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APPLICATIONFORMAPPLICATION TO RENEW PLUMBINGLICENCE/REGISTRATION AFTER EXPIRYHERE’S WHAT YOU NEED TO DOSAVE AND COMPLETE THIS FORM ON YOUR COMPUTER. DO NOT HANDWRITE.When to use this formUse this form to apply to renew your registration or licence as a plumbing practitioner if it has expired. P lease note: The VBA cannot renew the licence or registration of a person who applies to renew it afterit has expired, unless: the person pays a late renewal fee, and the VBA is satisfied that the person did not carry out any plumbing work or specialised plumbing workafter their registration or licence expired. ChecklistPlease tick once you have completed these sections of the application form:Part A: What we need to know about youPart B: Let us know about your registration/licence you wish to renewPart C: Reason for failing to renew and how you have kept your knowledge up-to-datePart D: Work History since your registration/licence expiredPart E: Complete your National Police Check via online providerPart F: DeclarationPart G: Proof of InsurancePart H: Fee and Payment methodPart I: Photo Identification FormPart J: Statutory DeclarationPart K: Your SignatureNote: The information provided in an application must be true and correct. It is an offence under s221V of the Building Act 1993to give false or misleading information in relation to an application for the renewal of a licence or registration, and this offencecarries a maximum penalty of 50 penalty units. If you provide false or misleading information, we may refuse your application.1 / 16
How to submit your applicationPlease fill out your application form electronically, then print and sign a hard copy.Submit a hard copy of your application by mail:Or in person at the VBA: Goods Shed NorthVictorian Building AuthorityGPO Box 536Melbourne VIC 3001733 Bourke StreetDocklands VIC 3008Privacy – Collection NoticeHOW THE VBA USES AND DISCLOSES YOUR PERSONAL INFORMATIONThe Victorian Building Authority (ABN 78 790 711 883) is a body corporate established under the Building Act1993 (Vic) (VBA). The VBA’s contact information is as follows: Address: Goods Shed North, 733 Bourke Street, Docklands Vic 3008.Telephone: 1300 815 127The VBA is committed to protecting the privacy of your personal information in accordance with the Privacyand Data Protection Act 2014 and the VBA’s Privacy and Privacy Statement as amended from time to time.The personal information you provide to the VBA, including any images or photographs and any and all detailsprovided in this Application Form, will be used by the VBA to process your application. If you do not provideall or any part of the information requested in this Application Form, the VBA may be unable to process andsubsequently grant your application.The VBA may also use such information for the following purposes:(a) Research, planning, to meet the VBA’s operational requirements, assessing the merit and impact ofproposed regulatory reforms and to assist in the development and delivery of services by the VBA(whether to you personally or a member of the public).(b) Law enforcement by the VBA or other regulatory bodies, including prosecutions or disciplinary action againstyou if required.(c) The production and administration of building and plumbing practitioners’ identification cards.(d) Maintaining disciplinary and licensing and registration registers for building and plumbing practitioners(published on the VBA’s website).(e) To enable the VBA to meet its statutory obligations or functions.(f)Such other purposes as required by law or authorised under the privacy legislation.The VBA may also share your personal information with third parties including, but not limited to, differentbusiness units within the VBA, the Building Appeals Board, Consumer Affairs Victoria, the Victorian ManagedInsurance Authority, your insurer, other regulators (both in Victoria and interstate), your clients and the VBA’s staffand/or service providers who need to know such information to perform services for the VBA.The VBA will only disclose your personal information to a third party claiming to act on your behalf (for example,your solicitor or interpreter) with your prior written consent.You can request access to the personal information which the VBA holds about you. If you become aware thatpersonal information the VBA holds about you is not accurate, complete or up to date, you can ask the VBA tocorrect it.The VBA’s full Privacy Policy and Privacy Statement are available at www.vba.vic.gov.au/legal/privacy. Bysubmitting your application to the VBA, you are deemed to have acknowledged and consented to the VBAusing and disclosing your personal information as set out in this Notice.2 / 16
Part AWHAT WE NEED TO KNOW ABOUT YOU (THE APPLICANT) * INFORMATION THAT YOU MUST SUPPLYYour title*MrYour first name*MrsMsMiss(as it appears on your drivers licence or passport)Your family name*(as it appears on your drivers licence or passport)Your middle nameYour date of birth*D D / M M / YYour residential address*YYY(must not be a post office box)SuburbState or territoryPostcodePLUMBING LICENCE/REGISTRATION, RENEWAL AFTER EXPIRY- APPLICATION SD-APP-029 V3.0Your postal address (if different from residential address)Your contact details:Email address*Mobile number*Home phone numberWork phone numberFax number3 / 16
Part BLET US KNOW ABOUT THE REGISTRATION/LICENCEYOU ARE APPLYING TO RENEW* INFORMATION THAT YOU MUST SUPPLYYour application is to renew the licence/registration you held immediately before it expired.Tick the relevant registration/licence you are applying to renew* :RegistrationYour Practitioner Number*LicencePrivate Plumbing Work LicenceReduced Fee RegistrationDate licence/registration expiredD D / M M / YYYYPart CREASON FOR FAILING TO RENEW AND HOW YOU HAVE KEPT YOURKNOWLEDGE UP-TO-DATEPLUMBING LICENCE/REGISTRATION, RENEWAL AFTER EXPIRY- APPLICATION SD-APP-029 V3.0 P lease remember when answering the following, if you do not provide sufficient detail the VBA will requestfurther information from you. This will increase the processing time of your application.Please explain why you failed to apply to renew your registration/licence before it expired.If your registration/licence expired more than three years ago, please explain your reason for the extended periodof time before you applied to renew it.Are you, or have you previously been, authorised to carry out plumbing workoutside of Victoria? YesNoIf YES, please attach a certified copy of that authorisation to this application.If your registration/licence expired more than three year ago, please explain what you have done to maintain yourknowledge of current Australian plumbing standards and regulatory requirements.4 / 16
Part DWORK HISTORY SINCE YOUR REGISTRATION/LICENCE EXPIREDPlease set out your employment history since your registration or licence expired.Employer 1Employer / Supervisor nameYour Position / TitleCompanyDates of employmentFrom:D D / M M / YYYYTo:D D / M M / YYYYPLUMBING LICENCE/REGISTRATION, RENEWAL AFTER EXPIRY- APPLICATION SD-APP-029 V3.0Address of employerSuburbState or territoryEmployer primary contact numberEmployer Practitioner NumberPostcodeWhat were your exact responsibilities/duties?Did you carry out plumbing work* during the above period of employment?YesNoEmployer 2Employer / Supervisor nameYour Position / TitleCompanyDates of employmentFrom:D D / M M / YYYYTo:D D / M M / YYYYAddress of employerSuburbState or territoryEmployer primary contact numberEmployer Practitioner NumberPART D CONTINUES NEXT PAGEPostcode5 / 16
D continuedWhat were your exact responsibilities/duties?Did you carry out plumbing work* during the above period of employment?YesNoPlease attach more pages if you have more than two employers since expiry has occurred.* ‘Plumbing work’ means work that falls within the scope of work as set out in the Plumbing Regulations 2018 for the following classes ofplumbing work and specialised plumbing work. Backflow Prevention work; Mechanical Services work; Type A Appliance Servicing work; Drainage work; Refrigerated Air-Conditioning work; Type B Gasfitting work; Fire Protection work; Roofing (Stormwater) work; Type B Gasfitting Advanced work; and Gasfitting work; Sanitary work; Water Supply work. Irrigation (Non-Agricultural) work; Type A Appliance Conversionwork;PLUMBING LICENCE/REGISTRATION, RENEWAL AFTER EXPIRY- APPLICATION SD-APP-029 V3.0Part ECOMPLETE YOUR NATIONAL POLICE CHECK VIA ONLINE PROVIDER To support your application, we require you to undertake a national police check. To apply, visit the VBA police checkportal and follow the steps. Upon completion, fill out the declaration below. I declare that I have completed an Australia Post police check, on date:// Please note: If you do not utilise Australia Post police check via finvite/org?ref 60425900) to complete your policecheck, you will be charged. Please note: If you do not complete your police check, your application will be returned toyou.6 / 16
Part FDECLARATION P lease provide an explanation even if the conviction, suspension, cancellation, insolvency or disqualificationoccurred outside Victoria. If you do not provide sufficient detail the VBA will request further information from you.This will increase the processing time of your application.1. Have you, since you were last registered or licensed in Victoria, been convicted of anyoffence involving fraud, dishonesty, drug trafficking or violence?YesNo2. Have you, since you were last registered or licensed in Victoria, been convicted of anoffence under any law regulating plumbing work or specialised plumbing work?YesNo3. Have you, since you were last registered or licensed in Victoria, had your authorisationto carry out plumbing work or specialised plumbing work suspended or cancelled inany jurisdiction for any reason other than failure to renew that authorisation?YesNo4. Have you, since you were last registered or licensed in Victoria, become an insolventunder administration?YesNo(a) the Fair Trading Act 1985?YesNo(b) the Fair Trading Act 1999?YesNo(c) the Trade Practices Act 1974?YesNo(d) the Australian Consumer Law (Victoria)?YesNo(e) the Competition and Consumer Act 2010 (Cwlth)YesNoYesNoPLUMBING LICENCE/REGISTRATION, RENEWAL AFTER EXPIRY- APPLICATION SD-APP-029 V3.05. Have you, since you were last registered or licensed, been convicted of an offence against:6. Are you currently disqualified by an order of any regulatory body from acting as alicensed or registered plumber (or equivalent occupation under the jurisdiction of theregulatory body) regardless of whether this occurred in Victoria or elsewhere? If YES for any of the above questions, please answer the following questions.What were the offences or breaches that resulted in the conviction, suspension, cancellation, insolvencyor disqualification?When did the event occur?PART F CONTINUES NEXT PAGE7 / 16
F continuedIn which State or Territory did the event occur?PLUMBING LICENCE/REGISTRATION, RENEWAL AFTER EXPIRY- APPLICATION SD-APP-029 V3.0What were the circumstances leading to the conviction, suspension, cancellation, insolvency or disqualification?What penalty did you receive?What have you done to prevent the event that resulted in the conviction, suspension, cancellation, insolvency ordisqualification from occurring again? Please attach any documentation you believe may be relevant e.g. evidence that you have paid yourfines, discharged bankruptcy etc8 / 16
Part G PROOF OF INSURANCE (required if renewing a licence)Insurance detailsOnly fill in this section if you are applying to renew a licence.If you are applying to renew a licence, the VBA will write to you to ask that you provide proof of insurance if it is satisfiedthat your application should be granted.You can provide this information upfront, but be aware that the VBA may not consider it appropriate to renew yourlicence. If you are providing this information upfront, please tick the type of insurance you are providing.Type of Insurance:General InsuranceType B and GeneralPrivate PlumbingAttach a copy of your current Certificate of Currency issued by your insurer in accordance with the Gazetted MinisterialOrder, and specify the type of insurance below.Part HPLUMBING LICENCE/REGISTRATION, RENEWAL AFTER EXPIRY- APPLICATION SD-APP-029 V3.0APPLICATION FEE AND PAYMENT METHOD Please tick the box below that relates your application to calculate the fee you are required to pay before theVBA can grant your application for renewal.If you are applying to renew your registration as a plumbing practitioner, your fee is 441.90( 79.50 late fee 362.40 renewal fee)If you are applying to renew your licence as a plumbing practitioner, your fee is 400.70( 79.50 late fee 321.20 renewal fee)If you are applying to renew your private plumbing work licence, your fee is 211.80( 79.50 late fee 132.30 renewal fee)Payment Due: 79.50Late fee Renewal feeTotal authorised payment amountPlease select your payment method:credit cardchequemoney orderPlease make cheques and money orders payable to: Victorian Building AuthorityNote: The VBA does not accept cash. If you do not authorise the correct payment, this will delay the processing of your applicationPART H CONTINUES NEXT PAGE9 / 16
H continued CREDIT CARD PAYMENT DETAILSCard type:VisaMastercardAmount:(select relevant fee from page 9)Card number:Name of card holder:Card expiry date:D D / M MPLUMBING LICENCE/REGISTRATION, RENEWAL AFTER EXPIRY- APPLICATION SD-APP-029 V3.0Signature of card holder Date of signatureD D / M M / YYYY(must be a handwritten signature)10 / 16
Part I PHOTO IDENTIFICATION FORMComplete and submit this form with your application.If the VBA grants your application to renew your registration/ licence, we will issue you with an identification cardshowing your name, your photograph and the classes or specialised classes of plumbing work that you areauthorised to carry out.Your detailsFirst nameLast nameYour date of birthD D / M M / YYYYPhoto requirementsYou must provide two photos of yourself with your application.Print your name on the back of each photo.PLUMBING LICENCE/REGISTRATION, RENEWAL AFTER EXPIRY- APPLICATION SD-APP-029 V3.0Affix the two photos in the space below with double sided tape. Do not place any tape on the front of the photos.The photos must be:In the photo, you must: identical be in sharp focus in colour have a plain, light-coloured background less than six months old be uniformly lit (no shadows or reflections) 4.5–5 cm in height and 3.5–4 cm in width look directly at the camera without a border not have hair or garments covering your face good quality gloss prints on photo paper.have a neutral expression (not laughing, smiling or frowning).AFFIX PHOTOHEREAFFIX PHOTOHERE11 / 16
I continuedVERIFY YOUR IDENTITYYou are required to verify your identity as part of your application process. To do this, you will need to providefour identity documents from the appropriate categories (see Evidence of Identity Documents below).All identity documents provided to the VBA must be certified copies. A certified copy is a copy of an originaldocument that has been verified as being a true copy of an original document. This is completed by anauthorised person who can certify documents. People authorised to certify documents can be found here.Evidence of Identity DocumentsTo verify your identity, you must provide the following: At least one document from Category A; and At least one document from Category B; and At least two documents from Category C OR you can make up the remaining two documents withany unused documents from Categories A or BPLUMBING LICENCE/REGISTRATION, RENEWAL AFTER EXPIRY- APPLICATION SD-APP-029 V3.0If your identity documentation is under different names, you will need to provide one document fromthe Difference in Name Documentation section.12 / 16
I continuedTick if document providedIdentity DocumentsCategory APassport (current or expired not more than three years ago, NOT cancelled)Australian birth certificateImmicardAustralian Citizenship CertificateCategory BAustralian driver's license, Learner Permit or Provisional LicenceAustralian Government issued Proof of ID cardForeign passport (with current Australian Visa Grant Notice)Firearms Photo ID Licence (not Minor or Junior Permit/Licence)Category CPLUMBING LICENCE/REGISTRATION, RENEWAL AFTER EXPIRY- APPLICATION SD-APP-029 V3.0Medicare CardSecurity Guard or Crowd Control Photo LicencePensioner Concession CardGovernment Issued Health Care CardCommonwealth Seniors Health CardDepartment of Veterans' Affairs CardCredit card or debit cardAustralian Tertiary Student Photo ID CardWorking with Children's Check Photo IDDifference in name documentationChange of name certificate - issued by Births, Deaths and MarriagesMarriage certificate - issued by Births, Deaths and MarriagesFor office use onlyApplication reference numberPractitioner identification number13 / 16
Part JSTATUTORY DECLARATIONI,(full name of applicant)of(full residential address of applicant)(occupation)make the following statutory declaration under the Oaths and Affirmations Act 2018:The information contained in this application and all supporting documentation is true and correct andundertake to immediately advise the Victorian Building Authority (in writing) of any change in circumstanceswhich may be relevant to my registration or licence.PLUMBING LICENCE/REGISTRATION, RENEWAL AFTER EXPIRY- APPLICATION SD-APP-029 V3.0I give consent to the making of inquiries of, and the exchange of information with, the authorities of any State orTerritory regarding my activities in the relevant occupation or occupations, or otherwise regarding mattersrelevant to this notice.I declare that the contents of this statutory declaration are true and correct and I make it knowing that making astatutory declaration that I know to be untrue is an offence.By signing this, I declare that I have read and understood how the VBA manages my personal information and theVBA's Privacy policy.Signed(signature of applicant)Declared at *in the state of Victoria(town in which declaration was signed)on day of 20(day of month)(month)(year)I am an authorised statutory declaration witness and I sign this document in the presence of the personmaking the declaration:Signature of authorised statutory declaration witnessFull name and personal or professional address of authorised statutorydeclaration witnessQualification of authorised statutory declaration witnessA person authorised under section 30(2) of the Oaths and Affirmations Act 2018 to witness the signing of astatutory declaration.14 / 16
*I confirm that reasonable modifications were used in preparing this statutory declaration and that the contentsof this statutory declaration were read to the person making the statutory declaration in a way that wasappropriate to the person's circumstances.Signature of authorised statutory declaration witness*delete if not applicablePLUMBING LICENCE/REGISTRATION, RENEWAL AFTER EXPIRY- APPLICATION SD-APP-029 V3.0The person making the statutory declaration must also make an oral declaration in the presence ofthe statutory declaration witness (unless the person has a disability that prevents the person fromdoing so) by saying: I, [full name of person making declaration] of [address], declare that the contentsof this statutory declaration are true and correct.15 / 16
Part KYOUR SIGNATURE I understand the VBA may request more information from me to help decide whether to renewmy licence/registration as a plumbing practitioner. I acknowledge that it is an offence to make any false or misleading statement or provide anyfalse or misleading information to the Victorian Building Authority in relation to this application(Section 221V of the Building Act 1993).Signature of applicant Date of signatureD D / M M / YYYY(must be a handwritten signature)PLUMBING LICENCE/REGISTRATION, RENEWAL AFTER EXPIRY- APPLICATION SD-APP-029 V3.0END OF APPLICATION FORM16 / 16
offence under any law regulating plumbing work or specialised plumbing work? Yes No 3. Have you, since you were last registered or licensed in Victoria, had your authorisation to carry out plumbing work or specialised plumbing work suspended or cancelled in any jurisdiction for any reason other than failure to renew that authorisation? Yes No 4.
