Standard Departmental Fax Cover Sheet

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Valuer Review Cultural Gifts Program Section 30-210 of the Income Tax Assessment Act 1997 COMPLETING THIS FORM:  Ensure that ALL sections are completed.  Please ensure that you address all the assessment criteria thoroughly, however keep your responses concise and do not repeat information.  ATTACH Valuer Referee Reports from TWO Referees for each class of property (see section 8).  ATTACH a signed Code of Conduct for Valuers form.  ATTACH a completed Valuer Private Interests Assurance form. HOW IS THE REVIEW CONDUCTED?  The Committee on Taxation Incentives for the Arts will make an assessment of your review documentation and make a recommendation to the Secretary. The Secretary will decide whether to continue your approval as a valuer for the purposes of the Program. HOW DO WE USE THE INFORMATION YOU PROVIDE?  Any personal information you provide in this form is used for the purpose of administering the Cultural Gifts Program. Such information may be provided to the Minister for the Arts, the Committee on Taxation Incentives for the Arts, the Australian Taxation Office and any other relevant party in the administration of the program and as required by law. 1. Valuer Details Name: Postal address: Work Phone: Home Phone: Fax: Mobile: Email: 2. Do you wish to continue as an approved valuer for the Cultural Gifts Program? Yes No please continue with Section 3 please sign at page 3 and return this form so that your details can be removed from the List of Approved Valuers. 3. Below are the classes of property you are currently approved to value. Please specify any requested changes to the classes of property above.* * Please note: If you are seeking to amend or expand your class(es) of property, you will need to ensure that your referees are able to address the new class(es) as well as your existing class(es) (see Section 8). You must also not value any items November 2008 -2in your requested potential amended class(es) of property until formal approval is obtained. November 2008 -3- 4. Please provide details of your current relevant qualifications. 5. Please outline your experience in valuing property in the nominated class(es) specified at section 3. 6. Please list any public collecting institutions and/or other clients for whom you have valued property in the last five years. NOTE: By submitting this application, you give us permission to contact the persons or institutions for whom you have undertaken valuations and to seek further information in relation to your application. November 2008 -4- 7. If there is any information that may affect your standing in the professional community or your ability to perform your duties as a valuer (such as a criminal conviction, bankruptcy, civil court action, etc) please provide details below. 8. Referee Reports: Please ATTACH referee reports from at least two referees*, including one from a major public collecting institution, who are able to comment, in a professional capacity, on your competence as a valuer and your knowledge of each of the Class of Property that you are approved to value and, if applicable, that you are applying to value. The Referee Reports must be in the format of the Valuer Referee Reports which can be downloaded from the CGP website at www.arts.gov.au/cgp. * Please be sure to provide sufficient referees so that EACH class of property you have specified is verified by two referees who have the professional competence to comment on these material types. Valuer’s Signature Date The valuer should keep a copy of all forms and submit the originals of this completed form, all applicable Valuer Referee Report forms, the Code of Conduct for Valuers and the Valuer Private Interests Assurance forms to: The Secretariat Committee on Taxation Incentives for the Arts Department of the Environment, Water, Heritage and the Arts GPO Box 787 CANBERRA ACT 2601 Telephone: (02) 6275 9651 November 2008

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