A1

Architects Act 2004 – s92 - Application for registration as an Architect in the ACT
Application	Renewal	Reapplication

1. Applicant details

Privacy  information

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

Title

Given names

Residential address

Postal address

Business address

Home phone

Surname

Date of birth	/	/

Territory/State	Postcode

Territory/State	Postcode

Territory/State	Postcode
Business phone

information may be disclosed to other architect  registration authorities.

Note

For  applicants  applying  for registration   that   are   not registered in another State or Territory complete points 1, 2,
4 & 5.

For  applicants  applying  for registration  under  Mutual Recognition  (registered  in another  State  or  Territory)

Mobile phone	Facsimile

Email

2. Documentary evidence

Qualifications	Photo identification	1 x professional reference	
AACA APE Certificate	1 x personal reference	1 x passport size photo	

Please attach
certified copies of:

3. Registration under Mutual Recognition - documentary evidence

Please attach

complete points 1, 3, 4 & 5.

certified copies of:

Interstate registration/s	Photo identification

For  applicants  renewing  or reapplying  for  registration complete points 1, 4 & 5 and

4. Questionnaire

list    your    previous    ACT registration number below your signature .

 Office use only
   
    Fees

No	Yes

No	Yes

No	Yes

No	Yes

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?
Have you been convicted or found guilty of an offence against the Architects Act 2004 or the repealed Architects Act 1959?
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?
Have you ever had Architects Registration disqualified, cancelled or suspended under the corresponding laws of any other State or Territory?

App fee.
Lic. fee. Other

If you have answered ‘Yes’ to any of the above questions please provide details:  ........................................................................................

..............................................................................................................................................................................................................................................................................
..............................................................................................................................................................................................................................................................................

Date received
/	/

Receipt no. Licence  no.
        Receiving officer

5. Declaration

I declare that the information contained in 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.

/	/
Signature of applicant	Date

Please attach your passport size photo here if required
to complete Par t 2

Previous ACT Registration no. (if applicable)

A1	Payment details for financial year 2010-2011

NOTE:	Application fee	$112.00	
	Registration/renewal fee	$154.00	
	
A4 certificate	
$15.60	

You will receive a registration card upon approval or renewal.

(GST does not apply)

Please indicate if you wish to pay for and receive the A4 certificate

Cheques should be made payable to the “Receiver of Public Monies”.
Please provide your name and address on the back of the cheque.

Payment options
IN PERSON - present your cash, cheque, money order or credit/debit card ($5000.00 maximum payment for credit card) at the ACT Planning and Land Authority Shopfront, ground floor, south, Dame Pattie Menzies House, 16 Challis Street, Dickson, ACT (8:30 am to 4:30 pm Monday to Friday except public holidays).

BY FAX - complete the credit card details and payment details ($5000.00 maximum payment for credit card) then fax
it to ACT Planning and Land Authority on fax number (02) 6207 1925 (Mastercard and VISA accepted).

BY MAIL- enclose a cheque or money order or complete the credit card details and payment details ($5000.00
maximum payment for credit card) then post it to ACT Architects Board, ACT Planning and Land Authority, GPO Box 1908, Canberra ACT 2601.

ACT ARCHITECTS BOARD ENQUIRIES - Please call (02)6207 6288, facsimile (02) 6207 6438.

Payment authority - for fax or mail payments only (see above)

Please charge the amount of $ 	 to the:	Mastercard	Visa   of:

Name of cardholder

Card number	Expiry date	/	/

Cardholder’s
signature	Date	/	/