Application for an earlier registration date

							Application for an earlier
registration date
                       When your record starts
                       You can only record periods of service from the registration date that is approved by the
                       Long Service Payments Corporation.

                       Setting an earlier registration date in certain circumstances
                       If you performed building and construction work before your registration date an earlier
                       date may be set if you have special circumstances.
                       The setting of an earlier date will depend on whether your circumstances satisfy
                       requirements. If you would like your circumstances to be considered they need to be fully
                       detailed and an explanation given as to how you believe they prevented or caused the
                       delay in applying for registration earlier.
                       Not knowing about portable long service entitlements or the need to register with the
                       Corporation are not acceptable reasons for the setting of an earlier registration date.
                       After considering the circumstances you provide the Corporation will determine your
                       registration date.

                       Setting a registration date more than 5 years earlier than the date of your
                       request
                       Only in exceptional circumstances will your registration date be set more than 5 years
                       earlier than the date of your request.
                       The exceptional circumstances you provide need to be specific to you. They need to show a
                       significantly diminished ability to keep your long service record up to date due to extreme
                       personal or family circumstances or trauma. The reasons you give must be supported
                       by evidence, e.g. medical reports, legal documents, decrees, certificates or statutory
                       declarations and you need to attach copies of your evidence to this application.

                       Lodging a request for the setting of an earlier registration date
                       Complete the application form and return it to the address shown.

                       Recording periods of employment from your registration date

FOR CUSTOMER SERVICE   The setting of a registration date in the past does not mean that periods of employment

13 14 41               are automatically recorded from that date. You must provide employment details.
                       If you are self employed you need to lodge Self Employed Workers Certificates of Service to
EMAIL
info@lspc.nsw.gov.au   have service credited to your record.
WEB
www.lspc.nsw.gov.au    Need more information?
ADDRESS
Level 1,               If you have any further enquiries contact our Helpline on 13 14 41 .
19-21 Watt Street,
Gosford NSW 2250
WRITE
Locked Bag 3000
Central Coast MC
NSW 2252
                                   For more info call 13 14 41 or visit www.lspc.nsw.gov.au
                                                                                                                   W003 – OCT08/167
                                                APPLICATION FOR AN EARLIER                                                 *ECOS001*
Building and Construction Industry
Long Service Payments Act 1986                  REgISTRATION DATE Long Service sign and return to the
                                                                    Complete,
                                                                               Payments Corporation                            W003-001

Please fill in all details with a black or blue pen, use capital letters and avoid the edge of the box
1. PERSONAL DETAILS – You must be a registered worker before you can apply for an earlier registration date.
WORKER REgISTRATION NUMBER                                                Date of birth

 W                                                                          D             M             Y
Family name                                                                                                                  *ECOS001*

                                                                                                                             ECOS001
First name/s



Address (number and street)

                                                                                                                            *SEWCOS001*

                                                                                                                            SEWCOS001
Suburb/Town



State                                Postcode
                                                                                                                            *EWAR001*
Phone                                                            Mobile
                                                                                                                            EWAR001


2. DECLARATION FOR REqUEST
Please complete the following declaration stating the circumstances that you wish the Corporation to consider when reviewing your
application for an earlier registration date.                                                                         *W008001*
After considering the circumstances you provide, the Corporation will determine your registration date. Only in exceptional
                                                                                                                         W008001
circumstances will your registration date be set more than 5 years earlier than the date of your application. For more information please
read Setting a registration date more than 5 years earlier than the date of your request on the front page of this application.

I (write your name)                                                                                            , request that my registration

 date be set at (write date)              D           M          Y                        for the following reasons:
I understand that granting of this request does not mean that periods of employment are automatically recorded from that date.
I understand that I must provide proof of employment from my date of registration for any missing periods of service.
I make this declaration with the knowledge that a false or misleading statement may result in a penalty of up to $5,500.

I have included documentation to support my application            Yes         No
(Note: failure to provide documentation will delay the processing of your application.)

Signature                                                        Date D             M            Y

               Building and Construction Industry Long Service Payments Corporation, Locked Bag 3000, Central Coast MC NSW 2252
                    Tel: 13 14 41 Fax: (02) 9287 5685 Email: info@lspc.nsw.gov.au www.lspc.nsw.gov.au       ABN 93 646 090 808
      Need more information or assistance?
      If you need help, telephone 13 14 41. An interpreter service is available.
      General information is also available at www.lspc.nsw.gov.au




Building and Construction Industry Long Service Payments Corporation, Locked Bag 3000, Central Coast MC NSW 2252
     Tel: 13 14 41 Fax: (02) 9287 5685 Email: info@lspc.nsw.gov.au www.lspc.nsw.gov.au       ABN 93 646 090 808