Fillable PAWNBROKERS AND SECOND-HAND DEALERS ACT 1996 APPLICATION FOR (Innovation and Science Australia)

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PAWNBROKERS AND SECOND-HAND DEALERS ACT 1996 APPLICATION FOR (Innovation and Science Australia)

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ABN 81 913 830 179
APPLICATION FOR A LICENCE UNDER THE
PAWNBROKERS AND SECOND-HAND DEALERS ACT 1996
Before completing this application, please read the accompanying guide notes
PART A – APPLICATION DETAILS
Select the licence duration you are applying for:
1. Is the applicant for a licence an individual or a corporation? (tick the appropriate box)
Individual
Corporation
2. What type of licence are you applying for? (tick the appropriate box)
Pawnbroker
Second-hand Dealer
Pawnbroker & Second-hand Dealer
3. How will the business be conducted? (NOTE: Pawnbrokers must only operate from a shopfront)
Shopfront
Market Stall or other place(s) to be occupied intermittently
Shopfront and Market Stall
PART B – PAYMENT & LODGEMENT DETAILS
In the case of a partnership, each partner must submit a separate licence application,
however only one partner is required to pay a fee.
1. Is it intended to operate the business as a partnership?
Yes
No
If you answered yes, are you the partner paying the fees?
Yes
No
For information on how much to pay, visit the fees section on the NSW Fair Trading website
https://www.fairtrading.nsw.gov.au/help-centre/fees2/pawnbrokers-and-second-hand-dealers-fees
For payment options please refer to the last page of this form.
Refund Policy: Sections 22 and 51 of the Licensing and Registration [Uniform Procedures] Act 2002 require that all
fees [other than any processing fee] paid in connection with an application that is refused, are to be refunded to the
applicant. Where an application has been refused by NSW Fair Trading, the appropriate refund amount will be
provided by sending a cheque to the applicant.
How to Lodge this Document
Email
businesslicensing@customerservice.nsw.gov.au
OR
In person at: Service NSW Service Centre
For your nearest Service NSW Service Centre, go to
www.service.nsw.gov.au or telephone 13 77 88
Enquiries:
Monday to Friday 8:30 am to 5:00 pm Telephone: 13 32 20
1 year
3 years 5 years
February 2021
PB200001 - Application for a Licence under the Pawnbrokers and Second-Hand Dealers Act
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USE BLOCK LETTERS WHEN COMPLETING THIS FORM
Note: If any individual (including partner, director or manager) on this application resides outside
of New South Wales, please provide a form of identification such as a copy of their current
driver’s licence, or current passport.
PART C - INDIVIDUAL APPLICANT DETAILS
Complete this part if you intend to conduct business either as a sole trader or as an individual with partners.
Once you have completed this part, proceed to Part E.
Surname: Given Names:
Former Names (if any):
Date of Birth: Place of Birth:
Residential Address:
Postcode:
Driver’s Licence No: Telephone No:
Mobile No:
Email Address to which all correspondence, including renewal applications, will be sent:
PART D – CORPORATION APPLICANT DETAILS
Complete this section if you intend to conduct business as a corporation or as a corporation with partners:
If the proposed business is to be a partnership, the corporation that will be the licence holder is to be shown
here and the remaining partners are to be shown in Part I of this form.
Corporation Name:
ACN: Date of Incorporation:
Registered Office Address
Postcode:
(Continued on next page)
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PART D – CORPORATION APPLICANT DETAILS - (continued)
ABN: Telephone No:
Email Address (if any):
If there are more than two directors, you will need to attach additional sheets
showing details of the third and any subsequent directors.
Director # 1
Surname: Given Names:
Former Names (if any):
Date of Birth: Place of Birth:
Residential Address:
Postcode:
Driver’s Licence No.: Telephone No.:
Mobile No:
Director # 2
Surname: Given Names:
Former Names (if any):
Date of Birth: Place of Birth:
Residential Address:
Postcode:
Driver’s Licence No: Telephone No:
Mobile No:
February 2021
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BUSINESS ADDRESSES - GENERAL NOTES
You must show details of all NSW premises that are to be used for both the conduct of the business and for
the storage of goods. Interstate addresses will not be accepted.
If you intend to conduct your business from a market stall or any other place occupied intermittently, you must
include the name of the market, street name and your stall number in the address (if stall numbers are not
allocated, mention this on your application).
You do not need to notify Fair Trading of any water craft not kept at business premises, however you must
keep an electronic record of the location and you may be required to provide this information on request from
Fair Trading or NSW Police.
Show details of the address that will be your principal place of business in Part E.
If you intend to carry on business at two or more locations, show details of the additional places of business
in Part G. If you are to conduct business from more than three locations, there is insufficient space on this
form and you will need to attach additional sheets showing full details of the fourth and any subsequent
business addresses.
PART E - PRINCIPAL BUSINESS ADDRESS
Business Address:
Postcode:
Telephone No:
Storage Premises Address
Postcode:
Business Name: If you intend to use a Business Name for the proposed business at these premises, provide
details below. The Business Name must be registered to the applicant (or, for a partnership, to all partners)
Business Name: Registration Number:
PART F - RECORD STORAGE ADDRESS
Will you only conduct business from a market stall or other place occupied intermittently?
Yes
No
If you answered Yes, you must nominate a location where, during normal business hours, an Authorised Officer can
inspect records required to be kept by the licensee under the Act. You only need to complete this part if you
answered Yes to the above question.
Storage Address for Records:
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PART G - ADDITIONAL BUSINESS ADDRESSES
You must show details of all premises that are to be used for both the conduct of the business and for the
storage of goods. If you intend to conduct your business from a Market stall or any other place occupied
intermittently, you must include the name of the market, street name and your stall number in the address
(if stall numbers are not allocated, mention this on your application). You do not need to notify Fair Trading
of any water craft not kept at business premises, however you must keep an electronic record of the
location and may be required to provide this information on request from Fair Trading or NSW Police.
Additional Business Address # 1:
Postcode:
Telephone:
Storage Premises Address for Additional Business Address # 1:
Postcode:
Business Name (if any) for Additional Business Address # 1: Registration Number:
Additional Business Address # 2:
Postcode:
Telephone:
Storage Premises Address for Additional Business Address # 2:
Postcode:
Business Name (if any) for Additional Business Address # 1: Registration Number:
Will you conduct business at any of these locations from a market stall or other place occupied intermittently?
Yes
No
If you answered Yes, you must nominate a location where, during normal business hours, an Authorised officer can
inspect records required to be kept by the licensee under the Act. You only need to complete this part if you
answered Yes to the above question.
Storage Address for Records:
If you intend to carry on business at more than three locations, attach additional
sheets showing full details of the fourth and any subsequent business addresses.
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PART H - EMAIL ADDRESS
Email Address to which all correspondence, including renewal applications, will be sent:
Postal Address – correspondence will only be sent to this address if an email address is not provided:
Postcode:
PART I - PARTNERSHIP DETAILS
Only complete this part if you intend to conduct business as a partnership.
EACH PARTNER NEEDS TO COMPLETE A SEPARATE APPLICATION FORM.
(Unless the other partners currently hold licences)
Provide details of all individuals or corporations who will be in partnership with you. Do not repeat the
information you have entered in Part C or D of this form. If necessary, attach additional sheets.
Surname: Given Names in Full:
Residential Address: Date of Birth:
Corporation Name: ACN (Australian Company Number):
PART J - CONTACT PERSON
If you want us to contact someone other than the applicant if any questions arise during the processing of this
application, provide their details here.
Name: Position in Organisation:
Telephone: Mobile:
Email Address (if any):
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PART K - COMPUTERISED RECORDS
All records created and maintained under sections 16 and 28 of the Pawnbrokers and Second-hand Dealers Act
1996 must be in a computerised format. Your computer must be capable of exporting and uploading record
details in a prescribed format to a database maintained by the NSW Police Service within three days of a
transaction being made. This database is accessible via the NSW Police Service Weblink system over the
Internet.
For information on record keeping, refer to the guide notes which accompany this form and to the Act and
Regulations.
PART L – HISTORY
NSW Fair Trading will conduct a criminal record check in respect of the Individual Applicant, all
Directors of a Corporation and all Managers.
Has the Applicant, or any Executive Officer or Director of a Corporation mentioned in this application, either in
NSW or elsewhere:
A. previously applied for an authorisation, whether it is described as a licence, permit, certificate of registration
or other authority under any act relating to the regulation of any business, trade or profession, industry or
occupation?
Yes
No If your answer is Yes, provide full details below.
If necessary, attach an additional sheet.
B. had any application refused, or any licence, permit, certificate of registration or other authority suspended,
revoked or cancelled?
Yes
No If your answer is Yes, provide full details below.
If necessary, attach an additional sheet.
(Continued on next page)
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PART L – HISTORY – (continued)
Has the Applicant, or any Executive Officer or Director of a Corporation mentioned in this application, either in
NSW or elsewhere:
C. had any licence, permit, certificate of registration or other authority granted which is no longer in force or
which has been suspended?
Yes
No If your answer is Yes, provide full details below.
If necessary, attach an additional sheet.
D. been subject to disciplinary action in the last ten (10) years relating to any licence, permit, certificate of
registration or other authority?
Yes
No If your answer is Yes, provide full details below.
If necessary, attach an additional sheet.
E. been investigated (or currently is being investigated) which may result in disciplinary action being taken?
Yes
No If your answer is Yes, provide full details below.
If necessary, attach an additional sheet.
F. been convicted for any offence involving fraud or dishonesty or served a term of imprisonment in the last
10 years or have been charged with any such offences and are awaiting the outcome of the proceedings?
Yes
No If your answer is Yes, provide full details below.
If necessary, attach an additional sheet.
G. entered into a recognisance, which is still in force in relation to any offence?
Yes
No If your answer is Yes, provide full details below.
If necessary, attach an additional sheet.
(Continued on next page)
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PART L – HISTORY – (continued)
Has the Applicant, or any Executive Officer or Director of a Corporation mentioned in this application, either in
NSW or elsewhere:
H. had their estate assigned for the benefit of creditors or been declared bankrupt?
Yes
No If your answer is Yes, provide full details below.
If necessary, attach an additional sheet.
I. at any time in the last 3 years, been an undischarged bankrupt, applied to take the benefit of any law for
the relief of bankrupt or insolvent debtors, compounded with his or her creditors or made an assignment of
his or her remuneration for their benefit?
Yes
No If your answer is Yes, provide full details below.
If necessary, attach an additional sheet.
J. been, at any time in the last 3 years, a secretary, director or a person concerned in the management of a
corporation when the corporation was the subject of a winding up order or when a controller or
administrator was appointed?
Yes
No If your answer is Yes, provide full details below.
If necessary, attach an additional sheet.
K. Is the applicant, or any Executive Officer or Director of a Corporation mentioned in this application, either
in NSW or elsewhere:
a secretary, director or person concerned in the management of a corporation that is the subject of a
winding up order or for which a controller or administrator has been appointed?
Yes
No If your answer is Yes, provide full details below.
If necessary, attach an additional sheet.
February 2021
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PART M - DECLARATION BY APPLICANT
INDIVIDUAL - declaration MUST be signed by the applicant.
CORPORATION - declaration MUST be signed by a Director of the corporation.
I apply for the grant of a licence under the Pawnbroker and Second-hand Dealers Act 1996 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
Pawnbroker and Second-hand Dealers Act 1996;
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.
NOTE: 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.
Signature: Date:
Full Name:
February 2021
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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.
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