"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 email@example.com 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: firstname.lastname@example.org 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: email@example.com www.lspc.nsw.gov.au ABN 93 646 090 808