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APPLICATION FORM - INDIVIDUAL

Contractor Licence, Building Consultancy Licence,


Qualified Supervisor Certificate or Tradesperson Certificate
HOME BUILDING SERVICE
13 32 20 www.fairtrading.nsw.gov.au/building

1. Type of Application
What type of licence or certificate are you applying for?

Individual Contractor Licence Qualified Supervisor Certificate Tradesperson Certificate (Plumbing only)

Variation to existing Licence/Certificate No. __________________ Building Consultancy Licence

Please note: Application fees are shown in the Home Building schedule of fees and charges, found at www.fairtrading.nsw.gov.au/building

A licence period of 1 year or 3 years is available. Please select 1 year OR 3 years

A 3 year licence period is NOT available for a Qualified Supervisor Certificate for the category of General Building Work

2. Details of Applicant

Family name (surname)

Given names

D a t e o f bi r t h Age M a le F e m a le
D D / M M / Y Y Y Y
Postal address

Postcode
Residential address (not PO Box)

Postcode
Home phone number Business phone number
( ) ( )
Fax number Mobile phone number
( )
Email address

Will you be trading under a business name No Please go to next section.


Yes Please complete the following details.
Registered business name

Business name number Australian business number

Please note: Applications that are incomplete, do not contain supporting documentation or include the prescribed fee, will not be accepted.

APPLICATION FORM 1
3. Category of Work
Place an ‘X’ next to the category(s) for which this application or variation is being made.

• BUILDING CONSULTANCY WORK

Pre-purchase inspections

• BUILDING WORK

General building work Supply of kit homes Kitchen, bathroom and laundry renovation
(includes garages, carports & sheds)
Swimming pool building Erection of pre-fabricated metal-framed home additions and structures
(includes all types of pools & spas)
Structural landscaping

• TRADE WORK

Bricklaying General concreting Plastering (dry) Wall & floor tiling

Carpentry Glazing Plastering (solid/wet) Waterproofing

Decorating Joinery Roof plumbing Underpinning/Piering

Demolishing Mechanical services Roof slating

Excavating Metal fabrication Roof tiling

Fencing Minor building maintenance Stonemasonry


Flooring Painting Swimming pool repairs & servicing (non-structural)

• MINOR TRADEWORK

Bitumen placement Shade sails & shade systems

Garage door installation Shower screen enclosures


Kitchen/Bathroom bench installation

• MINOR MAINTENANCE CLEANING

Pressure washing/graffitti removal/brick cleaning Resurfacing, bathroom tiles, baths etc.

Repairs non-structural

• SPECIALIST WORK

Electrical Wiring Gasfitting Plumbing – includes: Water plumbing – includes: Urban irrigation

Airconditioning LP Gasfitting • Sanitary plumbing • Urban irrigation Fire sprinkler systems

Refrigeration Advanced LP Gasfitting • Water plumbing • Fire Protection Fire protection systems

Disconnection & reconnection of fixed electrical equipment Draining

4. Current or Previous Licence


Licence/Certificate number
Do you hold or have you previously held a
No Yes
licence, certificate, registration for building,
building consultant, trade, electrical, plumbing, Date of expiry
air conditioning or refrigeration work of any kind? D D /M M / Y Y Y Y
Issuing authority

Work category

APPLICATION FORM 2
5. Qualifications, Experience and References
Please see the qualification requirements, and the Referee’s Statement Form relevant to your work category, as outlined in the Guide for Applicants or on the
internet at www.fairtrading.nsw.gov.au/building – NB: Only references presented on an OFT Referee’s Statement Form, available on
www.fairtrading.nsw.gov.au/building will be accepted.
Place an ‘X’ against the qualifications and references you hold and are supplying:

Trade qualifications Craft/proficiency certificate (if applicable)


Skills assessment results (if applicable) TAFE/University qualifications (if applicable)

Referees’ Statements Interstate/overseas authorities eg. Reciprocity certificates,


certificates of competency, licences etc.
(if applicable, please supply a certified copy)
Please note: Original documents or certified copies (as indicated above) must be attached to your application or it will not be accepted.

6. Experience History
Please note: This only applies to applications for General building work, Swimming pool building, Swimming pool repairs and servicing, Mechanical services
and all Specialist work categories. Detail your practical experience. If insufficient space, provide a separate signed and dated listing.

Period of experience Name and address of employer Type of work

/ / to / /

/ / to / /

/ / to / /

/ / to / /

/ / to / /

/ / to / /

Referees’ statements from employers/licensed supervisors covering the minimum required period of practical experience MUST accompany this
application. References supporting practical building or building trade experience may also be obtained from registered architects, engineers and
local council building surveyors.

7. Financial and Criminal History


Place an ‘X’ in the appropriate box and attach relevant documents.

(i) Have you ever been known by any other name/alias? No Yes Attach details

(ii) Have you, or any partnership or company of which you were a member or director, ever been
refused or disqualified from holding a licence, authority, certificate or registration or had any
No Yes Attach details
such instrument cancelled or suspended? (Note: this does not include your Driver’s Licence).

(iii) Have you, in the last 10 years, had a conviction for a criminal offence recorded, or are you
No Yes Attach details
now subject to a bond, or have a criminal charge pending?

(iv) Have you been declared bankrupt, been discharged from bankruptcy, entered into No Yes Attach details
arrangements with creditors or assigned your property to pay debts within the last 3 years?

(v) Have you ever been a director or manager of a company which was subject to a winding
up order, placed in receivership or administration, or under official management, had a No Yes Attach details
controller appointed, or entered into other arrangements with creditors due to insolvency?

(vi) Have you, or any partnership or company of which you were/are a member or director, been
No Yes Attach details
subject to any order of a Tribunal/Court that has not been complied with?

(vii) Have you, or any partnership or company of which you were/are a member or director, had
No Yes Attach details
any insurance claims paid against contracts entered into for residential work?

APPLICATION FORM 3
8. Home Warranty Insurance (Contractors Only)
All licence applicants for Building work categories must provide evidence from an approved insurer of:
• holding current Home Warranty Insurance, or
• a current certificate of eligibility to obtain Home Warranty Insurance
Home Warranty Insurance certificates, or certificates of eligibility, must be in the exact name of the applicant.
Alternatively, applicants may apply for an exemption from the need to hold Home Warranty Insurance. In the case of licensees granted an exemption, the
licence will be endorsed with the condition ‘ONLY FOR CONTRACTS NOT REQUIRING HOME WARRANTY INSURANCE’. Licensees with this exemption can
only contract to do work up to $12,000.
Place an ‘X’ next to the Home Warranty Insurance evidence you are supplying or exemption you are seeking:

Certificate of Home Warranty Insurance or Certificate of eligibility is attached. Yes No


Exemption sought from Home Warranty Insurance requirement. If issued, it is understood that the licence will be endorsed with a condition limiting
the extent of contracts I may enter into until I receive advice regarding eligibility from the Office of Fair Trading.

9. Declaration and Photograph


Before you sign your declaration please note the following penalties for false or misleading statements:
Under s.307A of the Crimes Act 1900 a person is guilty of an offence if she/he makes a false or misleading statement in an application for an authority or
benefit. The penalty for false or misleading application is imprisonment for 2 years, or a fine of $22,000 or both.
Under s.43(1) of the Home Building Act 1989 the Commissioner may cancel a licence if it is later discovered that a licence holder misrepresented
information in their licence application.
Read and sign the declaration below and submit your application, supporting documents, POI documents and fee for assessment.
Please note: The photograph will be used to verify your identity and will be placed on your Office of Fair Trading file.

(Enter name in BLOCK letters)


I, ________________________________, the applicant for this licence/certificate hereby authorise:
• the Office of Fair Trading to make necessary inquiries with any organisation or individual to verify any information provided in this application to
establish my identity and my eligibility for a licence or certificate
• the Office of Fair Trading to publicise or pass to other governments and police agencies in other jurisdictions details of any lost or stolen document, to
restrict its illegal use
• any organisation or individual to disclose relevant information to the Office of Fair Trading for these purposes
• the Office of Fair Trading to make any inquiries and to receive and disclose any information which is relevant to the applicant’s initial and ongoing
eligibility to hold this licence/certificate.

(Enter name in BLOCK letters)


I, ________________________________, the applicant for this licence/certificate understand that:
• it is a criminal offence under the Crimes Act 1900 to deliberately make false or misleading statements
• this application and the information provided in this form remains the property of the NSW Government
• information will be placed on a register open to the public in accordance with the Home Building Act 1989 and available under the Freedom of
Information Act 1989
• failure to supply information required on this form may delay the processing of this application
• I have a right to seek access to and correct any information I have supplied.

Glue photo in the box below


I declare that the statements made in this application are true
and correct.
The photo on the right is a true
likeness of: Signature of Applicant
Max. 36mm
Min. 32mm

_____________________
Name of Applicant

_____________________
Signature of Checking Officer
Date
D D /M M / Y Y Y Y

For Home Building Service’s Use Only Licence/Certificate number: _________________________________

APPLICATION FORM 4
10. Checklist
Applications that are incomplete, do not contain all supporting documentation or the prescribed fee, will not be accepted
.
Place an ‘X’ in the relevant box as you complete the required action and attach the required documents to your application.

Financial and criminal history documents (where applicable) At least one POI List 1 document with current photo and date of birth
(see section 7) (refer to section 7 of the Guide For Applicants)
Relevant qualification Two POI List 2 documents at least one of which shows your current
address (refer to section 7 of the Guide For Applicants)
HWI evidence (where applicable) (see section 8)

Referees’ Statements or craft/proficiency certificate. One passport quality photo


(see section 6) (see section 9)

Application fee as per the Home Building schedule of fees Read, understood and signed Declaration on page 4
(see section 9)

.
11. Office of Fair Trading or Government Access Centre Use Only

The Applicant must provide one document from Proof of Identity documents ‘List 1’ (refer to section 7 of the Guide For Applicants).
The ‘List 1’ document must show the applicant’s day, month and year of birth, current photo and signature.
Place an ‘X’ next to the box of the Proof of Identity provided:

A current Australian photo driver’s licence or other current photo card issued by a State or Territory Government agency
A current Australian passport
A current non-Australian passport

Enter details of ‘List 1’ document provided:

Document type
Original document
POI List 1 document
Document number Date of issue Expiry date Place of issue sighted by (please
Example:
print name)
Australian passport

Provide 2 documents from Proof of Identity documents ‘List 2’ (refer to section 7 of the Guide For Applicants).
One ‘List 2’ document must show the applicant’s current address.
Place an ‘X’ next to the box of the Proof of Identity provided:

A current Medicare card

A current credit card

A current passbook or account statement from a bank, building society or credit union up to 1 year old

A telephone, gas or electricity bill up to 1 year old

A water rates, council rates or land valuation notice up to 1 year old

A residential tenancy agreement

An electoral enrolment card or the evidence of enrolment not more than 2 years old

A current student identity card or a certificate or statement of enrolment up to 2 years old from an education institution

I have sighted and confirmed the Proof of Identity documents against original documents submitted with the application form.

N a m e of C h ec k i n g O f fi c er Signature of Checking Officer

Date
D D /M M / Y Y Y Y

APPLICATION FORM 5
12. Receipting Panel – for Fair Trading Centre and Government Access Centre use only

1 year 3 years
A m o u nt p ai d : M e t h o d o f p a y m e nt :
$ $

R e ce i pt n um be r : Date of receipt:

L o c a t i o n of F T C /G A C : Officer’s initial:

APPLICATION FORM 6

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