Mutual Recognition Declaration by shimeiyan1


									                                                                                                                                                October 2008, Version 2

                                       Mutual Recognition Declaration Notice
                                                           Please complete the following details in BLOCK letters
1. Declaration by Applicant                      I, ____________________________________ here do solemnly and sincerely declare and affirm that:

   The Principle of Mutual Recognition is        (i)   I am applying for a licence in accordance with the mutual recognition principle under the Mutual
   that any person holding a current                   Recognition Act 1992 or the Trans-Tasman Mutual Recognition Act 1997
   occupational licence or registration in
   one State / Territory or New Zealand is
   entitled to a comparable licence or
                                                 (ii) All information contained in or attached to this notice is complete and true to the best of my
   registration in another State/ Territory or        knowledge
   New Zealand.
                                                 (iii) Any accompanying document evidencing my existing registration is the original or a complete
   A person who lodges a notice for
   registration under the mutual                       and accurate copy of the original, verified by statutory declaration
   recognition legislation pending the grant
   or refusal of registration, taken to be       (iv) I am not the subject of disciplinary proceedings in any State /Territory or New Zealand (including
   registered. Such registration is called            any preliminary investigations or actions that might lead to disciplinary proceedings)
   ‘deemed registration’.

   Deemed registration in one State /            (v) My registration in any State /Territory or New Zealand is not cancelled or currently suspended as
   Territory or New Zealand does not of              a result of disciplinary action
   itself provide a basis for registration in
   another State / Territory or New
   Zealand.                                      (vi) I am not otherwise personally prohibited from carrying out the occupation/s for which registration
                                                      is sought in any State / Territory or New Zealand and am not subject to any special conditions in
   Registration under mutual recognition              carrying out that occupation, as a result of criminal, civil or disciplinary proceedings in any State /
   includes the licensing, approval,
   admission, certification (including by
                                                      Territory or New Zealand
   way of practising certificates), or any
   other form of authorisation, of a person      (vii) I give consent to the making in inquiries of, and the exchange of information with, the Authorities
   required by or under legislation for                of any State /Territory or New Zealand regarding my activities in the occupation/s for which
   carrying on an occupation.
                                                       registration is sought or otherwise regarding matters relevant to this notice.

                                                 And I make this solemn declaration, as to the aforesaid, according to the law in this behalf and subject to the
                                                 punishment by law provided for any wilfully false statement in any such declaration.

                                                 Taken and Declared before me, at                                                     (Location)

                                                 on this day                                                                          (Day / Month / Year)

                                                 before me:
                                                                  (Name of Justice of the Peace / Commissioner for Declaration)

                                                 Signature:                                                             Date:
                                                                 (Justice of the Peace / Commissioner for Declaration)

                                                 Signature:                                                             Date:

                                                      MUTUAL RECOGNITION ACT 1992 CANNOT BE GRANTED AND ‘DEEMED’ REGISTRATION WILL NOT APPLY.

Privacy Statement - The Department of Infrastructure and Planning (DIP) respects your privacy and is committed to protecting your personal information. The
information on this form is collected for purposes related to deciding this application and monitoring compliance under the Plumbing and Drainage Act 2002(“the Act”).
This information may be stored in the Department of Infrastructure and Planning (DIP) database. If you do not wish for this to occur, please contact the Plumbers and
Drainers Board on (07) 3235 4149.
DIP may also use your information for statistical research, information provision and evaluation of Board services. Your personal information will be provided to the
financial institution which handles the Queensland Government’s EFTPOS transactions and may be disclosed to other Government Agencies, Local Government
Authorities and third parties for purposes related to this application and/or monitoring compliance with the Act. Except in these circumstances, personal information will
only be disclosed to third parties with your consent or in accordance with the Queensland Government’s Information Standard 42.
FOI: The information collected on this form will be retained as required by the Public Records Act 2002 and other relevant Acts and regulations, and is subject to the
Freedom of Information regime established by the Freedom of Information Act 1992. If you have any further questions regarding your privacy, please contact DIP’s
Privacy Contact Officer on (07) 3225 8463.

     DATE RECEIVED                                           DATE PROCESSED                                          PROCESSING OFFICER

  INFORMATION VERIFIED              YES / NO                 LICENCE ISSUED:                                          LICENCE NUMBER:


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