SECTION 5.
Disclosure
If you answer yes to any of the following questions, please provide full details in Attachment Section 5.
Yes No
☐ ☐ Have you been convicted in NSW or elsewhere of ANY offence that was recorded in the last 10 years?
Yes No
☐ ☐ Have you had a conviction recorded in the last 5 years for an offence of licence or certificate lending
under this Act?
Yes No
☐ ☐ Are you disqualified from holding a licence, certificate of registration, permit or other authority under
legislation administered by the Minister responsible for Fair Trading or under a corresponding law?
Yes No
☐ ☐ Do you owe an amount to the Crown for the recovery of payments from the Compensation Fund?
Yes No
☐ ☐ Do you owe a monetary penalty payable in relation to disciplinary proceedings or have you failed to
comply with a direction given by the Commissioner under the Property, Stock and Business Agents Act 2002?
SECTION 6.
Attachments
The following items must be attached to this application for progression:
• A clearly legible copy of your qualifications (not applicable if you are applying under mutual recognition
legislation)
• Proof of Identification as set out in the checklist
SECTION 7.
Declaration
I apply for the grant of a licence under the Property and Stock Agents Act 2002 and certify that the particulars
specified in this application and all attachments are, to the best of my knowledge, true and correct in every detail.
Statement under the Privacy and Personal Information Protection Act 1998.
The applicant for this licence:
1. authorises NSW Fair Trading to make any inquiries and to receive and disclose any information which
is relevant to the applicant's initial and ongoing eligibility to hold this licence;
2. acknowledges that information will be placed on a register open to the public in accordance with the
Property and Stock Agents Act 2002;
3. accepts that failure to supply information required on this application form may delay the processing of
the application and;
4. has a right to seek access to and correction of information supplied.
5
July 2020
Application for Certificate of Registration: 1 Year - PL200005-1Y, 3 Year - PL200005-3Y, 5 Year - PL200005-5Y
