NO FEE
Application for Removal of Agent
from Employee Licence
Security and Investigations Agents Act 2002
Department of Justice
Consumer, Building and Occupational Services
PO Box 56, ROSNY 7018
Phone: 1300 65 44 99
Email: [email protected] Web: www.justice.tas.gov.au/licensing
NOTE: This form is usually completed by the holder of an Individual or Body Corporate licence, who is no longer the manager for
employees, and is required to have those details removed from the licence.
Part 1 - Applicant (agent/manager licence details)
Licence Number
Provide details of the Individual or the Body Corporate
licence holder who is being removed as manager.
Agent Name
Part 2 - Declaration
I confirm that I am now no longer the recorded manager / agent for the
employee licence holder/s listed below. The information supplied in this
application is true and accurate.
Full name of applicant
Applicant Signature:
Date:
Penalty for supplying and false or misleading
information
Section 27D - Security and Investigations Agents Act 2002
A person must not, in giving any information under this
Act (a) make a statement knowing it to be false or misleading;
or
(b) omit any matter from a statement knowing that
without that matter that statement is false or misleading
Part 3 - Employees to be Removed from an Agent's Licence
Provide details of all the employees being removed from
the agent's licence
Date employees stopped being
employed by the above agent
Employee name
Licence number
Employee name
Licence number
Employee name
Licence number
Employee name
Licence number
Employee name
Licence number
Employee name
Licence number
Lodging the form
Post the completed form to:
Consumer, Building and Occupational Services
PO Box 56, ROSNY 7018
Personal information protection statement
In line with the Personal Information Protection Act 2004, the Consumer, Building and Occupational Services Division of the Department of
Justice, is collecting this information so that it can determine your eligibility to obtain the requested licence. You are required to provide this
information by the Security and Investigations Agents Act 2002. If you do not provide all of the information requested then your application may
not be processed. Your personal information will be used for the primary source for which it is collected and may be disclosed to law
enforcement agencies, courts and other organisations authorised to collect it. Your basic personal information may be disclosed to other
public sector bodies where necessary for the efficient storage and use of the information. Personal information will be managed in
accordance with the Personal Information Protection Act 2004 and may be accessed by the individual to whom it relates on request to
Consumer, Building and Occupational Services. You may be charged a fee for this service.
Office use only DOC/16/38371 Expires 30 June 2018 - Security and Investigations Agents Act 2002
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