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Renewal Form - MSIC Renewal Application Form

VIEWS: 18 PAGES: 8

									Maritime Security Identification Cards Australia (MSIC) Application Form




MSIC Renewal Application Form
Instructions for Applicant
Please complete each of the following steps

    1. Get copy of primary documentation signed by Certifying Officer

    2. Get copy of secondary (1 required) or tertiary documentation (2 required) signed by
       the Certifying Officer (refer to useful information on page 4 for assistance)

    3. Stick passport style photo on Page 3 and sign underneath by a certifying officer

    4. Get Operational Need letter signed by employer, or sign yourself if self employed

    5. If not Australian or New Zealand citizen, get proof of work status/residency signed by
       the Certifying Officer

    6. Get a copy of your ASIC Card (of you have one) signed by the Certifying Officer

    7. Complete AUSCHECK Application either on the attached form.

    8. Complete payment online, post a cheque or fill in the information below
       To pay via EFT: please email admin@clientview.com.au to request an invoice


Manual Payment Method payable

Please include cheque for $230.00 (2 year) (includes a $15 administration fee) or
                          $330.00 (4 year) (includes a $15 administration fee)

Or complete your Credit Card Details below:

Credit Card type: Visa, Mastercard, Bankcard

Card Number: ________________________________________
Expiry Date_______/________ CSC ________(3 digit number on back of card)
Mobile:______________________Fax:______________________
Email: ________________________________________________
I authorise a debit my credit card for the amount of
 $230.00(2 years) _____ or $330.00(4 years)

Signature_____________________________________ Date__________

Send this page and the other documents you gathered to
P.O. BOX 456
MT GAMBIER SA 5290




Page | 1                                            For assistance during business call 1300 855 960
Maritime Security Identification Cards Australia (MSIC) Application Form




Useful Information

Who can certify your documentation?
  Bailiff
  Clerk of the Court Commissioner for Affidavits
  Commissioner for Declarations
  Member of the Institute of Chartered Accountants or the Australian Society of Certified
Practising Accountants
  Justice of the Peace
  Legal Practitioner
  Magistrate
  Medical Practitioner, Dentist, Pharmacist or Nurse
  Notary Public
  Permanent employee of the Australian Postal Corporation
  Police officer
  Registrar, or Deputy Registrar, of a court
  Sheriff or Sheriffs Officer
  Teacher employed on a full-time basis at a school or tertiary education institution

Accepted forms of Identification Item Examples

Primary Documentation Certified Birth Certificate (not birth extract)
  Certified Australian Citizenship Certificate
  Foreign Certified Citizenship Certificate
  Valid Passport
  Expired Passport Not More Than Two Years Out Of Date
Secondary Documentation Australian drivers licence
  Government Issued Employee Identification Card
  Student Identification Card
Tertiary Documentation Statement from Current or Former Employer
  Certified Land Titles Record
  Land Rates Record
  Extract from the Electoral Roll by the/Intellectual Commission
Proof of Residency
  Certificate of residency
  Working Visa




Page | 2                                            For assistance during business call 1300 855 960
Maritime Security Identification Cards Australia (MSIC) Application Form

Instructions for the Certifying Officer

___________________________has applied for the Commonwealths Maritime Security
Identification Card.

As part of the process, ___________________ needs to provide certified copies
of the documents above and a recent passport style photograph.

You are requested to verify the copies against the originals and sign the Certifying Officer’s
section below.

Please complete all of the boxes, including your provider or registration number.

Each copy of the document must be certified separately and must clearly show:

The words "certified true copy of the original" and Your signature
The photograph to the right is a true likeness of
_________________________, the applicant

* Please do not sign the back of the photograph.
* Ensure that photograph does not bend when
* Head and shoulders must show in the photograph




Certifying Officer’s Details:
I hereby certify that I have sighted the original documentation and that the above photograph
is a true
representation of_________________________.

Name:
Signature
Address:
Phone:
Date:
Provider
Number:
Page | 3                                            For assistance during business call 1300 855 960
Maritime Security Identification Cards Australia (MSIC) Application Form




                                Operational Need Letter


Please have this form signed by the following form on your company letterhead (if you have
one) and have it signed by a Company Officer.

If you are self employed or seeking work requiring an MISC please complete this form
yourself.




Dear Sir/Madam,


RE: OPERATIONAL NEED TO HOLD A MARITIME SECURITY IDENTIFICATION CARD (MSIC)


Please accept this letter as evidence that ______________________________________
has the following operational need to hold an MSIC and will require unmonitored access to a
Maritime Security Zone at least once each year (tick most appropriate):

         A person whose work(employed or self employed) takes him or her into a Maritime
        Security Zone
         A representative of a maritime industry participant that has a business connection
        with a     Maritime Security Zone

          A representative of an employee association whose members work in a Maritime
        Security Zone
          A representative of an industry association whose members include a maritime
        industry participant that has a connection with a Maritime Security Zone

           A representative of an Issuing Body


Regards,
Signature______________________________________________
Date: _________________


Name and Title
_________________________________________________________________




Page | 4                                            For assistance during business call 1300 855 960
Maritime Security Identification Cards Australia (MSIC) Application Form




       The following section is only
      required to be completed if you
      have NOT completed the online
                application




Page | 5                                            For assistance during business call 1300 855 960
Maritime Security Identification Cards Australia (MSIC) Application Form




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Maritime Security Identification Cards Australia (MSIC) Application Form




Page | 7                                            For assistance during business call 1300 855 960
Maritime Security Identification Cards Australia (MSIC) Application Form




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