CHANGE OF AUTHORISED REPRESENTATIVE FORM
This form is to be completed and sent to NCS International as below.
It is important so that we know who to contact in your organisation and so that you are aware of
your obligations to NCSI as a part of certification.
FAX OR Sydney Reception FAX No. 1300 856 524
EMAIL TO NCS International Pty Limited EMAIL sydreception@ncsi.com.au
The application form is also available on the NCS International web site (www.ncsi.com.au)
DETAILS OF ORGANISATION
Organisation Name:
Certification Number(s):
I hereby advise that __ __________________________ (Full Name) has ceased to be the
Authorised Representative of this organisation for the above certification(s).
NOMINATION OF NEW AUTHORISED REPRESENTATIVE
I nominate the following person to represent this organisation in all matters affecting the
certification of this organisation by NCS International Pty Limited and declare that the nominated
person has the authority to commit the organisation to compliance with all certification
requirements.
Name: Position
Postal Address:
Phone: Email Fax:
Nominated by: Position
Signature: Date:
ACCEPTANCE OF NOMINATION
I, _ ____________________ (full name) hereby accept nomination as the Authorised
Representative for my organisation in all dealings with NCS International and declare that the
organisation has read and will comply with the terms and obligations detailed within the NCS
International publication G014 “Certification & Assessment Services Recognition Booklet”
available on the NCSI website.
Signature: Date:
FC4-01-03/Issue 3/March 2010 Print Date: 9 February 2012
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