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
(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 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)
(Name of Justice of the Peace / Commissioner for Declaration)
(Justice of the Peace / Commissioner for Declaration)
NOTE: IF THIS DECLARATION CANNOT BE MADE IN FULL REGISTRATION FOR A LICENCE UNDER THE
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.
OFFICE USE ONLY
DATE RECEIVED DATE PROCESSED PROCESSING OFFICER
INFORMATION VERIFIED YES / NO LICENCE ISSUED: LICENCE NUMBER: