Online Renewal Form

PROPERTY AGENTS BOARD OF TASMANIA

Licence Renewal 2020-2021 Online Application Form- Individual

Renewal should be submitted before 31 July 2020

* Indicates required field

Licence type *

Licence number *

Title *

First Name *

Middle Name (s) *

Last Name *

Preferred name used for marketing *

First

Last

Residential Address *

Line 1

Line 2

City

State

Zip Code

Country

Mobile Work *

Postal Address *

Line 1

Line 2

City

State

Zip Code

Country

Mobile personal *

Email - Work *

Email - Personal *

Your employing property agent (if applicable) *

Business Name - for Division 1 licence holders *

Continuing Professional Development (CPD)

Continuing Professional Development (CPD) *

CPD Code *

Name of CPD Activity *

Provider *

Activity Date *

No. of Points *

More CPD? add it here *

Disclosures by the Applicant

In the last 12 months have you been found guilty (whether or not in this State) of an offence? *

Yes No

In the last 12 months have you been charged (whether or not in this State) with an offence? *

Yes No

Are you, or in the last 12 months have you become an undischarged bankrupt or have you applied to take the benefit of any law for the relief of bankrupt or insolvent debtors, compounded with creditors or made an assignment for your remuneration for their benefit? (eg debt agreement) *

Yes No

Are you disqualified from holding a licence, certificate or registration or had a licence, certificate or other authority suspended (whether or not in this State)? *

Yes No

Declaration by the Applicant

All statements and information contained in this application are true and correct to the best of my knowledge *

Yes No

I have read and understood the information contained in this application. *

Yes No

I authorise the Property Agents Board to make any enquiries and to receive and disclose any information relevant to this application. *

Yes No

I acknowledge that specific information will be placed on a public register in accordance with the Property Agents and Land Transactions Act 2016 *

Yes No

I accept that failure to supply information required for renewal will delay the processing of the application. *

Yes No

I understand that the giving of false or misleading information is a serious offence under the Criminal Code Act 1924. *

Yes No

Licence fee

Licence fee has been paid? *

Yes Later

Bank Receipt Number *

Expected payment date *

I warrant that the contents of my Application for Licence (renewal) are true and correct and I acknowledge it will be lodged electronically when I press submit.

Submit

Licence Renewal 2020-2021 Online Application Form- Individual

Continuing Professional Development (CPD)

Disclosures by the Applicant

Declaration by the Applicant

Licence fee

I warrant that the contents of my Application for Licence (renewal) are true and correct and I acknowledge it will be lodged electronically when I press submit.

The board

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