Fillable Notification of Change of Details (Innovation and Science Australia)

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Notification of Change of Details (Innovation and Science Australia)

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Country of origin: AUSTRALIA
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Notification of Change of Details v1.0 12032020
pg. 1
SECTION 1.
Notification of Change of Details
Property and Stock Agents Act 2002
Please select the licence you hold which we are updating details on.
□
Individual
☐ Corporation
Licence or Certificate number
First Name Surname
Corporation Name:
SECTION 2.
Please tick the box of the details you are changing and complete the particulars below (*please see
page 4 for evidence required for specific changes):
Current Details New Details
□ Name of
individual*
□ Residential
Address
□ Postal
Address
□ Phone
Number
□ Email
Address
This is the primary
channel for
correspondence
Notification of Change of Details v1.0 12032020
pg. 2
□ Business
Name*
□ Principal Place
of Business or
Employment*
□ Additional
Place of
Business*
□ Removal of
additional Place
of Business*
□ Corporation
Name*
□ Removal of
and Director*
□ New Director
☐ Partnership
details
□ Other
details
□ Other
details
SECTION 3
Declaration
I hereby provide the above changes to my certificate of registration particulars under the Property
and Stock Agents Act 2002 and certify that the particulars specified in this form and all
attachments, are to the best of my knowledge, true and correct in every detail.
Notification of Change of Details v1.0 12032020
pg. 3
Statement under the Privacy and Personal Information Protection Act 1998
The Licence holder/Director:
1. authorises NSW Fair Trading to make any inquiries and to receive and disclose any
information which is relevant to the licensee's 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 form may delay the processing of the
form 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.
This declaration must be signed by either the:
Individual Licence – by the individual licence holder or
Corporation Licence - by the Director of the Corporation.
Name (BLOCK LETTERS):
Applicant Signature: Date:
click to sign
signature
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Notification of Change of Details v1.0 12032020
pg. 4
*Change of details
Change of Name
To advise of a change of name you must provide evidence of that change of name.
• Individual change of name - provide a copy of a document evidencing the change of
name such as a Marriage Certificate or Change of Name Certificate.
• Corporation change of name - provide a copy of ASIC records confirming the change
(Note: a change of company name will only be accepted if the licensed corporations
ACN is unchanged. If the company's ACN has changed a new corporation licence will
need to be obtained.
Business Name
If you wish to advise of a business name under which you will be carrying on the business of an agent at
either the above-specified address or any additional place of business, you must provide a copy of a
document issued by the Australian Securities and Investments Commission that confirms you are the
business name holder in order for the business name to be updated on your licensing records.
Additional/Removal of place of business
Please complete the address details of the place of business you are adding or removing. This information
will be updated and appear on the NSW online property licence check facility.
Partnerships
To advise of a change in a Partnership arrangement, please complete the Notification of
Partnership Particulars form which is available on the Fair Trading website.
Change of Director
To advise of change of director/s appointed to a licensed corporation, provide a copy of Australian
Securities and Investments Commission (ASIC) records confirming the changes made and evidence of
identification for new director/s being (such as a copy of a driver licence or passport).
Please retain a copy of this form for your records.
Fair Trading will not send you confirmation that the details in this form have been recorded unless you
are advising of a change to your principal place or additional places of business.
You can confirm that changes to your principal place of employment have been completed by visiting
the NSW Fair Trading NSW online property licence check facility.
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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Notification of Change of Details (Innovation and Science Australia)

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Completed 14 June 2021

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