Applicationforaccreditation.docVIP

Application for accreditation Section 263 of the Radiocommunications Act 1992 Instructions for completion Please read the attached notes before completing this form. Print clearly. Illegible, unclear or incomplete applications may delay processing. Applicants must complete all sections of this form and provide an Approved Deed of Indemnity Note: A Deed of Indemnity is not required if the accreditation sought is for the purposes of work undertaken as a Commonwealth employee of an agency governed by the Public Governance, Performance and Accountability Act 2013. Successful applicants will be given accreditation to issue both frequency assignment and interference impact certificates. Please select from the choices below if you do not want to be issued with accreditation for one of these: Do not give me accreditation to issue frequency assignment certificates subs 100 4A of the Radiocommunications Act 1992 . Do not give me accreditation to issue interference impact certificates subs 145 3 of the Radiocommunications Act 1992 . Application fee: $476.00 Applicants will be sent a tax invoice for the application fee upon receipt of their completed application by the ACMA. Send the completed form to: Manager Licence Issue and Allocation Section Australian Communications and Media Authority PO Box 78 Belconnen ACT 2616 General enquiries: Telephone: 1300 850 115 Facsimile: 02 6219 5347 Email: info@acma.gov.au The information that must be provided on or with this form is being sought for the purpose of considering applications for accreditation under section 263 of the Radiocommunications Act 1992, and to enable the ACMA to perform a number of its spectrum management functions under section 9 of the Australian Communications and Media Authority Act 2005, in particular those under paragraphs 9 a , b , h and j . The ACMA may make the information provided in this application available to other Government agencies and departments in accordance with Part 7A of the Aus