Last updated November 2019 Please check the ACECQA website to ensure that you are using the current version
© 2019 Australian Children’s Education and Care Quality Authority
Skills Assessment
Authorised Representative Declaration and Consent Form
Authorised representative declaration and consent
Please tick each clause below and sign the declaration in the presence of the witness. The witness must be a person
authorised to legally witness or certify documents.
I, (the applicant’s migration agent or authorised
representative) declare that:
I have been authorised by the applicant to discuss, request and provide information about this
application on their behalf.
I understand that providing false or misleading information is an offence and all the information I have
provided is true and correct to the best of my knowledge and is as was conveyed to me by the
applicant.
I understand that the applicant may withdraw this authority at any time.
Day Month Year
Signature of Date
authorised
representative
Day Month Year
Signature of Date
authorised
witness
Authorised witness name
(Printed)
Authorised witness occupation
or JP number
/ /
/ /
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