Application to have a conviction extinguished – applicant is the convicted person 
Spent Convictions Act 2000 – Form one

Overview of the scheme
The scheme for the extinguishing of consensual homosexual offences is established under the Spent Convictions Act 2000. The scheme allows people to apply to have a conviction for consensual homosexual sex erased permanently from their criminal record. This means that a person’s employment, appointment, licensing or travel opportunities are not affected by having a sexual offence conviction on their criminal record. If a conviction is extinguished the person will be under no obligation to disclose their prior conviction under any circumstances. Although the scheme is contained in the Spent Convictions Act 2000 it operates differently than a spent conviction.

Assistance to make an application
If you require assistance to make an application under the scheme please contact ACT Legal Aid on 1300 654 314 or civil@legalaidact.org.au.
A guide to making an application is available at www.justice.act.gov.au. 

Personal Information 
Last Name: 
First Name(s):
Street Address:
City: 
State:			Postcode: 
Email address: 
Phone Number:
Date of birth:
Gender:
What is the best way to contact you in relation to your application?

Details about the conviction
Due to the passage of time since your conviction we understand that you may not be able to recall all the following information or have access to the records requested. Please try to answer these questions to the best of your ability. 
Name at time of conviction:
Address at the time of conviction:
Date of conviction:
Court in which you were convicted: 
Offence convicted of: 
Name and birth date of other person involved in the sexual activity:

Supporting documentation
Please list and attach copies of any documents you have to support your application. Examples of documents you might attach that relate to the conviction include a newspaper article, personal correspondence or documents in relation to the conviction, a police report, a charge sheet or a copy of your criminal history. 
List of supporting documents (please attach an additional list to this application if enough space is not provided).
	Name of document	
1		
2		
3		
4		
5		

Declaration
I understand that because of me making this application officers of the Justice of Community Safety Directorate will make reasonable attempts to obtain documents related to the conviction such as police records and court documents to inform the decision maker under the scheme. 
I understand that these documents will be obtained under section 19F of the Spent Convictions Act 2000 and that officers do not require my consent to obtain this information. 
I declare that, to the best of my knowledge and belief, the information provided in this form is complete and correct. I understand that giving false or misleading information is a serious offence.
Name of applicant: 
Signature: 
Date:

Submit your application
This application should be addressed to: 
Executive Director
Legislation, Policy and Programs
GPO Box 158 
CANBERRA ACT 2601
Or alternatively email jacslpp@act.gov.au.