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Application to renew RTO registration

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					    Application to renew RTO registration
    About this form
    You need to complete this form if you are applying to renew the registration of your national
    VET regulator (NVR) registered training organisation (RTO). Please note that this form
    must be submitted a minimum of 90 days before the expiry of your organisation’s
    registration.
    There are five sections to this application form:
    Section 1—Applicant details
    Section 2—Ownership, management structure and control of the organisation
    Section 3—Applicant history
    Section 4—RTO details, scope and operating context
    Section 5—Statutory declaration by chief executive
    You must refer to the Application guide—Application to renew RTO registration when
    preparing your application.
    Some of the questions in Section 2 require a free-text response. The text entry section will
    expand to accommodate your response as you enter it.
    Unless otherwise indicated, you must provide a response to each question
    and to each part of each question.

    Application fee
    Attach a cheque (personal, business or bank) payable to Australian Skills Quality Authority for
    the prescribed application fee to this application or fill out the Credit card information section.

    Submitting the application
    This form can be emailed to registration@asqa.gov.au or submitted as a printed application to:
    Registration
    ASQA
    GPO Box 9928
    Melbourne Vic 3001
    Your application must be accompanied by the required attachments. Incomplete
    applications or applications completed incorrectly will be returned to you for completion. A
    Checklist for submitting an application to renew RTO registration has been provided at the
    back of this form to help you ensure your application is complete.

    Assistance in completing this form
    For assistance in completing this form, please call the ASQA info line on 1300 701 801 or
    email your enquiry to enquiries@asqa.gov.au. Further information about the renewal of
    RTO registration process is available at www.asqa.gov.au/for-training-organisations.html.




    Application to renew RTO registration         July 2011                                    Page 1 of 21
Section 1:                        Applicant details
Refer to Part C of the Application guide—Application to renew RTO registration
when completing this section.



1.1            Australian Business Number
 ABN



1.2            Name of legal entity applying for registration
          Note: Special requirements exist for trusts seeking registration. Refer to the
          Application guide—Application to renew RTO registration.




1.3            Australian Company Number (if relevant)
 ACN



1.4            Type of legal entity
     Natural person (sole trader)          Pty Ltd company          Ltd company

     Incorporated association              Partnership              Trust

     Cooperative association               Government entity        Other (specify)




1.5            Registered business (trading) name/s (if relevant)




Application to renew RTO registration             July 2011                                Page 2 of 21
1.6            Address of head office of entity applying for registration

  Head office
  Street Address:
  Postal Address
  (if different from street address):
  Phone:                                           Website (if relevant):



1.7            Principal place of business of entity applying for
               registration (if different from head office)
Refer to the Application guide—Application for initial RTO registration for definition of principal
place of business.

  Principal place of business

  Street address:
  Phone:
  Contact person

  Title:                                Surname:                            Given name(s):
  If contact person is not an employee of the applicant entity,
  enter name of employer organisation:
  Position:
  Phone:                                            Email:




Application to renew RTO registration                    July 2011                           Page 3 of 21
Section 2:                        Ownership, management structure and
                                  control of the organisation
Refer to Part C of the Application guide—Application to renew RTO registration
when completing this section.



2.1            Details of all natural persons who own/are the legal
               entity applying for registration
Refer to the Application guide—Application for initial RTO registration for a definition of
executive officer and high managerial agent. Please note that all company directors and shareholders
must be listed and these details must align to records held by the Australian Securities and
Investments Commission (ASIC).



  Owner 1

  Title:                          Surname:                               Given name(s):
  Phone:                                                       Mobile:
  Email:
  Residential address:
  This person is best described as (select one):
               Owner and executive officer
               Owner and high managerial agent
        Owner and a person who will exercise a degree of control or influence over the
  management or direction of the RTO but who is not an executive officer of high managerial agent
        Owner and a person who will not exercise a degree of control or influence over the
  management or direction of the RTO and who is not an executive officer or high managerial agent
  Describe the role this person will undertake in relation to the RTO (position title alone is not
  sufficient):




  Owner 2

  Title:                          Surname:                               Given name(s):
  Phone:                                                       Mobile:
  Email:
  Residential address:
  This person is best described as (select one):
               Owner and executive officer
               Owner and high managerial agent
        Owner and a person who will exercise a degree of control or influence over the
  management or direction of the RTO but who is not an executive officer of high managerial agent




Application to renew RTO registration              July 2011                                         Page 4 of 21
        Owner and a person who will not exercise a degree of control or influence over the
  management or direction of the RTO and who is not an executive officer or high managerial agent
  Describe the role this person will undertake in relation to the RTO (position title alone is not
  sufficient):




  Owner 3

  Title:                          Surname:                               Given name(s):
  Phone:                                                       Mobile:
  Email:
  Residential address:
  This person is best described as (select one):
               Owner and executive officer
               Owner and high managerial agent
        Owner and a person who will exercise a degree of control or influence over the
  management or direction of the RTO but who is not an executive officer of high managerial agent
        Owner and a person who will not exercise a degree of control or influence over the
  management or direction of the RTO and who is not an executive officer or high managerial agent
  Describe the role this person will undertake in relation to the RTO (position title alone is not
  sufficient):




  Owner 4

  Title:                          Surname:                               Given name(s):
  Phone:                                                       Mobile:
  Email:
  Residential address:
  This person is best described as (select one):
               Owner and executive officer
               Owner and high managerial agent
        Owner and a person who will exercise a degree of control or influence over the
  management or direction of the RTO but who is not an executive officer of high managerial agent
        Owner and a person who will not exercise a degree of control or influence over the
  management or direction of the RTO and who is not an executive officer or high managerial agent
  Describe the role this person will undertake in relation to the RTO (position title alone is not
  sufficient):




                  Tick this box if additional tables are attached.




Application to renew RTO registration              July 2011                                         Page 5 of 21
2.2            Details of other entities (not natural persons) that own
               the legal entity applying to renew registration (if relevant)
Please note that all shareholders must be listed and these details must align to records held by ASIC
or other state or territory business registers as displayed on the Australian Business Register (ABR).



  Entity 1

  Name:
                               Pty Ltd company                        Ltd company
  Entity type:                 Cooperative association                Trust
                               Incorporated association               Other (specify)


  % share:


  Entity 2
  Name:
                               Pty Ltd company                        Ltd company
  Entity type:                 Cooperative association                Trust
                               Incorporated association               Other (specify)


  % share:


                  Tick this box if additional tables are attached.




Application to renew RTO registration                     July 2011                           Page 6 of 21
2.3            Details of influential non-owners of the legal entity
               applying to renew registration (if relevant)

  Person 1

  Title:                            Surname:                         Given name(s):
  Phone:                                                   Mobile:
  Email:
  Residential address:
  This person is best described as (select one):
               An executive officer but not an owner
               A high managerial agent but not an owner
        A person who will exercise a degree of control or influence over the
  management or direction of the RTO but who is not an executive officer or high
  managerial agent or an owner
  Describe the role this person will undertake in relation to the RTO (position title alone is
  not sufficient):




  Person 2

  Title:                            Surname:                         Given name(s):
  Phone:                                                   Mobile:
  Email:
  Residential address:
  This person is best described as (select one):
               An executive officer but not an owner
               A high managerial agent but not an owner
        A person who will exercise a degree of control or influence over the
  management or direction of the RTO but who is not an executive officer or high
  managerial agent or an owner
  Describe the role this person will undertake in relation to the RTO (position title alone is
  not sufficient):




                  Tick this box if additional tables are attached.




Application to renew RTO registration              July 2011                             Page 7 of 21
Section 3:                        Applicant history
Refer to Part C of the Application guide—Application for initial RTO registration
when completing this section.

3.1            Apart from the RTO for which renewal of registration is
               being sought, does any natural person or other entity
               named in Section 2 above currently hold registration as a
               RTO registered with ASQA or a state or territory
               registering body?
      No                Yes             If yes—provide details in the table below.

  Current registration
  Which person or entity?:

  Legal name of RTO:

  Trading name(s):
                                                       State or territory registering
  RTO ID number:
                                                                               body:
                                                                                To
  Current period of registration:                    From:
                                                                                 :

  ACN:                                                                       ABN:

  Chief executive of the RTO:



3.2            Is any natural person or other entity named in Section 2
               above currently associated with a RTO registered with
               ASQA or a state or territory registering body—apart from
               the RTO for which renewal of registration is being sought?

      No                Yes             If yes—provide details in the table below.

  Current association
  Which person or entity?:

  Legal name of RTO:

  Trading name(s):

  RTO ID number:                                     State or territory registering body:

  Current period of registration:                     From:                             To:

  ACN:                                                                            ABN:

  Chief executive of the RTO:




Application to renew RTO registration                    July 2011                            Page 8 of 21
3.3            Has any natural person or other entity named in Section 2
               above ever been registered as a RTO with ASQA or a
               state or territory registering body (do not include current
               registration/s held)?

      No                Yes             If yes—provide details in the table below.

  Previous registration
  Which person or entity?:

  Legal name of RTO:

  Trading name(s):
                                                       State or territory registering
  RTO ID number:
                                                                               body:
                                                                                To
  Current period of registration:                    From:
                                                                                 :

  ACN:                                                                       ABN:

  Chief executive of the RTO:

  Which person or entity?:



3.4            Has any natural person or other entity named in Section 2
               above ever been associated with an RTO registered with
               ASQA or a state or territory registering body—apart from
               the RTO for which renewal of registration is being sought?

      No                Yes             If yes—provide details in the table below.

  Previous association
  Which person or entity?:

  Legal name of RTO:

  Trading name(s):

  RTO ID number:                                      State or territory registering body:

  Current period of registration:                     From:                             To:

  ACN:                                                                               ABN:

  Chief executive of the RTO:




Application to renew RTO registration                    July 2011                            Page 9 of 21
3.5            Apart from this application, does any natural person or
               other entity named in Section 2 above have an application
               for registration currently lodged with ASQA or a state or
               territory registering body?

      No                Yes             If yes—provide details in the table below.

  Other current pending registration

  Which person or entity?:

  Legal name of RTO:

  Trading name(s):

  State or territory registering body:

  ACN:                                                        ABN:

  Chief executive of the RTO:



3.6            Apart from this application, does any natural person or
               other entity named in Section 2 above have an
               association with any entity that currently has an
               application for registration lodged with ASQA or a state or
               territory registering body?

      No                Yes             If yes—provide details in the table below.

  Other current pending registration

  Which person or entity?:

  Legal name of RTO:

  Trading name(s):

  State or territory registering body:

  ACN:                                                        ABN:

  Chief executive of the RTO:




Application to renew RTO registration                    July 2011                   Page 10 of 21
Section 4:                        Proposed RTO details, scope and operating
                                  context
Refer to Part C of the Application guide—Application to renew RTO registration
when completing this section.



4.1            Type of training organisation (based on Australian
               Vocational Education and Training Management
               Information Statistical Standard—AVETMISS—definitions.
               Select one type only)
  School                                                      Enterprise
            Government school                                        Government enterprise
            Catholic school                                          Non-government enterprise
            Independent school

            Australian technical college


  TAFE, Skills Institute or Polytechnic                       Community-based adult education
            Technical and Further Education Institute,               Community-based adult education
            Skills Institute or Polytechnic                          provider


  University                                                  Other training providers
                                                                     Education/training business or centre:
            Government university
                                                                     privately operated RTO
            Non-government Catholic university                       Professional association
            Non-government independent university                    Industry association
                                                                     Equipment/product manufacturer or
                                                                     supplier
                                                                     Other—not classified elsewhere




4.2            Chief executive (legally responsible person for
               registration)
 Chief executive contact details
 Title:                            Surname:                        Given name(s):
 Position:
 Phone:                                                       Mobile (if relevant)
 Email::                                                      Fax (if relevant)




Application to renew RTO registration             July 2011                                         Page 11 of 21
4.3            Contact for general enquiries
 General enquiries contact details (details must be provided for a person OR a group)
 Person—if a specific individual will be the contact for general enquiries:
 Title:                            Surname:                        Given name(s):
 Position:
 Phone:                                                      Mobile (if relevant)
 Email::                                                     Fax (if relevant)
 OR
 Group—if a group will be the contact for general enquiries (e.g. reception):
 Group:
 Phone:                                                      Mobile (if relevant)
 Email::                                                     Fax (if relevant)



4.4            Registration contact person
 Registration contact details
 Is this person an employee of the applicant (legal entity)?
                 Yes
                 No—insert name of employer organisation:
 Title:                            Surname:                        Given name(s):
 Position:
 Phone:                                                      Mobile (if relevant)




4.5            Planned location for the majority of delivery of training
               and/or assessment services (tick one only)
      QLD                 NSW           VIC   ACT             SA           TAS      WA    NT


                  Offshore/outside of Australia (provide the name of the country)




Application to renew RTO registration            July 2011                               Page 12 of 21
4.6            Proposed permanent delivery site/s (within and outside
               Australia, where different to head office)
             Tick this box if details of more delivery sites are attached.


 Delivery site 1
 Street address:
 Contact person
 Title:                            Surname:                       Given name(s):
 Position:
 Email::                                                          Phone:


 Delivery site 2
 Street address:
 Contact person
 Title:                            Surname:                       Given name(s):
 Position:
 Email::                                                          Phone:


 Delivery site 3
 Street address:
 Contact person
 Title:                            Surname:                       Given name(s):
 Position:
 Email::                                                          Phone:




Application to renew RTO registration                July 2011                     Page 13 of 21
4.7            Proposed scope of registration
As part of this application to renew your RTO’s registration, you may apply to retain your current
scope of registration. You may also remove qualifications, accredited courses, units of competency,
modules and skill sets from your current scope of registration.


Are you only seeking to renew your current scope of registration?          Yes go to Section 4.8
                                                                           No    continue below


Remove qualification/s, accredited course/s, unit/s of competency, modules and/or skill set/s
Use this table if you want to REMOVE any qualification, accredited course, unit of competency,
module or training package defined skill set from your RTO’s current scope of registration.
Notes: Please note if the scope of registration to be renewed includes an accredited course, you
       must attach a copy of the course owner’s permission to use the course.
             Please note that skill sets do not have national codes.




 National code of
 qualification or                  Title of qualification or
 course, unit or                   accredited course
 module
 Example: AUR31005 Determine legal aspects of automotive service and repair




Application to renew RTO registration                          July 2011                   Page 14 of 21
  Does your organisation currently deliver training and/or assessment              Yes         No
  services from multiple sites, or do you expect to do so in the future?
  Does your organisation currently deliver training and/or assessment              Yes         No
  services offshore/outside Australia, or do you expect to do so in the
  future?
  Has your organisation entered partnership or subcontracting                      Yes         No
  arrangements, or do you intend to do so in the future?
  Is your organisation a recipient of government training contracts, or do         Yes         No
  you intend to apply for such contracts in the future?
  What modes of delivery does your organisation currently use or intend to
  use in the future? (select all relevant modes)
  What modes of delivery does your organisation currently use or intend to use in the future? (select
  all relevant modes)
       Face-to-face at RTO premises                   Face-to-face at workplaces
       Online                                         Distance
  Does your organisation deliver training and/or assessment services to            Yes         No
  overseas students studying in Australia, or do you intend to do so in the
  future?
  Does your organisation currently accept fees in advance from students,           Yes         No
  or do you intend to do in the future?
  Does your organisation currently deliver training and/or assessment              Yes         No
  services to school students, or do you intend to do so in the future?
  Does your organisation currently deliver training and/or assessment              Yes         No
  services to students under the age of 18, or do you intend to do so in the
  future?
  Does your organisation currently deliver training and/or assessment              Yes         No
  services to apprentices or trainees employed under a training contract, or
  do you intend to do so in the future?



4.8            Current and recent activity

Are there students currently enrolled with your RTO?
      Yes
      No


Have students completed their training and/or assessment with your RTO within the last 12
months?
      Yes
      No


If you answer ‘Yes’ to either of the above questions, you will need to complete a Delivery
Activity Data Summary, available at www.asqa.gov.au.




Application to renew RTO registration            July 2011                                   Page 15 of 21
  Section 5:                         Statutory declaration by chief executive
  Refer to Part C of the Application guide—Application to renew RTO registration
  when completing this section.


  This statutory declaration must be completed by the chief executive of the legal entity
  applying to renew its RTO registration. If the legal entity applying is a person, that person
  must complete the declaration.




                                                     Commonwealth of Australia
                                                   STATUTORY DECLARATION
                                                   Statutory Declarations Act 1959
1. Insert the name, address and           1
   occupation of person making the
                                     I,
   declaration




                                              1.    I declare that I have read and understand the VET Quality
                                                    Framework, as amended from time to time, comprising:
                                                    (a)   the Standards for NVR Registered Training Organisations
                                                    (b)   the Australian Qualifications Framework
                                                    (c)   the Fit and Proper Person Requirements
                                                    (d)   the Financial Viability Risk Assessment Requirements
                                                    (e)   the Data Provision Requirements.


                                              2.    I declare that I understand that:
                                                    (a)   I will be required to submit to a Financial Viability Risk
                                                          Assessment to determine if my organisation meets the
                                                          financial viability requirements of the Australian Skills Quality
                                                          Authority (ASQA), and that I will need to provide statements
                                                          and evidence requested by ASQA’s contracted supplier of this
                                                          service in order for the assessment to be conducted.
                                                    (b)   the results of the Financial Viability Risk Assessment will be
                                                          taken into consideration in the assessment of my application.
                                              3.    I declare that if registration is granted I will:
                                                    (c)   accept responsibility for ensuring my organisation’s
                                                          compliance with the VET Quality Framework and the
                                                          conditions of registration as defined within Part 2, Division 1,
                                                          Subdivision B—Conditions of registration of the National
                                                          Vocational Education and Training Regulator Act 2011 (the
                                                          Act); as amended from time to time.
                                                    (d)   ensure my organisation cooperates with ASQA, as the
                                                          national VET regulator:
                                                          i.   in the conduct of audits and the monitoring of its




  Application to renew RTO registration                              July 2011                                      Page 16 of 21
                                                               operations
                                                          ii. by providing information about significant changes to its
                                                              operations
                                                          iii. by providing information about significant changes to its
                                                               ownership
                                                          iv. in the retention, archiving, retrieval and transfer of records
                                                              consistent with ASQA’s requirements
                                                          v. by providing a statement demonstrating its financial
                                                             viability and/or financial projections and/or financial
                                                             statements and/or a business plan on the request of
                                                             ASQA.


                                          4.     I declare that I understand that ASQA, as the national VET
                                                 regulator:
                                                 (a) may impose conditions on the registration of a registered
                                                     training organisation (RTO);
                                                 (b) may share information about this application with other state
                                                     and territory registering bodies and with other relevant
                                                     authorities, bodies, persons and agencies in accordance with
                                                     the Act
                                                 (c) may audit my organisation to assess compliance with the VET
                                                     Quality Framework
                                                 (d) may refuse this application if my organisation fails to provide
                                                     true and correct information of a material nature in this
                                                     application or fails to fulfill the undertakings made in this
                                                     declaration.


                                          5.     I declare that I agree to pay to ASQA, as the national VET regulator,
                                                 the registration assessment fee that I will be invoiced for once my
                                                 application is accepted by ASQA as being complete.
                                    I understand that a person who intentionally makes a false statement in a
                                    statutory declaration is guilty of an offence under section 11 of the Statutory
                                    Declarations Act 1959, and I believe that the statements in this declaration are
                                    true in every particular.
2. Signature of person making the   2
   declaration

3. Place                                              3                                                            4                  5
                                    Declared at                                                               on                 of
4. Day

5. Month and year
                                    Before me,
6. Signature of person before whom 6
   the declaration is made (see over)

7. Full name, qualification and     7
   address of the person before
   whom the declaration is made (in
   printed letters)



  Note 1 A person who intentionally makes a false statement in a statutory declaration is guilty of an offence, the punishment for which is imprisonment
  for a term of 4 years — see section 11 of the Statutory Declarations Act 1959.

  Note 2 Chapter 2 of the Criminal Code applies to all offences against the Statutory Declarations Act 1959 — see section A of the Statutory
  Declarations Act 1959.




  Application to renew RTO registration                                 July 2011                                                           Page 17 of 21
A statutory declaration under the Statutory Declarations Act 1959 may be made before–
         (1) a person who is currently licensed or registered under a law to practise in one of the
         following occupations:
                   Chiropractor                 Dentist                   Legal practitioner
                   Medical practitioner         Nurse                     Optometrist
                   Patent attorney              Pharmacist                Physiotherapist
                   Psychologist                 Trade marks attorney      Veterinary surgeon
         (2) a person who is enrolled on the roll of the Supreme Court of a State or Territory, or the
         High Court of Australia, as a legal practitioner (however described); or
         (3) a person who is in the following list:
Agent of the Australian Postal Corporation who is in charge of an office supplying postal services to
the public
Australian Consular Officer or Australian Diplomatic Officer (within the meaning of the Consular Fees
Act 1955)
Bailiff
Bank officer with 5 or more continuous years of service
Building society officer with 5 or more years of continuous service
Chief executive officer of a Commonwealth court
Clerk of a court
Commissioner for Affidavits
Commissioner for Declarations
Credit union officer with 5 or more years of continuous service
Employee of the Australian Trade Commission who is:
         (a) in a country or place outside Australia; and
         (b) authorised under paragraph 3 (d) of the Consular Fees Act 1955; and
         (c) exercising his or her function in that place
Employee of the Commonwealth who is:
         (a) in a country or place outside Australia; and
         (b) authorised under paragraph 3 (c) of the Consular Fees Act 1955; and
         (c) exercising his or her function in that place
Fellow of the National Tax Accountants’ Association
Finance company officer with 5 or more years of continuous service
Holder of a statutory office not specified in another item in this list
Judge of a court
Justice of the Peace
Magistrate
Marriage celebrant registered under Subdivision C of Division 1 of Part IV of the Marriage Act 1961
Master of a court
Member of Chartered Secretaries Australia
Member of Engineers Australia, other than at the grade of student
Member of the Association of Taxation and Management Accountants
Member of the Australasian Institute of Mining and Metallurgy
Member of the Australian Defence Force who is:
         (a) an officer; or
         (b) a non-commissioned officer within the meaning of the Defence Force Discipline Act 1982
         with 5 or more years of continuous service; or
         (c) a warrant officer within the meaning of that Act
Member of the Institute of Chartered Accountants in Australia, the Australian Society of Certified
Practising Accountants or the National Institute of Accountants
Member of:
         (a) the Parliament of the Commonwealth; or
         (b) the Parliament of a State; or




Application to renew RTO registration          July 2011                                    Page 18 of 21
          (c) a Territory legislature; or
          (d) a local government authority of a State or Territory
Minister of religion registered under Subdivision A of Division 1 of Part IV of the Marriage Act 1961
Notary public
Permanent employee of the Australian Postal Corporation with 5 or more years of continuous service
who is employed in an office supplying postal services to the public
Permanent employee of:
          (a) the Commonwealth or a Commonwealth authority; or
          (b) a State or Territory or a State or Territory authority; or
          (c) a local government authority;
with 5 or more years of continuous service who is not specified in another item in this list
Person before whom a statutory declaration may be made under the law of the State or Territory in
which the declaration is made
Police officer
Registrar, or Deputy Registrar, of a court
Senior Executive Service employee of:
          (a) the Commonwealth or a Commonwealth authority; or
          (b) a State or Territory or a State or Territory authority
Sheriff
Sheriff’s officer
Teacher employed on a full-time basis at a school or tertiary education institution




Application to renew RTO registration          July 2011                                    Page 19 of 21
Checklist for submitting an Application to renew RTO
registration
To avoid any delay in the processing of your application, please ensure that your
application is complete and check that all of the required documents have been attached.
Applications which are not accompanied by the required attachments will be returned to
your organisation for completion.


  Section 1            Applicant details                                                                Tick
  1.1 – 1.8            Full and accurate responses have been provided to all questions
  1.5                  Evidence of the type of legal entity, as described in the Application Guide,
                       is attached
  1.6                  A copy or extract of a Certificate of the Registration of a Business Name,
                       as issued by the relevant authority for each business/trading name, has
                       been attached


  Section 2            Ownership, management structure and control of the organisation
  2.1 – 2.3            Full and accurate responses have been provided to all questions
  2.1                  A Fit and Proper Person Requirements declaration has been completed by
                       each executive officer and high managerial agent and attached
  2.2                  A certificate of incorporation and historical company extract has been
                       attached for each shareholder that is a Pty Ltd or Ltd company
                       A Fit and Proper Person Requirements declaration has been completed by
                       each non-natural person that owns the legal entity applying for registration
                       and attached
  2.3                  A Fit and Proper Person Requirements declaration has been completed by
                       each influential non-owner and attached


  Section 3            Applicant history
  3.1 – 3.6            Full and accurate responses have been provided to all questions


  Section 4            RTO details, scope and operating context
  4.1 – 4.6            Full and accurate responses have been provided to all questions
  4.7                  If qualifications, accredited courses, units of competency or modules are
                       being removed, full and correct codes and titles have been used
  4.8                  Responses have been provided to all questions
  4.9                  Responses have been provided to both questions and a Delivery Activity
                       Data Summary is attached


  Section 5            Statutory declaration by chief executive
                       The statutory declaration has been signed by the chief executive and
                       witnessed by an authorised person


        General        A cheque in the amount of the prescribed application fee is included or the
                       Credit card information section of this form has been completed.




Application to renew RTO registration                  July 2011                                      Page 20 of 21
  CREDIT CARD INFORMATION
  If paying by credit card please complete the following details:
  Card type:                            MasterCard               Visa
  Card number:                                              Expiry Date:   /
  Name on card:                                             CCV:
  Signature:
  Payment                        $ 640.00                   Date:          /   /
  amount:
  Please send
  receipt to (email
  or postal
  address):




Application to renew RTO registration                July 2011                     Page 21 of 21

				
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