen to complete this form. Please print in BLOCK LETTERS. NAATI Number: (if known) Part 1 Please provide
More informationApplication for a Company Licence
Private Security Personnel Licensing Authority For more information visit www.pspla.govt.nz Application for a Company Licence Under the Private Security Personnel and Private Investigators Act 2010 1 What
More informationForm 47 Application for trainer approval in Responsible management of licensed venues course
Form 47 Application for trainer approval in Responsible management of licensed venues course Liquor Act 1992 s. 142B V2 Aug 2013 Office use only Receipt no.... Amount $... Date... Instructions Please complete
More informationCHC30113 Certificate III in Early Childhood Education and Care
ENROLMENT APPLICATION FORM CHC30113 Certificate III in Early Childhood Education and Care About this application Use this Enrolment Application to apply for enrolment in the CHC30113 Certificate III in
More informationPlease only use this form when you wish to open a Suncorp Share Trade Account: in your name, or in joint names
Stockbroking INDIVIDUAL/JOINT ACCOUNT application form Please only use this form when you wish to open a Suncorp Share Trade Account: in your name, or in joint names In order to process your application
More informationAdvance Retirement Suite Super Early Release Financial Hardship Application
Advance Retirement Suite Super Early Release Financial Hardship Application Trustee: BT Funds Management Ltd (BTFM) ABN 63 002 916 458 AFSL 233724 GUIDE TO COMPLETING THIS FORM > > Use this form if you
More informationLUMP SUM APPLICATION FOR PAYMENT OF A PRESERVED LUMP SUM ENTITLEMENT 1. PERSONAL DETAILS 2. TAX FILE NUMBER (TFN) 3. TYPE OF ENTITLEMENT APPLIED FOR
LUMP SUM APPLICATION FOR PAYMENT OF A PRESERVED LUMP SUM ENTITLEMENT Form Please complete all the details on this form in BLOCK LETTERS and return the signed original to. 1. PERSONAL DETAILS Mr Ms Miss
More informationApplication for adoption information: Relative or guardian of adopted person who is deceased or does not have capacity
The purpose of the application for adoption information: is deceased or does not have capacity form This form is for use by a relative or guardian of an adult adopted person to apply for adoption information
More informationApplication for Construction Occupation Licence Individual Plumber Construction Occupations (Licensing) Act 2004, s128 and s17
Application for Construction Occupation Licence Individual Plumber Construction Occupations (Licensing) Act 2004, s128 and s17 This approved form is to be used for individuals applying under the Construction
More informationING DIRECT Customer Identification Procedures for Brokers
ING DIRECT Customer Identification Procedures for Brokers Managing obligations of the Anti-Money Laundering and Counter-Terrorism Financing Act ( AML/CTF Act ) for the purpose of Customer Identification
More informationComplete this form to withdraw part or all of your benefit as a lump sum, roll over to another GESB account and/or to another complying super fund.
Benefit access Gesb Super and West State Super SUP E R ANNUATION Complete this form to withdraw part or all of your benefit as a lump sum, roll over to another GESB account and/or to another complying
More informationRequest to Increase Insurance Life Event
Request to Increase Insurance Life Event Accumulation Scheme (Division 5) members only Use this form to apply to increase your insurance cover when a specific life event has occurred. As an accumulation
More informationApplication 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 informationLandlords Residential Property Insurance Claim Report
Landlords Residential Property Insurance Claim Report CGU Insurance Limited ABN 27 004 478 371 Please retain this page for your information About your claim We will contact you as quickly as possible about
More informationBlue Care Income Protection Claim Form
Blue Care Income Protection Claim Form INCOME PROTECTION CLAIMS In order to alleviate any delay in the processing time of your claim, please ensure the following: The claim form is returned with all fields
More informationApplication for a Security Firm licence
Private Security Act Please print in block letters 1. Type of application How will the business be structured? Natural person (Sections 2, 3, 9, 13, 14 and 15 of application) Natural persons in partnership
More information2. Probate 2.1. Probate, what is it? 2.2. When will I need probate? 2.3. How do I apply for probate?
GE Money Term Life Insurance Claims Fact Pack (WA) GPO Box 1571, Sydney NSW 1025 Telephone: 1800 800 230 Facsimile: (02) 8249 3884 Dear Customer, This document has been provided to assist you through the
More informationSuperannuation and Deferred Annuity Redemption / transfer form
Superannuation and Deferred Annuity Redemption / transfer form This form is to be used when redeeming your superannuation benefit from the Zurich Deferred Annuity or from the Zurich Master Superannuation
More informationApplication for Security Officer and/or Crowd Controller Licence
Application for Security Officer and/or Crowd Controller Licence Private Security Act Please print in block letters. All questions must be answered and full particulars provided. If there is insufficient
More informationAPPLICATION FORM VET FEE HELP (VFH)
APPLICATION FORM VET FEE HELP (VFH) (AUSTRALIAN CITIZEN OR PERMANENT HUMANITARIAN VISA HOLDER RESIDING IN AUSTRALIA, MUST BE 18 YEARS OF AGE TO ENROL) PERSONAL DETAILS (PLEASE FILL USING CAPITAL LETTERS)
More informationLead health monitoring report
FORM 86 V13.3.12 Lead health monitoring report The person conducting the business or undertaking (PCBU) must: ensure that a registered medical practitioner with experience in health monitoring carries
More informationOccupational Health and Safety Act 2000
New South Wales Occupational Health and Safety Amendment (National Code of Practice and National Standard for Licensing) Regulation 2009 under the Occupational Health and Safety Act 2000 Her Excellency
More informationApplication for Benefits under the Motor Accidents (Compensation) Act
Application for Benefits under the Motor Accidents (Compensation) Act Application for Benefits The MAC Act provides a wide range of benefits to compensate people injured in a motor vehicle accident for
More informationInternational Student Application Form
Please complete this form and attach certified copies of all documents required. If these documents are not provided, your application will be incomplete. Your application cannot be considered without
More informationAMSA 419 Information Guide
AMSA 419 Information Guide Application for STCW Qualifications including Service Books FOR OVERSEAS APPLICATIONS Please read these notes carefully, they are intended to help you complete your application
More informationAPPLICATION FOR GAS WORK AUTHORISATION (MOTOR FUEL)
Applicant Details APPLICATION FOR GAS WORK AUTHORISATION (MOTOR FUEL) Petroleum and Gas (Production and Safety) Act and Regulation 2004 Corporation Application Details Do NOT complete if you are an Individual
More informationChange My Insurance Details Form
Change My Insurance Details Form Please complete and return this form to: NESS Super, Locked Bag 20, Parramatta NSW 2124 Complete in pen using CAPITAL letters or type directly into this form and print
More informationEarly release of super on compassionate grounds How to make a claim
Early release of super on compassionate grounds How to make a claim Please note if you have ceased work due to sickness or injury, call us on 13 11 84 before proceeding. Am I eligible to make a claim?
More informationInstruction Pages Individual Operator Private Security Licence Application
Please remove Instruction Pages before submitting your application VP Form 1080 Instruction Pages Individual Operator Private Security Licence Application Security Guard, Crowd Controller, Investigator,
More informationUC s lecture theatre Course Preferences Research Degree Application Form Tick in the box below to indicate your choice of course Doctor of Philosophy (PhD) in Management Doctor of Philosophy (PhD)
More informationApplication Form and Lodgement Guide
First Home Owner Grant Application Form and Lodgement Guide Please read the Terms used for explanations in completing the application 4 easy steps to claim your grant 01 02 03 04 Read lodgement guide Important
More informationPlumbing Mutual Recognition Application
Plumbing Mutual Recognition Application Address: GPO Box 536, Melbourne VIC 3001 Phone: 1300 815 127 Fax: (03) 9618 9049 Email: regmail@vba.vic.gov.au Mutual recognition is based on an agreement between
More informationStudent Enrolment Form Life Insurance Adviser Course RG146
Student Enrolment Form Life Insurance Adviser Course RG146 Applications may be submitted by ANY of the following methods: Email: enrol@monarch.edu.au (Preferred option) Post: Monarch Institute Administration:
More informationClaim for Compensation for a Work-related death
SRC 184 (March 2014) Claim for Compensation for a Work-related death This form is to be completed if you wish to claim compensation under the Safety, Rehabilitation and Compensation Act 1988 (SRC Act)
More informationNext of Kin: please provide details of preferred person to be contacted in the event of an emergency Name Relationship Hm. 1.
PERSONAL DETAILS Name Marital Status DOB Property Weekly Rent Term of Tenancy Occupation Date No. of Adults Ages of Children Pets Type No Registered Car Rego No Drivers Lic No Home ph Email Mobile Wk Current
More informationFatality Claim Form. South Australia Compulsory Third Party (CTP)
South Australia Compulsory Third Party (CTP) Fatality Claim Form This form is to be completed by any person who is claiming compensation as a result of a person s death in a motor vehicle accident (please
More informationGuide to Lodging Application Form First Home Owner Grant Scheme
Guide to Lodging Application Form First Home Owner Grant Scheme Guide to Lodging Application Form First Home Owner Grant Scheme NOTE This guide is for your assistance and should not be lodged with your
More informationApplication for benefit payment or transfer
Application for benefit payment or transfer Use this form if you want to cash in your benefit or transfer all or part of your super balance to another super fund. This form should not be used by temporary
More informationApplication for a departing Australia superannuation payment
Instructions and form for temporary residents Application for a departing Australia superannuation payment How to complete your Application for a departing Australia superannuation (super) payment. WHO
More informationWithdrawal Flexi Pension
Fact sheet and form Withdrawal Flexi Pension You can make a full or partial lump sum withdrawal from your Flexi Pension account at any time. What this fact sheet covers This fact sheet explains the rules
More informationApplication for Registration as an Agent s Representative
Application for Registration as an Agent s Representative Agents Licensing Act Please print in block letters. If there is insufficient space, attach extra sheets. All questions must be answered and full
More informationTax file number application or enquiry for an individual
Tax file number application or enquiry for an individual ABOUT TAX FILE NUMBERS The tax file number (TFN) is a unique number issued by the Tax Office to individuals and organisations to help the Tax Office
More informationAsbestos removal and licensing
Applicant Guide Asbestos removal and licensing Includes: Asbestos removal and asbestos assessor licence and notifications of asbestos removal work, asbestos fibres and emergency demolition of structures
More informationApplication to copy or transfer from one Medicare card to another
Application to copy or transfer from one Medicare card to another When to use this form Use this form if you need to do any of the following 4 actions: Transfer to a new Medicare card When a person transfers
More information