Application for approval of a place for performance of quarantine

2014/3020
APRIL 2014
Application for approval of a place for performance of quarantine
Form approved under section 46A of the Quarantine Act 1908
Section A: General information
Purpose of this form
1 To apply for approval as an owner or occupier to operate a quarantine approved premises
(QAP) where goods that are subject to quarantine may be treated or otherwise dealt with.
2 To change details of an existing QAP.
3 To apply for approval to operate a co-located QAP.
Before applying
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To complete this form
Electronically
Check the ICON database for import conditions.
See QAP class criteria to identify the QAP class you need to apply for.
Check postcodes to determine whether your location is appropriate for the proposed activity.
Learn about QAP conditions of approval (for exemptions see relevant QAP class criteria).
See information about fees.
You will need the latest version of Adobe Acrobat Reader to save changes to your document.
Ensure you retain copies of your application and supporting documents.
Manually
Use black or blue pen
Print in BLOCK LETTERS
Mark boxes with a tick or a cross.
Your application must
include
Post or email your
application
a completed and signed application form
proof of legal entity or a copy of a certificate issued by ASIC of the business or organisation
name
additional information required by the QAP class criteria and QAP conditions of approval.
To your nearest Department of Agriculture regional office.
Application for approval of a place for performance of quarantine
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Form identification number 2014/3020
Section B: Quarantine approved premises
1
Application type
Apply to operate a new QAP
Existing QAP approval number
Change details of existing QAP
Existing QAP approval number
Add co-located QAP(s)
Apply to operate a new QAP
and co-located QAP(s)
Section C: Applicant
The applicant is an individual, group of people, a registered partnership, an Australian registered company or government body
that is seeking approval as the operator of a QAP under section 46A of the Quarantine Act 1908.
2
Australian Business Number (ABN)
3
Name of applicant (legal entity name)
4
Status or type of applicant (legal entity type)
5
Registered business name(s) (attach a sheet if necessary)
6
Business address
Street address
Suburb/town/city
7
State
Postcode
State
Postcode
Postal address
If the same as your street address, write AS ABOVE
Suburb/town/city
8
Do you agree to your QAP details being published on the Department of Agriculture website?
No
Yes
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Form identification number 2014/3020
Section D: Management and control
9
People in management and control (attach a sheet if necessary)
Person 1 Senior manager (authority to sign this application)
Title
Given name(s)
Family name
Job title
Work phone
Mobile phone
Email
Fax
Person 2
Title
Given name(s)
Family name
Job title
Work phone
Mobile phone
Email
Fax
Person 3
Title
Given name(s)
Family name
Job title
Work phone
Mobile phone
Email
Fax
Person 4
Title
Given name(s)
Family name
Job title
Work phone
Email
Application for approval of a place for performance of quarantine
Mobile phone
Fax
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Form identification number 2014/3020
Section E: Contact person
10 Nominate a person the department can contact at the QAP
Title
Given name(s)
Family name
Business address
Suburb/town/city
State
Work phone
Mobile phone
Email
Postcode
Fax
Preferred method of contact
Email
Post
Section F: Location of premises
11 QAP location
Room number(s)
Floor/level
Street number
Street name
Suburb/town/city
Building name
State
Postcode
Section G: Class(es) of quarantine approved premises
12 Indicate the QAP class(es) you are applying for
13 List the proposed imported commodities for each class
14 List the mode of arrival of these commodities
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Form identification number 2014/3020
15 List the proposed quarantine activities
If you are not applying for a co-located QAP, go to section I.
Section H: Co-located QAP(s)
Attach information if applying for more than two co-located QAPs
16 Co-located QAP 1
Room number(s)
Floor/level
Street number
Street name
Suburb/town/city
Building name
State
Postcode
17 Indicate the co-located QAP class you are applying for
18 List the proposed imported commodities for the class
19 List the mode of arrival of these commodities
20 List the proposed quarantine activities
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Form identification number 2014/3020
21 Co-located QAP 2
Room number(s)
Floor/level
Street number
Street name
Suburb/town/city
Building name
State
Postcode
22 Indicate the co-located QAP class you are applying for
23 List the proposed imported commodities for the class
24 List the mode of arrival of these commodities
25 List the proposed quarantine activities
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Form identification number 2014/3020
Section I: Compliance
The Department of Agriculture may require the applicant to sign a written declaration under section 46A(3)(a) of the
Quarantine Act 1908, subject to Part VIIC of the Crimes Act 1914. The applicant may be asked to provide information about any
person who manages or controls, or is an occupier of, the premises under s. 46A(4)(f) of the Quarantine Act 1908, subject to
Part VIIC of the Crimes Act 1914.
26 Has the applicant and/or persons nominated as being in management or control been convicted of any
offence against the Quarantine Act 1908?
No
Yes
Attach details of the circumstances
27 Has the applicant and/or persons nominated as being in management or control been convicted of any offence against
the Customs Act 1901 in relation to importation, movement of, or interference with goods?
No
Yes
Attach details of the circumstances
28 Has the applicant and/or persons nominated as being in management or control been convicted of any offence against
the prescribed laws as determined in s. 40 of the Quarantine Regulations 2000?
No
Yes
Attach details of the circumstances
29 Has the applicant previously applied for an approval under the Quarantine Act 1908 that has been refused?
No
Yes
Attach details of the circumstances
30 Has the applicant previously been granted approval under the Quarantine Act 1908 that has been suspended
or revoked?
No
Yes
QAP approval number
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Form identification number 2014/3020
Section J: Conditions of application
a
The applicant under section 46A of the Quarantine Act 1908 is responsible for ensuring the Department of
Agriculture is notified in writing if the applicant:
i commences any process of liquidation, winding up, dissolution or bankruptcy, any form of external
administration or scheme of arrangement/s
ii proposes to assign, transfer, cease or materially reduce business operations that include the procedures
covered by this approval
iii changes persons nominated in sections D and E of this application.
b An applicant under section 46A of the Quarantine Act 1908 is responsible for complying with conditions and
procedures imposed on the approval; however:
i this does not limit the powers available to departmental officers and other officers under the Act
ii responsibilities for complying with conditions and procedures cannot be assigned, subcontracted or
transferred to another person
iii approvals subject to conditions does not constitute approval or delegation or authority to exercise any
statutory power or function or otherwise act on behalf of the Director of Quarantine, the Department of
Agriculture or any other part of the Commonwealth of Australia.
c The applicant under section 46A of the Quarantine Act 1908 is responsible for:
i ensuring compliance with all relevant conditions and the procedures carried out in relation to goods at the
approved place. The involvement of the Commonwealth or its representatives in monitoring compliance
with those procedures does not relieve or diminish their responsibility
ii payment of the fees for service imposed in accordance with section 46A(1) and section 86E of the
Quarantine Act 1908 in relation to the approved place at the time this application is submitted
iii providing information about the names and details of other persons associated with the application,
including those who may be occupiers, or in management and control of the approved place.
iv ensuring that its officers, employees, agents and contractors act consistently with, and ensure the proper
performance of, the relevant conditions and the procedures in relation to the goods at the approved place.
d Approvals under section 46A of the Quarantine Act 1908 are subject to enforceable conditions, breach of which
is a criminal offence. The conditions which apply to this approval include:
i relevant quarantine approved premises class criteria
ii Quarantine Approved Premises Conditions of Approval, except where excluded in quarantine approved
premises class criteria
iii relevant import conditions and any other conditions and directions from the department.
It is an offence for a person to contravene a condition to which their approval is subject (section 46A(8)
Quarantine Act 1908).
Section K: Applicant declaration
To be completed and signed by person 1, listed in section D of this application.
I am authorised to sign this declaration. The information supplied on this form and any other attachments are true
and correct and I am aware that giving false or misleading information is a serious offence and may be punishable by
imprisonment or a fine under the Quarantine Act 1908 or corresponding state law.
I will comply with the relevant conditions and any other requirements in relation to the approved premises.
I understand that department officers will be required to audit the premises and that these audits could be
announced or unannounced.
I will ensure that all relevant individuals who are required to carry out activities in relation to the approval granted
under Section 46A of the Quarantine Act 1908 understand their responsibilities.
Signature
Date (dd/mm/yyyy)
Full name
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Section L: Privacy notice
‘Personal information’ means any information or opinion about an identified, or reasonably identifiable, individual.
‘Sensitive personal information’ means any information or opinion about an individual’s racial or ethnic origin, political
opinion or association, religious beliefs or affiliations, philosophical beliefs, sexual preferences or practices, trade or
professional associations and memberships, union membership, criminal record, health or genetic information and
biometric information or templates.
The collection of personal information by the Department of Agriculture (the department) in relation to this form
is for the purposes of assessing your application for approval of a place for performance of quarantine and related
purposes. If the relevant personal information requested in this form is not provided by you, the department will be
unable to assess your eligibility as a quarantine approved premises.
Personal information may be disclosed to other Australian agencies, including the Australian Customs and Border
Protection Service, persons or organisations where necessary for these purposes, provided the disclosure is consistent
with relevant laws, in particular the Privacy Act 1988. Your personal information will be used and stored in accordance
with the Privacy Principles.
By completing and submitting this form you consent to the collection of all personal information, including sensitive
personal information, contained in this form.
The department’s Privacy Policy, including information about access to and correction of your personal information,
can be found on the department’s website.
To contact the department about your personal information or to make a complaint:
Phone +61 2 6272 3933
Email [email protected]
Post Privacy Contact Officer
Department of Agriculture
GPO Box 858 Canberra ACT 2601
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