form. - Business Licence Finder
Transcription
form. - Business Licence Finder
Application for a Live-stock Export Licence Form approved under Regulation 14 of the Australian Meat and Live-stock Industry (Export Licensing) Regulations 1998 This is the appropriate application form if you are applying to be an exporter licensed by the Department of Agriculture for the export of prescribed live-stock species (cattle, sheep, goats, buffalo, deer, and camelids) or for the renewal of your licence. 1. LIVE-STOCK EXPORT LICENCE Licence Number (if applicable) Please indicate the type of live-stock: Please indicate the international transport method: Sheep Buffalo Alpacas Sea Goats Camels Llamas Air Cattle Deer 2. APPLICANT DETAILS Title Given Name(s) Date of Birth (dd/mm/yyyy) Surname Address Suburb State Postcode Trading name ABN ACN (if applicable) Postal Address Suburb State Postcode Phone Fax Mobile Email 3. FOREIGN CONTROL If the applicant is a body corporate, and is a subsidiary of, or under the direction or financial control of, a foreign corporation, authority or organisation that has direct or indirect control of the importation of live-stock into the country in which the foreign corporation, authority or organisation was incorporated or established please name the foreign corporation, authority or organisation in the space below. Name of foreign corporation, authority or organisation DEPARTMENT OF AGRICULTURE Application for a Live-stock Export Licence Form approved under Regulation 14 of the Australian Meat and Live-stock Industry (Export Licensing) Regulations 1998 4. PARTNERSHIP DETAILS Do you operate or intend to operate the business in partnership with another individual or body corporate? If yes, please supply the name and address for each partner below (attach a sheet if necessary): Name Address Suburb State Postcode State Postcode Name Address Suburb 5. PERSONS IN MANAGEMENT AND CONTROL Details for each person in a position of management and control must be supplied. (Attach a sheet where necessary) Title Given Name(s) Date of Birth (dd/mm/yyyy) Surname Position Address Suburb Title State Postcode Given Name(s) Date of Birth (dd/mm/yyyy) Surname Position Address Suburb State Postcode DEPARTMENT OF AGRICULTURE Application for a Live-stock Export Licence Form approved under Regulation 14 of the Australian Meat and Live-stock Industry (Export Licensing) Regulations 1998 6. QUALITY ASSURANCE Does the business operate under a quality assurance program? If yes, please attach details. 7. OFFENCE DETAILS Has the applicant or any person in management and control been charged with or convicted of an offence against a law of the Commonwealth or a State or Territory, for which the maximum penalty is a period of imprisonment or a fine of at least $1,000. Yes No Yes No Yes No Yes No Yes No Yes No 8. OFFENCE DETAILS Subject to Part VIIC of the Crimes Act 1914, has the applicant or any person in management and control been convicted (within the meaning given by subsection 85ZM(1) of that Act) of an offence against a law of the Commonwealth or a State or Territory, for which the maximum penalty is a period of imprisonment or a fine of at least $1,000. 9. FEE PAYMENT DETAILS Does the applicant or any person in management and control of the business owe, or ever owed, the Commonwealth any amount by way of a fee, charge or levy payable under a law of the Commonwealth, or by way of penalty for failing to pay such a fee, charge or levy? If yes, please attach details of the circumstances. 10. EXPORT LICENCE COMPLIANCE DETAILS Has the applicant or any person in management and control of the business failed to comply with a condition of an export licence, or with an order made or a direction given under the Australian Meat and Live-stock Industry Act 1997? If yes, please attach details of the circumstances. 11. LICENCE COMPLIANCE DETAILS Has the applicant or any person in management and control of the business failed to comply with a condition of a licence of any other kind issued by the Commonwealth, a State or a Territory, or an authority of the Commonwealth, a State or a Territory? If yes, please attach details of the circumstances. 12. LICENCE REFUSAL DETAILS Has the applicant or any person in management and control of the business ever been refused a licence of any kind by the Commonwealth, a State or a Territory, or an authority of the Commonwealth, a State or a Territory? If yes, please attach details of the circumstances. ADDITIONAL INFORMATION DEPARTMENT OF AGRICULTURE Application for a Live-stock Export Licence Form approved under Regulation 14 of the Australian Meat and Live-stock Industry (Export Licensing) Regulations 1998 13. THE FOLLOWING MUST BE PROVIDED WITH THE APPLICATION a.) An operations and governance manual which sets out how the business will operate and be governed, including information about the following aspects of the business: - How the operations of the business will comply with the Australian Standards for the Export of Livestock; - The organisational structure of the business; - People management and staff training; - Risk management; - Records management; and - Compliance strategy and review. b.) Australian Federal Police criminal history checks for the applicant and each person in management and control c.) The applicant’s audited statement of assets and liabilities for previous financial year d.) The applicant’s audited statement of profit and loss for previous financial year e.) A declaration signed by the applicant (or, if the applicant is a body corporate, a director of the body corporate). See section 14 of this application. f.) A $300 licence application fee either by cheque or credit card payment (form attached). Please ensure all cheques are made out to “Department of Agriculture-Collector of Public Monies” Please send to: DEPARTMENT OF AGRICULTURE Live Animal Exports PO Box 858 Canberra ACT 2601 For applications operating or intending to operate as a partnership, the following partnership information must also be provided with the application: 1. A copy of the partnership agreement 2. The partnership’s audited financial statement of assets and liabilities for previous financial year 3. The partnership’s audited financial statement of profit and loss for previous financial year 14. DECLARATION (Must be signed by the applicant (or, if the applicant is a body corporate, a director of the body corporate). □ □ I declare that I am aware that giving false or misleading information to the Secretary for the purposes of this application is a serious offence. I agree to the terms listed in the Privacy Policy located at the end of this application. Signature: Date Name: DEPARTMENT OF AGRICULTURE Application for a Live-stock Export Licence Form approved under Regulation 14 of the Australian Meat and Live-stock Industry (Export Licensing) Regulations 1998 15. PRIVACY POLICY Personal information means any information or opinion about an identified, or reasonably identifiable, individual. Sensitive personal information means any information or opinion about an individual’s racial or ethnic origin, political opinion or association, religious beliefs or affiliations, philosophical beliefs, sexual preferences or practices, trade or professional associations and memberships, union membership, criminal record, health or genetic information and biometric information or templates. The collection of personal information by the Department of Agriculture in relation to the application to obtain a Livestock Export Licence is authorised under the Australian Meat & Live-Stock Industry (Export Licensing) Regulations 1998 for the purposes of processing information in regards to the export of live animals and related purposes. If the relevant personal information requested in this application is not provided by you, the department will be unable to process your application. Personal information may be disclosed to relevant authorities in an importing country and other Australian agencies including the Australian Maritime Safety Authority and Department of Immigration and Border Protection, persons or organisations where necessary for these purposes, provided the disclosure is consistent with relevant laws, in particular the Privacy Act 1988. Your personal information will be used and stored in accordance with the Privacy Principles. By completing and submitting this form you consent to the disclosure of all personal information, including sensitive personal information, contained in this form to the relevant authorities in the importing country. The department has not taken steps to ensure that the relevant authorities in the importing country do not breach the Privacy Principles. This means that: - relevant authorities in the importing country will not be accountable under the Privacy Act - you will not be able to seek redress under the Privacy Act - you may not be able to seek redress in the overseas jurisdiction Relevant authorities in the importing country may not be subject to any privacy obligations or to any principles similar to the Privacy Principles. The department's Privacy Policy, including information about access to and correction of your personal information is available on the departmental website at privacy policy (http://www.daff.gov.au/about/accessing-information/foi/ips/operational-information/privacypolicy). To contact the department about your personal information or to make a complaint: Telephone: Switchboard +61 2 6272 3933 Email: [email protected] Post: Privacy Contact Officer, Department of Agriculture GPO Box 858, Canberra ACT 2601. DEPARTMENT OF AGRICULTURE