Australian Capital Territory
Shopgoods Fireworks Permit 
Approved Form No 1
Approved Form AF 2003 —5
made under the
Dangerous Goods Act 1975 – Section 45 (Approved Form)

I hereby approve the attached application for Shopgoods Fireworks Purchases Permit for the purposes of Regulation 57 of the Dangerous Goods Regulations 1978. 

Chief Inspector
29 May 2003

APPLICATION for a SHOPGOODS FIREWORKS PURCHASER’S PERMIT
Dangerous Goods Act 1975

Checklist for office use only

Is Part 1 complete?
Yes      No

Identification presented?
Yes      No

ACT resident?
Yes      No

Age > 18yrs?  Yes      No

Is Part 2 complete?
Yes      No

Written approval provided
(if required)?
Yes      No

Is Part 3  signed?
Yes      No 

Application fee paid?
Yes      No

Permit Issued?
Yes      No

RAPS Code:
13-0001

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IMPORTANT!  Please read the requirements and conditions on the reverse prior to completing this form.
Note the following:
•	Each person wishing to purchase shopgoods fireworks must obtain a permit;
•	The applicant must be at least 18 years old and a resident of the ACT;
•	This application must be accompanied by the payment of the prescribed fee of $7.50;
•	A valid driver’s licence or equivalent photographic identification must be presented in order to obtain a permit;
•	If the location where the fireworks will be used is on unleased land, then written approval from the relevant Government authority must accompany this application.

Part 1- Applicant’s details (please print in BLOCK LETTERS)

Family name:				    Given names:

Residential address of the applicant:							Postcode:	 

Telephone No.:					Mobile No.:

Date of Birth: (Applicant must be at least 18 years old) 

________/________/________

Part 2- Location where the fireworks will be used

Address:							

Type of property (please tick an appropriate box):

	House			Townhouse			Public Place (approval required)

	Unit/			Other (please specify):  ________________________________
	Apartment										 	

Part 3- Declaration by applicant

I declare that, to the best of my knowledge, the information provided in this application and supporting this application is true and correct, and I have read and understood the terms and conditions for purchasing and using shopgoods fireworks:

Signature of applicant:						Date:

Office use only
Date Received:  ________/______/_____
Signature:  ________________________
Permit Number:  ___________________

The information sought on this form is required to process your application for a Shopgoods Fireworks Purchaser’s Permit authorising the purchase and use of shopgoods fireworks in the ACT.  The information may be disclosed to Commonwealth, Territory or State government agencies authorised by law.  Information provided is protected by the Privacy Act 1988.

Fees

The application fee for the permit is $7.50. 

Requirements and Conditions

The Shopgoods Fireworks Purchaser’s Permit is subject to the following main terms and conditions: 

•	The purchaser must be at least 18 years old.
•	The permit authorises the purchase and use of shopgoods fireworks only as defined under the Dangerous Goods Act 1975.
•	The permit is only valid in the Australian Capital Territory and is non-transferable.  The purchaser should retain the permit as an authority to purchase, possess and use fireworks.
•	The shopgoods fireworks may only be purchased during the 14-day sale period shown on the permit.
•	Fireworks may only be discharged on the Queen’s Birthday long weekend between the hours of 5.00pm and 10.00pm.  A penalty will apply if you are found in possession of fireworks after this period or use fireworks outside of the permitted times.
•	The shopgoods fireworks must be used by or remain under the immediate supervision of the permit holder at all times.
•	The shopgoods fireworks must be used in a manner so as not to endanger any person, animal or damage property.
•	If you intend using unleased land for fireworks, prior written approval must be obtained from the relevant Government authority and a copy submitted with this application form.  For information relating to obtaining approval for the use of unleased land telephone 6207 7132.
•	Fireworks may not be used during a total fire ban.  It is the permit holder’s responsibility to check that a total fire ban is not in place at the time of using fireworks.  For information relating to fire bans telephone 6207 8603. 
•	A person may not receive more than 50kg of shopgoods fireworks under a shopgoods fireworks purchaser’s permit without first obtaining a “License to Keep Explosives”.

A person who fails to comply with the requirements of the Dangerous Goods legislation or any condition specified in the permit is liable to prosecution or a penalty.

ACT WorkCover,
Eclipse House, Level 4				Telephone: (02) 6205 0200
197 London Circuit,				Facsimile:  (02) 6207 7249
CANBERRA CITY 2601 
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