Australian Capital Territory
Architects (Intention to use the term Architect and Registered Architect) Approval 2004
Approval Statement for
Approved Form AF2004-9
made under the 
Architects Act 2004, section 92 (Approved forms)

1	Name of instrument
	This instrument is the Architects (Intention to use the term Architect and Registered Architect) Approval 2004.
2	Commencement 
	This instrument commences on the day after notification.
3	Approval
The attached form is approved for the purpose of an interstate architect to notify the board of their intention to use the term Architect and Registered Architect in the Australian Capital Territory.

Cynthia Breheny
Chair
ACT Architects Board
24 June 2004

Privacy
Information

The information you are asked to provide will be used to assess your ability to hold registration as an Architect in the ACT. 

The lawful authority for the collection of this information is the Architects Act 2004. The information may be disclosed to other Architect Registration Authorities. 

Note

Should your registration within the state/territory of which you hold residence expire, be cancelled, suspended and/or disqualified this notification will be subject to your eligibility.

A3

Notification – Intention to Use the Term Architect and Registered Architect.

Interstate registrant Details

    Surname  __________________________________ Date of Birth __________________
          Given Names  _______________________________________________________________
Residential Address  _______________________________________________________________
		        _________________ Territory/State _________________ Postcode ________
       Postal Address  _______________________________________________________________
 	       __________________ Territory/State _________________ Postcode _______
   Business Address _______________________________________________________________
 	       __________________ Territory/State _________________ Postcode _______
           Home Phone __________________ Business Phone _______________________________

Registration details for state/territory where you hold residence 

          Mobile Phone __________________ Email ________________________________________

  State/Territory __________________________ Date first registered ________________________ Registration No. __________________________Registration expiry date ____________________ 

Please attach to this notification a certified copy of photo identification, which contains your current residential address.	

Questionnaire

Have you been bankrupt, or are applying to take the benefit of any law for the relief of bankrupt or insolvent debtors, or compounding with creditors or making an assignment of remuneration for the benefit of creditors?  No  Yes

Have you been convicted or found guilty of an offence against the Architects Act 2004 or the Repealed Architects Act 1959?  No  Yes

Have you been convicted or found guilty of an offence against a Commonwealth, Territory or State law punishable by imprisonment for 1 year or longer?  No  Yes

Have you ever had Architects registration disqualified, cancelled or suspended under the corresponding laws of any other State or Territory?  No  Yes

If you have answered yes to any of the above questions please provide details: ________________________________________________________________________________

Date Received

Date Processed

Declaration

Office Use Only

I declare that all the information contained and attached to this application is complete, accurate and true to the best of my knowledge. I understand that there are severe penalties for providing false or misleading information and am aware of my responsibilities as stipulated within the ACT Architects Act 2004.

Delivery options

Signature __________________________ Date_____________________

IN PERSON – at the ACT Building, Electrical and Plumbing Control office, ground floor, north, Dame Pattie Menzies House, 16 Challis Street, Dickson, ACT (8:30 am to 4:30 pm Monday to Friday except public holidays).
BY FAX – fax it to ACT Building, Electrical and Plumbing Control on fax number (02) 6207 6324 
BY MAIL – post it to ACT Architects Board, GPO Box 1908, Canberra ACT 2601.
ACT ARCHITECT BOARD ENQUIRIES – Please call (02) 6207 6288, facsimile (02) 6207 6324