TBC use only Application fee: This form is used for the registration of a plant Date received: $105.00 design in accordance with Regulation 243 of the Fee received: $ Work Health and Safety (National Uniform Type of application: Legislation) Regulations. Receipt no: New design Received by (TBC staff name): Please refer to the guide to plant design Alteration of registration for further information. design Applicant details Designer Person with management or control of item of plant Company ABN: name: Trading name: Contact Position title: person: Business address: Suburb: State: Postcode: Is your postal address the same as above? Yes No (If no, complete below) Postal address: Suburb: Postcode: Work Mobile number: number: Email address: Plant details Name of manufacturer: Description of Name of plant (e.g. amusement device name): Model no: Date of design or alteration: Information required for representation drawing(s) Title: Drawing number: Revision number: Location If applicant/body corporate is located outside the Northern Territory, please provide circumstance to justify the grant of registration:
TBC use only Date received: Fee received: $ Receipt no: Received by (TBC staff name): This form is used for the registration of a plant design in accordance with Regulation 243 of the Work Health and Safety (National Uniform Legislation) Regulations. Please refer to the guide to plant design registration for further information. Application fee: $105.00 Type of application: New design Alteration of design Applicant details Designer Person with management or control of item of plant Company name: ABN: Trading name: Contact person: Position title: Business address: Suburb: State: Postcode: Is your postal address the same as above? (If no, complete below) Yes No Postal address: Suburb: Postcode: Work number: Mobile number: Email address: Plant details Name of manufacturer: Description of Name of plant (e.g. amusement device name): Model no: Date of design or alteration: Information required for representation drawing(s) Title: Drawing number: Revision number: Location If applicant/body corporate is located outside the Northern Territory, please provide circumstance to justify the grant of registration:
registration-of-plant-design.docx