A2

Architects Act 2004- s92 – 
Notification - appointment of nominees

Organisation details

Organisation
name Partnership or Company
Postal address

ACN

Privacy  information

Information you are asked to provide will be used to assess your ability to hold registration

Business address

Territory/State	Postcode

Territory/State	Postcode

as an Architect in the ACT.

Business phone	Business fax

The  lawful  authority  for  the
collection of this information is the Architects Act 2004. The information may be disclosed to other architect  registration authorities.

Email/
website address
Contact

Declaration - Director/Partner

Mobile phone

Note

If a firm has only 1 nominee
they  become  the  Primary
Nominee.

If  a  firm  has  more  than  1 nominee  and  a  director  or par tner is listed as 1 of those nominees  they  become  the Primary Nominee.

If  a  firm  has  more  than  1 nominee  and  more  than  1 director  or  par tner  listed  as

As a director of the company (or partner of the partnership) I declare that the information
contained in or attached to this notification is complete and true to the best of my knowledge and hereby appoint the Primary Nominee and Nominees listed in this notification.
Print full name

/	/

Signature of applicant	Date

Primary nominee

Affix
Company Seal
Here

nominees   the   firm   must nominate  1  to  become  the Primary Nominee.

Office use only

Fees

App fee.

I (print full name) ............................................................................................................................................................ agree to the appointment of being

the Primary Nominee for ...........................................................................................................................................in relation to architectural services
.................................................................................................................................................................................................................................................................................... provided by the firm and as a (director, partner, employee).................................................................................. of the firm understand the responsibilities required by the ‘Architects Act 2004’ while I am a nominee.

/	/

Lic. fee. Other

Nominee signature	Date

Nominee

ACT Registration No.

Date received
/	/

Receipt no. Licence  no.
Receiving officer

I (print full name) ............................................................................................................................................................ agree to the appointment of being

a Nominee for ................................................................................................................................................................... in relation to architectural services

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

provided by the firm and as a (director, partner, employee).................................................................................. of the firm understand the responsibilities required by the ‘Architects Act 2004’ while I am a nominee.

/	/

Nominee Signature	Date

ACT Registration No.

A2	Nominee
I (print full name) ............................................................................................................................................................ agree to the appointment of being

a Nominee for ................................................................................................................................................................... in relation to architectural services
.................................................................................................................................................................................................................................................................................... provided by the firm and as a (director, partner, employee).................................................................................. of the firm understand the responsibilities required by the ‘Architects Act 2004’ while I am a nominee.

/	/

Nominee Signature	Date

ACT Registration No.

Nominee

I (print full name) ............................................................................................................................................................ agree to the appointment of being

a Nominee for ................................................................................................................................................................... in relation to architectural services
.................................................................................................................................................................................................................................................................................... provided by the firm and as a (director, partner, employee).................................................................................. of the firm understand the responsibilities required by the ‘Architects Act 2004’ while I am a nominee.

/	/

Nominee Signature	Date

ACT Registration No.

Payment details for financial year 2010-2011

NOTE:	Appointment of nominees - $19.70 (GST does not apply).
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	/	/