This form should be completed to apply for a Fish Receiver Permit.
Fees may apply for this service. Please refer to the schedule of fees
listed on the AFMA website www.afma.gov.au or contact AFMA
licensing on 1300 723 621.
What you need to do
Post or fax this completed form along with any attachment(s) to:
Australian Fisheries Management Authority
Box 7051
Canberra Business Centre ACT 2610
Fax: (02) 6225 5426
Who can sign this form?
Trading Name – All individual or corporate owners of a trading
name must be specified as the applicants and all sign this form.
Companies – A company may sign in any manner (including under
seal) authorised by s127 of the Corporations Act 2001.
Co-Holders – If the concession is in more than one name
(partnership or otherwise), all holders must sign this form. If there
are more than two holders please attach and date a separate sheet.
Powers of Attorney – If a party signs under a Power of Attorney
the attorney must state ‘Signed for (name of principal) by
his/her/their/its attorney (name of attorney) pursuant to Power of
Attorney Register number (number or date if not required to be
registered in that State) who states that he/she has no notice of the
revocation of the power’. A copy of the registered power should
accompany this form.
Trusts – The beneficial interests in any trust will not be recognised
by AFMA (see s47 FM Act). A Trustee may only sign and date this
form as the legal owner in their own right.
Client Service Charter
In relation to services that AFMA provide to our industry clients, we
will process routine applications for leases, transfers and other
dealings affecting fishing concessions within seven days of receipt,
subject to you supplying us with everything we need to complete
the transaction and to clearance being obtained from other State
licensing authorities, where relevant.
Privacy information
The Australian Fisheries Management Authority (AFMA) is authorised to
collect the information provided on this form under the Fisheries Management
Act 1991. Information is collected pursuant to our data collection functions
under the Fisheries Administration Act 1991 (section 7).
Consistent with AFMA’s objectives and/or functions and/or powers, the
information provided may be disclosed to:
Australian, State and Territory governments and agencies involved in the
enforcement of law;
Australian and International fisheries research and management
organisations, and
foreign governments in support of domestic and international obligations
in relation to fisheries management,research and compliance.
For more information about privacy please contact AFMA on 1300 723 621.
AFMA Direct 1300 723 621 www.afma.gov.au Protecting our fishing future
PART A – Applicants details
1
Name(s) of applicant(s)
2
ACN
(if applicable)
Application for a
Fish Receiver Permit
FR (July 13) Page 1 of 2
FR
ABN 81 098 497 517
3
4
Postal address
ABN
(if applicable)
Postcode
5
Street address (if same as postal address, write ‘As above’)
Postcode
6
Contact person’s name
Business phone
Mobile
Fax
Email address
Note: If you need more space for any of your answers,
please attach a separate sheet with the details.
FR (July 13) Page 2 of 2
AFMA Direct 1300 723 621 www.afma.gov.au Protecting our fishing future
PART B – Details of premises
7
Address of the main premises where the fish will be received
Postcode
Type of premise
Fish packer
Processing plant
Fish farm
Wholesaler
Other
Specify
8
Address(es) of additional premises where the fish will be
received
Postcode
Type of premise
Fish packer
Processing plant
Fish farm
Wholesaler
Other
Specify
PART C – Requirement to complete Southern
Bluefin Tuna Catch Documentation
Scheme Documents
IMPORTANT
Please follow ALL instructions set out in this Part and complete
all mandatory components for this Part before signing the
Declaration in PART D.
a) Address
Postcode
Type of premise
Fish packer
Processing plant
Fish farm
Wholesaler
Other
Specify
b) Address
Postcode
Type of premise
Fish packer
Processing plant
Fish farm
Wholesaler
Other
Specify
c)
Address
9
Will you be receiving, or may you in future receive
Southern Bluefin Tuna?
No
Yes
Go to PART D
You MUST complete the following steps as soon
as possible.
1. Download and read the form Validation of the
Southern Bluefin Tuna Catch Documentation
Scheme (CDS) Documents from
www.afma.gov.au; and
2. Complete the form as instructed; and
3. Send the completed form to AFMA as soon as
possible to:
The Logbook Coordinator
Australian Fisheries Management Authority
BOX 7051
Canberra Business Centre ACT 2610
I, the applicant detailed in Part A of this form:
apply for a Fish Receiver Permit for the premises named in
Part B, and
declare that the information provided on this form is, to the
best of my knowledge, true and correct.
Company seal (if applicable)
Signature
and date
Full name
Position held in company (if applicable)
/ /
Signature
and date
Full name
Position held in company (if applicable)
/ /
PART D – Declaration by applicant
IMPORTANT
Please read ‘Who can sign this form’ on page 1 before
completing this Declaration.
It is an offence under s136.1(1) of the Criminal Code Act
1995 to make a false or misleading statement or omission.
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