Address Email Phone Number Other Information DECLARATION I wish to apply for the above premises to be considered an Approved Inspection Station. I give my consent for the Department of State Growth to conduct a probity check into myself or any of my business details and to my premises being checked for suitability prior to contracting to undertake vehicle/structural inspections. Signature Name Date Personal Information Protection Statement: Personal information we collect from you for assessing your suitability to become an Authorised Inspection Station will be used by the Department for that purpose only. Your personal information may be disclosed to contractors and agents of the Department, courts and other public sector bodies or organisations authorised to collect it. This information will be managed in accordance with the Personal Information Protection Act 2004 and may be accessed by you on request to this Department. You may be charged a fee for this service. Failure to provide this information may result in your application not being processed. This page has been intentionally left blank Application to Become a Vehicle Examiner/Motor Body Examiner To be completed by applicant wishing to become a vehicle examiner Full Name Address Date of Birth Licence No and Expiry Phone No Email Qualifications: Experience:
Address Email Phone Number Other Information DECLARATION I wish to apply for the above premises to be considered an Approved Inspection Station. I give my consent for the Department of State Growth to conduct a probity check into myself or any of my business details and to my premises being checked for suitability prior to contracting to undertake vehicle/structural inspections. Signature Name Date Personal Information Protection Statement: Personal information we collect from you for assessing your suitability to become an Authorised Inspection Station will be used by the Department for that purpose only. Your personal information may be disclosed to contractors and agents of the Department, courts and other public sector bodies or organisations authorised to collect it. This information will be managed in accordance with the Personal Information Protection Act 2004 and may be accessed by you on request to this Department. You may be charged a fee for this service. Failure to provide this information may result in your application not being processed. This page has been intentionally left blank Application to Become a Vehicle Examiner/Motor Body Examiner To be completed by applicant wishing to become a vehicle examiner Full Name Address Date of Birth Licence No and Expiry Phone No Email Qualifications: Experience: