form. - Business Licence Finder

Application for a
Live-stock Export Licence
Form approved under Regulation 14 of the Australian Meat and
Live-stock Industry (Export Licensing) Regulations 1998
This is the appropriate application form if you are applying to be an exporter licensed by the Department of
Agriculture for the export of prescribed live-stock species (cattle, sheep, goats, buffalo, deer, and camelids) or for the
renewal of your licence.
1. LIVE-STOCK EXPORT LICENCE
Licence Number
(if applicable)
Please indicate the type of live-stock:
Please indicate the international
transport method:
Sheep
Buffalo
Alpacas
Sea
Goats
Camels
Llamas
Air
Cattle
Deer
2. APPLICANT DETAILS
Title
Given Name(s)
Date of Birth (dd/mm/yyyy)
Surname
Address
Suburb
State
Postcode
Trading name
ABN
ACN (if applicable)
Postal Address
Suburb
State
Postcode
Phone
Fax
Mobile
Email
3. FOREIGN CONTROL
If the applicant is a body corporate, and is a subsidiary of, or under the direction or financial control of, a foreign
corporation, authority or organisation that has direct or indirect control of the importation of live-stock into the
country in which the foreign corporation, authority or organisation was incorporated or established please name the
foreign corporation, authority or organisation in the space below.
Name of foreign corporation, authority or organisation
DEPARTMENT OF AGRICULTURE
Application for a
Live-stock Export Licence
Form approved under Regulation 14 of the Australian Meat and
Live-stock Industry (Export Licensing) Regulations 1998
4. PARTNERSHIP DETAILS
Do you operate or intend to operate the business in partnership with another individual or body corporate? If yes,
please supply the name and address for each partner below (attach a sheet if necessary):
Name
Address
Suburb
State
Postcode
State
Postcode
Name
Address
Suburb
5. PERSONS IN MANAGEMENT AND CONTROL
Details for each person in a position of management and control must be supplied. (Attach a sheet where necessary)
Title
Given Name(s)
Date of Birth (dd/mm/yyyy)
Surname
Position
Address
Suburb
Title
State
Postcode
Given Name(s)
Date of Birth (dd/mm/yyyy)
Surname
Position
Address
Suburb
State
Postcode
DEPARTMENT OF AGRICULTURE
Application for a
Live-stock Export Licence
Form approved under Regulation 14 of the Australian Meat and
Live-stock Industry (Export Licensing) Regulations 1998
6. QUALITY ASSURANCE
Does the business operate under a quality assurance program? If yes, please attach details.
7. OFFENCE DETAILS
Has the applicant or any person in management and control been charged
with or convicted of an offence against a law of the Commonwealth or a
State or Territory, for which the maximum penalty is a period of
imprisonment or a fine of at least $1,000.
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
8. OFFENCE DETAILS
Subject to Part VIIC of the Crimes Act 1914, has the applicant or any person
in management and control been convicted (within the meaning given by
subsection 85ZM(1) of that Act) of an offence against a law of the
Commonwealth or a State or Territory, for which the maximum penalty is a
period of imprisonment or a fine of at least $1,000.
9. FEE PAYMENT DETAILS
Does the applicant or any person in management and control of the
business owe, or ever owed, the Commonwealth any amount by way of a
fee, charge or levy payable under a law of the Commonwealth, or by way of
penalty for failing to pay such a fee, charge or levy? If yes, please attach
details of the circumstances.
10. EXPORT LICENCE COMPLIANCE DETAILS
Has the applicant or any person in management and control of the business
failed to comply with a condition of an export licence, or with an order
made or a direction given under the Australian Meat and Live-stock Industry
Act 1997? If yes, please attach details of the circumstances.
11. LICENCE COMPLIANCE DETAILS
Has the applicant or any person in management and control of the business
failed to comply with a condition of a licence of any other kind issued by the
Commonwealth, a State or a Territory, or an authority of the
Commonwealth, a State or a Territory? If yes, please attach details of the
circumstances.
12. LICENCE REFUSAL DETAILS
Has the applicant or any person in management and control of the business
ever been refused a licence of any kind by the Commonwealth, a State or a
Territory, or an authority of the Commonwealth, a State or a Territory? If
yes, please attach details of the circumstances.
ADDITIONAL INFORMATION
DEPARTMENT OF AGRICULTURE
Application for a
Live-stock Export Licence
Form approved under Regulation 14 of the Australian Meat and
Live-stock Industry (Export Licensing) Regulations 1998
13. THE FOLLOWING MUST BE PROVIDED WITH THE APPLICATION
a.) An operations and governance manual which sets out how the business will operate and be governed,
including information about the following aspects of the business:
- How the operations of the business will comply with the Australian Standards for the Export of Livestock;
- The organisational structure of the business;
- People management and staff training;
- Risk management;
- Records management; and
- Compliance strategy and review.
b.) Australian Federal Police criminal history checks for the applicant and each person in management and
control
c.) The applicant’s audited statement of assets and liabilities for previous financial year
d.) The applicant’s audited statement of profit and loss for previous financial year
e.) A declaration signed by the applicant (or, if the applicant is a body corporate, a director of the body
corporate). See section 14 of this application.
f.) A $300 licence application fee either by cheque or credit card payment (form attached). Please ensure
all cheques are made out to “Department of Agriculture-Collector of Public Monies”
Please send to:
DEPARTMENT OF AGRICULTURE
Live Animal Exports
PO Box 858
Canberra ACT 2601
For applications operating or intending to operate as a partnership, the following partnership information
must also be provided with the application:
1. A copy of the partnership agreement
2. The partnership’s audited financial statement of assets and liabilities for previous financial year
3. The partnership’s audited financial statement of profit and loss for previous financial year
14. DECLARATION (Must be signed by the applicant (or, if the applicant is a body corporate, a director of the body
corporate).
□
□
I declare that I am aware that giving false or misleading information to the Secretary for the
purposes of this application is a serious offence.
I agree to the terms listed in the Privacy Policy located at the end of this application.
Signature:
Date
Name:
DEPARTMENT OF AGRICULTURE
Application for a
Live-stock Export Licence
Form approved under Regulation 14 of the Australian Meat and
Live-stock Industry (Export Licensing) Regulations 1998
15. PRIVACY POLICY
Personal information means any information or opinion about an identified, or reasonably identifiable,
individual.
Sensitive personal information means any information or opinion about an individual’s racial or ethnic
origin, political opinion or association, religious beliefs or affiliations, philosophical beliefs, sexual
preferences or practices, trade or professional associations and memberships, union membership, criminal
record, health or genetic information and biometric information or templates.
The collection of personal information by the Department of Agriculture in relation to the application to
obtain a Livestock Export Licence is authorised under the Australian Meat & Live-Stock Industry (Export
Licensing) Regulations 1998 for the purposes of processing information in regards to the export of live
animals and related purposes. If the relevant personal information requested in this application is not
provided by you, the department will be unable to process your application.
Personal information may be disclosed to relevant authorities in an importing country and other Australian
agencies including the Australian Maritime Safety Authority and Department of Immigration and Border
Protection, persons or organisations where necessary for these purposes, provided the disclosure is
consistent with relevant laws, in particular the Privacy Act 1988. Your personal information will be used
and stored in accordance with the Privacy Principles.
By completing and submitting this form you consent to the disclosure of all personal information, including
sensitive personal information, contained in this form to the relevant authorities in the importing country.
The department has not taken steps to ensure that the relevant authorities in the importing country do not
breach the Privacy Principles. This means that:
-
relevant authorities in the importing country will not be accountable under the Privacy Act
-
you will not be able to seek redress under the Privacy Act
-
you may not be able to seek redress in the overseas jurisdiction
Relevant authorities in the importing country may not be subject to any privacy obligations or to any
principles similar to the Privacy Principles.
The department's Privacy Policy, including information about access to and correction of your personal
information is available on the departmental website at privacy
policy (http://www.daff.gov.au/about/accessing-information/foi/ips/operational-information/privacypolicy).
To contact the department about your personal information or to make a complaint:
Telephone: Switchboard +61 2 6272 3933
Email: privacy@daff.gov.au
Post: Privacy Contact Officer,
Department of Agriculture
GPO Box 858, Canberra ACT 2601.
DEPARTMENT OF AGRICULTURE