Fillable Application for a Licence - Corporation (Innovation and Science Australia)

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Application for a Licence - Corporation (Innovation and Science Australia)

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The Application for a Licence - Corporation (Innovation and Science Australia) form is 23 pages long and contains:

  • 4 signatures
  • 51 check-boxes
  • 90 other fields

Country of origin: AUSTRALIA
File type: PDF

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Application for a Licence - Corporation
Property and Stock Agents Act 2002
Checklist for new application form
Please ensure you have checked off all items on this list prior to submitting this form.
For information about your obligation to be insured under a policy of professional indemnity insurance, go to
NSW Fair Trading
The person filling out this form must be the Director or Secretary.
Identification Documents
All persons nominated in this application must attach clearly legible evidence of their identity.
Provide a copy of one of the following documents:
Australian State/Territory issued Drivers Li
cence
Australian Passport
Australian Issued Birth Certificate
Australian Issued Citizenship Certificate
Travel Visa (supported by foreign passport)
Immicard
Business Name
If you own the business that will be carried on at the specified business address and that
business will be carried on under a business name.
Provide one copy of the following:
A document issued by the Australian Securities and Investment Commission that
confirms you are the business name holder
Partnership Details
If you intend to carry on business in a partnership under the Property, Stock and Business
Agents Act 2002,
Provide one completed:
Notification of Partnership Particulars form
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Application for a Licence - Corporation: 1 Year - PL200004-1Y, 3 Year - PL200004-3Y, 5 Year - PL200004-5Y July 2020
Application for a Licence - Corporation
Property and Stock Agents Act 2002
Please complete all sections of this form, including the disclosure and declaration.
For the purposes of this application the Property and Stock Agents Act 2002 will be referred to as the Act.
SECTION 1.
Applicant Details
The person lodging this application must be the Director of the corporation
I am applying for the licence term of 1, 3, or 5 years:
1 year 3 years 5 years
Corporation Name:
Australian Company Number (ACN): Australian Business Number (ABN, if applicable):
Email Address
This is the primary channel for all correspondence
Postal Address:
If no email address is provided, all correspondence will be sent here Postcode
Preferred Telephone contact
number:
Previous Licence Details
Has the corporation held a licence under the Property, Stock and Business Agents Act 1941 or under the
Property and Stock Agents Act 2002?
Yes (please provide licence number below) No
Previous licence number:
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Application for a Licence - Corporation: 1 Year - PL200004-1Y, 3 Year - PL200004-3Y, 5 Year - PL200004-5Y July 2020
Is your corporation a franchise?
Yes (please provide details below) No
Franchisor Name Australian Company Number (ACN)
Business Address Postcode
SECTION 2.
Details of Director/Secretary
Provide the following details for each director and/or secretary of the applicant corporation. If there is insufficient space,
please provide the details of each additional director or secretary in the Attachments Section 2.
Any discrepancies between the directors/secretaries listed in this application and those recorded by the Australian
Securities and Investments Commission for the applicant corporation will delay the processing of this application.
At least one Director must be licenced under the Act.
Director 1:
First Name: Surname:
Other names you have been known by (if any) including Maiden name:
Date of Birth:
Licence Number under the Act:
Residential Address Postcode:
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Application for a Licence - Corporation: 1 Year - PL200004-1Y, 3 Year - PL200004-3Y, 5 Year - PL200004-5Y July 2020
Director 2:
First Name: Surname:
Other names you have been known by (if any) including Maiden Name:
Date of Birth
Licence Number under the Act:
Residential Address Postcode:
Secretary (if applicable):
First Name: Surname:
Other names you have been known by (if any) including Maiden name:
Date of Birth:
Licence number under the Act:
Residential Address: Postcode:
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Application for a Licence - Corporation: 1 Year - PL200004-1Y, 3 Year - PL200004-3Y, 5 Year - PL200004-5Y July 2020
SECTION 3.
Business Address
A licensee must have a registered office in New South Wales
The address specified below will be taken to be the registered office of the licensee. If however a licensee carries on
the business of an agent pursuant to a licence or other authorisation under the laws of another State at an office that
is within 50 kilometre’s of New South Wales, then the licensee may have their registered office at the interstate office
(even though it is not in New South Wales).
If the applicant intends to carry on business at more than one place of business, the address nominated below will
be taken to be the principal place of business and the registered office of the licensee for the purposes of the Act.
Street address and postcode in NSW where the Corporation intends to carry on
business: Postcode:
Business Phone Number Business Mobile Number:
SECTION 4.
Business Name
Is the corporation using a business name at the registered office?
A business name will only be added to the applicant corporation's licence record if this document has been provided.
Yes
No
If Yes, attach extract from ASIC Business Name Register.
Business Name (if applicable):
Do you have additional business names?
Yes
No
If yes, attach extract from ASIC Business Name Register.
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Application for a Licence - Corporation: 1 Year - PL200004-1Y, 3 Year - PL200004-3Y, 5 Year - PL200004-5Y July 2020
SECTION 5.
Declaration by Licensee in Charge
Name of licensee in Charge at the corporation specified
In section 1: I declare that my licence number is:
I am (please tick the applicable box):
not the licensee-in-charge of my own place of business or any other corporation or individual OR
presently the licensee-in-charge of a business owned by:
At the following place of business located at: Postcode:
and undertake to resign as licensee-in-charge of this place of business prior to the issue of the corporation licence for
which this application is being made.
Signature of nominated Licensee in Charge: Date:
SECTION 6.
Partnership Details
I am intending to carry on business in a partnership under the Act.
Yes
No
If Yes, a Notification of Partnership Particulars form must be completed and attached to this application.
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Application for a Licence - Corporation: 1 Year - PL200004-1Y, 3 Year - PL200004-3Y, 5 Year - PL200004-5Y July 2020
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SECTION 7.
Disclosure Questions
If you answer 'Yes' to any of the following questions, please complete and submit the Additional Details form with this
application
1. Has any director or person concerned with the management of the applicant corporation:
a. Yes No
Been convicted in NSW or elsewhere of ANY offence that was recorded in the last 10 years?
b. Yes No
Been convicted in the last 5 years of an offence of licence or certificate lending under this Act?
c. Yes No
the preceding 3 years, been an undischarged bankrupt or applied to take the benefit of any law
for the relief of bankrupt or insolvent debtors, compounded with his/her creditors or made an assignment of his/her
remuneration for their benefit
d. Yes No
in the preceding 3 years been a director or person concerned in the management of ANY externally-
administered body corporate (within the meaning of the Corporations Act 2001)? If Yes, provide relevant company
names and Australian Company Numbers (ACN).
e. Yes No
in the preceding 3 years ceased to be a director or person concerned in the management of ANY
corporation that became an externally-administered body corporate within 12 months of the date they ceased? If
Yes, provide relevant company names and Australian Company Numbers (ACN).
2. Is any director or person concerned with the management of the applicant corporation currently:
a. Yes No
an undischarged bankrupt?
b. Yes No
a director or person concerned in the management of ANY externally-administered body corporate
(within the meaning of the Corporations Act 2001)? If Yes, provide relevant company names and Australian
Company Numbers (ACN).
3. Is the applicant corporation or any director or person concerned with the management of the
applicant corporation:
a. Yes No
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?
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Application for a Licence - Corporation: 1 Year - PL200004-1Y, 3 Year - PL200004-3Y, 5 Year - PL200004-5Y July 2020
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Yes No
b. Yes No
the holder of a licence, certificate of registration, permit or other authority that is suspended under
legislation administered by the Minister responsible for Fair Trading or under a corresponding law?
4. Does the applicant corporation or any director or person concerned with the management of the
applicant corporation:
a. Yes No
owe an amount to the Crown for the recovery of payments from the Compensation Fund?
b.
owe a monetary penalty payable in relation to disciplinary proceedings or failed to comply with a
direction given by the Commissioner under the Act?
5. Is the applicant corporation the subject of a winding up order or the appointment of a controller or
administrator?
a. Yes No
Is the applicant corporation the subject of a winding up order or the appointment of a controller or
administrator?
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Application for a Licence - Corporation: 1 Year - PL200004-1Y, 3 Year - PL200004-3Y, 5 Year - PL200004-5Y July 2020
SECTION 8.
Attachments
Please ensure all requested documents are attached to this application.
SECTION 9.
Declaration
I, on behalf of the applicant corporation, 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.
It is an offence under the Crimes Act 1900 to make a false or misleading statement in this document. The
maximum penalty is imprisonment for two years or a fine of $22,000 or both.
Full Name of Director:
Signature of Director: Date:
Processing Time
Please allow up to 30 days for this application to be processed in accordance with NSW Fair Trading Customer Service
Standards.
Lodgement
This form and supporting documentation can be lodged via email to: propertylicensing@customerservice.nsw.gov.au
Enquiries: call NSW Fair Trading on 13 32 20
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Application for a Licence - Corporation: 1 Year - PL200004-1Y, 3 Year - PL200004-3Y, 5 Year - PL200004-5Y July 2020
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signature
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Attachments Section 2
Director 3:
First Name: Surname:
Other names you have been known by (if any including Maiden name):
Date of Birth:
Licence Number under the Act:
Residential Address: Postcode:
Director 4:
First Name: Surname:
Other names you have been known by (if any including Maiden name):
Date of Birth:
Licence Number under the Act:
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Application for a Licence - Corporation: 1 Year - PL200004-1Y, 3 Year - PL200004-3Y, 5 Year - PL200004-5Y July 2020
Residential Address: Postcode:
Secretary 2:
First Name: Surname:
Other names you have been known by (if any including Maiden name):
Date of Birth:
Licence Number under the Act:
Residential Address: Postcode:
Secretary 3:
First Name: Surname:
Other names you have been known by (if any including Maiden name):
Date of Birth:
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Application for a Licence - Corporation: 1 Year - PL200004-1Y, 3 Year - PL200004-3Y, 5 Year - PL200004-5Y July 2020
Licence Number under the Act:
Residential Address: Postcode:
SECTION 5. Attachments
Declaration by Licensee in Charge
If you have more than 1 Licensee in Charge, please complete additional details below
Name of licensee in Charge at the corporation specified
In section 1: I declare that my licence number is:
I am (please tick the applicable box):
not the licensee-in-charge of my own place of business or any other corporation or individual OR
presently the licensee-in-charge of a business owned by:
At the following place of business located at: Postcode:
and undertake to resign as licensee-in-charge of this place of business prior to the issue of the corporation licence for
which this application is being made.
I understand that the place of business specified in section 3 of this form will be updated on my individual licence
record as my business address when this corporation licence is granted.
Signature of nominated Licensee in Charge: Date:
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Application for a Licence - Corporation: 1 Year - PL200004-1Y, 3 Year - PL200004-3Y, 5 Year - PL200004-5Y July 2020
SECTION 5. Attachments cont.
Declaration by Licensee in Charge
If you have more than 1 Licensee in Charge, please complete additional details below
Name of licensee in Charge at the corporation specified
In section 1: I declare that my licence number is:
I am (please tick the applicable box):
not the licensee-in-charge of my own place of business or any other corporation or individual OR
presently the licensee-in-charge of a business owned by:
At the following place of business located at: Postcode:
and undertake to resign as licensee-in-charge of this place of business prior to the issue of the corporation licence for
which this application is being made.
I understand that the place of business specified in section 3 of this form will be updated on my individual licence
record as my business address when this corporation licence is granted.
Signature of nominated Licensee in Charge: Date:
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Application for a Licence - Corporation: 1 Year - PL200004-1Y, 3 Year - PL200004-3Y, 5 Year - PL200004-5Y July 2020
Attachments Section 7
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Application for a Licence - Corporation: 1 Year - PL200004-1Y, 3 Year - PL200004-3Y, 5 Year - PL200004-5Y July 2020
Attachments Section 7. Continued
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Application for a Licence - Corporation: 1 Year - PL200004-1Y, 3 Year - PL200004-3Y, 5 Year - PL200004-5Y July 2020
Attachments Section 7. Continued
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Application for a Licence - Corporation: 1 Year - PL200004-1Y, 3 Year - PL200004-3Y, 5 Year - PL200004-5Y July 2020
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Application for a Licence - Corporation: 1 Year - PL200004-1Y, 3 Year - PL200004-3Y, 5 Year - PL200004-5Y July 2020
Payment
A fee must be paid on lodgement of the application form.
Pay by credit card or PayPal using the following link:
www.fairtrading.nsw.gov.au/applicationpayments
Step 1 – Click on the link or type the URL into your web browser
Step 2 – Follow the instructions online to complete the payment
Step 3 – When the lodgement fee is paid online you will receive a receipt number.
Please record the receipt number below before lodging the application, not providing this
information may result in delays in processing your application.
Receipt number:
Note: If you are having difficulty lodging the application please contact NSW Fair Trading on 13 32 20.
Fees
For current licence fees click here or visit the website at https://www.fairtrading.nsw.gov.au/
help-centre/fees2/Property-and-stock-agent-fees.
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Application for a Licence - Corporation (Innovation and Science Australia)

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Completed 21 June 2021

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