Send to: Apprenticeships Administration Unit
GPO Box 2317, Melbourne VIC 3001
Telephone: 1300 722 603 Fax: (03) 9637 3564
Email: [email protected]
www.vrqa.vic.gov.au
Application for Issue of a Duplicate Certificate of Completion
OR Extract from the Register
Surname:_____________________________________________ Given Names:________________________________________
(A copy of a Marriage Certificate or Deed Poll is required if your name has changed since the apprenticeship)
Date of Birth: ________ /_______ /_______ Email:_____________________________________ Phone:____________________
Name at time of apprenticeship:______________________________________________________________________________
Current Address:________________________________________________________________ Postcode:__________________
Postal Address:_________________________________________________________________ Postcode:___________________
Trade you were apprenticed in:_______________________________________________________________________________
Apprenticeship Registration Number (if known):___________________________________________
Date you commenced
the apprenticeship:………..…. /……….….../…………………
Date you completed
the apprenticeship: ………..…. /……….….../…………………
OR
Date you terminated
the apprenticeship: ………..…. /……….….../…………………
Last employer you
served the apprenticeship with:_______________________________________________________________________________
Did you pass all of the trade schooling:
Yes
No
(If yes, where possible, please provide a statement of completion from the school or college you attended or have them
complete the statement overleaf)
Do you want the Certificate laminated:
Yes
No
Apprentice Signature: ………………………………………………………………………….. Date: ………..…. /……….….../…………………
An application fee of $80.00 (inc GST) applies to both a Duplicate Certificate of Completion and an Extract from the Register.
Payment Options. Please nominate your payment method by ticking the appropriate box below
Money Order (made payable to the Victorian Registration and Qualifications Authority)
Bank Cheque (made payable to the Victorian Registration and Qualifications Authority)
Credit Card (please insert your details below)
Receipt Required
YES / NO
Card Holder Name: ________________________________________________________________________________________
Card Type: Visa / Master Card
Card Number_____________-_____________-_____________-_____________. Expiry Date ______________/ _____________
Amount: $_____________________________________
Signature _____________________________________
AAB006 v3.00 2015
STATEMENT OF COMPLETION OF COURSE
This section is to be completed by the trade school (Registered Training Organisation)
Apprentice Name: ___________________________________________ Registration No: ______________________________
Trade Completed:________________________________________________________________________________________
Date the Course was Completed: _______ /_______ / _______
This apprentice has passed all the prescribed competencies in the course for the above vocation
Signed _____________________________________
Date: _______ / ______ / ______
Registered Training
Organisation
stamp here
Office Use Only
Date received _____ /____ /____
Date issued_____ /____ /____
Date refused _______ /______ /______
Reason for refusal:________________________________________________________ ______________________________
AAB006 v3.00 2015