New licence application – Form 1–1 (IND), Application for an individual’s licence (Real estate agent, property auctioneer, resident letting agent, motor dealer, chattel auctioneer, field agent) Instructions

Enter the existing licence number for the licence you are adding classes to exactly as it appears on the licence. Fill only if 'Yes (add class to existing licence)' is 'Yes'.

Check this box if you are applying to add one or more classes to an existing licence.

Check this box if you are not applying to add any classes to an existing licence.

Check this box if you or any business associates listed in Parts 8 and 10 have received an adverse order from QCAT or the District Court under the listed Acts within the last five years.

Check this box if neither you nor any business associates listed in Parts 8 and 10 have received an adverse order from QCAT or the District Court under the listed Acts within the last five years.

Enter the day of the month on which the applicant signed the declaration.

Enter the month in which the applicant signed the declaration.

Enter the year in which the applicant signed the declaration.

Enter the applicant's full name (given names and surname) exactly as it should appear on the licence.

Enter the applicant's family or last name exactly as it appears on official identification.

Enter the applicant's first name and any middle names in full as shown on official identification.

Tick this box if the applicant's preferred title is 'Mr'.

Tick this box if the applicant's preferred title is 'Mrs'.

Tick this box if the applicant's preferred title is 'Ms'.

Tick this box if the applicant's preferred title is 'Miss'.

Enter the applicant's preferred title if it is not one of the listed options (for example: Dr, Prof, Rev, Hon), using the exact text you want displayed.

Check this box if you are an Australian citizen.

Check this box if you are not an Australian citizen.

Check this box if you will send your payment (cheque or money order) and the application form by post. Fill only if 'Payment method: Money order', 'Payment method: Cheque' is 'Yes' (any).

Check this box if the card to be charged is a MasterCard. Fill only if 'Payment method: Debit/Credit card' is 'Yes'.

Check this box if the card to be charged is a Visa card. Fill only if 'Payment method: Debit/Credit card' is 'Yes'.

Enter the full name as it appears on the debit/credit card being used for payment. Fill only if 'Payment method: Debit/Credit card' is 'Yes'.

Check this box if an amount has been paid from the Claim Fund because of an action or omission that gave rise to a claim.

Check this box if no amount has been paid from the Claim Fund because of an action or omission that gave rise to a claim.

Enter the primary business phone number for the contact.

Enter the phone number to use for contacting you after normal business hours.

Enter the fax number for the contact, if applicable.

Enter the mobile phone number for the contact.

Enter the email address for the contact.

Check this box if you or any listed business associates have been convicted of an offence and/or disqualified from holding a licence or registration certificate under a relevant Act.

Check this box if neither you nor any listed business associates have been convicted of an offence or disqualified from holding a licence or registration certificate under a relevant Act.

Enter the full legal name of the corporation.

Enter the corporation’s Australian Company Number (ACN).

Enter the corporation’s licence number.

Enter the day of your birth as a two-digit day number (e.g., 05 for the fifth).

Enter the month of your birth as a two-digit month number (e.g., 04 for April).

Enter the year of your birth as a numeric value.

Enter the first 4 digits of the debit/credit card number. Fill only if 'Payment method: Debit/Credit card' is 'Yes'.

Enter the second set of 4 digits of the debit/credit card number. Fill only if 'Payment method: Debit/Credit card' is 'Yes'.

Enter the third set of 4 digits of the debit/credit card number. Fill only if 'Payment method: Debit/Credit card' is 'Yes'.

Enter the last 4 digits of the debit/credit card number. Fill only if 'Payment method: Debit/Credit card' is 'Yes'.

Enter the full driver licence number exactly as shown on your licence (include any letters, numbers or leading zeros).

Enter the town, office or jurisdiction where the driver licence was issued (for example the city or state name shown on the licence).

Check this box if you have been an executive officer of a corporation licensed under a relevant Act that has been placed into receivership or liquidation.

Check this box if you have not been an executive officer of a corporation licensed under a relevant Act that has been placed into receivership or liquidation.

Enter the full legal name of the first partner.

Enter the Australian Company Number (ACN) for the first partner if the partner is a corporation.

Enter the first partner’s licence number if the partner is licensed.

Check this box if you or any business associate listed in Parts 8 and 10 has been (or is) insolvent under administration, including bankruptcy, a Personal Insolvency Agreement (Part X), or being a debtor to a debt agreement (Part IX) under the Bankruptcy Act 1966.

Check this box if neither you nor any business associate listed in Parts 8 and 10 has been (or is) insolvent under administration, bankrupt, in a Personal Insolvency Agreement (Part X), or a debtor to a debt agreement (Part IX) under the Bankruptcy Act 1966.

Check this box if you have ever had a licence or registration certificate refused, suspended, or cancelled under a relevant Act.

Check this box if you have never had a licence or registration certificate refused, suspended, or cancelled under a relevant Act.

Check this box if you will have more than two places of business.

Check this box if you will not have more than two places of business.

Check this box if you or any business associates listed in Parts 8 and 10 have been named in the register of persons disqualified from managing corporations under the Corporations Act.

Check this box if you and any business associates listed in Parts 8 and 10 have not been named in the register of persons disqualified from managing corporations under the Corporations Act.

Check this box if you or any listed business associate has been found guilty of an offence (excluding traffic or misdemeanour offences) in Queensland or elsewhere within the last five years.

Check this box if neither you nor any listed business associate has been found guilty of an offence (excluding traffic or misdemeanour offences) in Queensland or elsewhere within the last five years.

Check this box if you have previously been known by any other name and will provide those previous names in the 'Previous names' field.

Check this box if you have never been known by any other name.

Enter any other or former names you have been known by (e.g., maiden name, former legal names or aliases), separated by commas if there are multiple. Fill only if 'Have you been known by any other name — Yes' is 'Yes'.

Provide a brief explanation for why your name changed (for example: marriage, divorce, deed poll, adoption), using a concise phrase or short sentence. Fill only if 'Have you been known by any other name — Yes' is 'Yes'.

Enter the registered national business name for this other place of business (if applicable).

Enter the street address for this other place of business (not a post office box).

Enter the suburb for this other place of business address.

Enter the state or territory for this other place of business address.

Enter the postcode for this other place of business address.

Enter the full name of the person who will be in charge at this other place of business.

Enter the licence number of the person in charge for this other place of business.

Enter the day portion of the individual's date of birth.

Enter the month portion of the individual's date of birth.

Enter the year portion of the individual's date of birth.

Enter the business associate (partner)'s family name (surname).

Enter the business associate (partner)'s given name(s).

Enter the town where the business associate (partner) was born.

Enter the state where the business associate (partner) was born.

Enter the country where the business associate (partner) was born.

Check this box if the business associate (partner) prefers the title “Mr”.

Check this box if the business associate (partner) prefers the title “Mrs”.

Check this box if the business associate (partner) prefers the title “Ms”.

Check this box if the business associate (partner) prefers the title “Miss”.

Enter the preferred title if it is not Mr, Mrs, Ms, or Miss.

Check this box if the business associate (partner) has been known by any other name.

Check this box if the business associate (partner) has not been known by any other name.

Enter any previous or other names you have been known by. Fill only if 'Part 10 Section 1: Known by any other name — Yes' is 'Yes'.

Enter your current residential street address (not a post office box).

Enter the suburb for your residential address.

Enter the state or territory for your residential address.

Enter the postcode for your residential address.

Enter the full postal street address (or write “as above” if the same as the residential address).

Enter the suburb or locality for the postal address.

Enter the state or territory for the postal address.

Enter the postcode for the postal address.

Enter the business phone number for the individual business associate (partner).

Enter the home phone number for the individual business associate (partner).

Enter the fax number for the individual business associate (partner), if applicable.

Enter the mobile phone number for the individual business associate (partner).

Enter the email address for the individual business associate (partner).

Check this box if this person performs an activity in the business that requires them to hold a licence, and provide their licence number.

Enter the licence number for this person if they perform an activity in the business that requires them to hold a relevant licence. Fill only if 'Part 10 Section 5: Yes (licence required)' is 'Yes'.

Check this box if this person does not perform any activity in the business that requires them to hold a licence.

Enter the full name of the employer or the person in charge who is signing this section.

Enter the day of the month for the date the employer/person in charge signs the form.

Enter the month for the date the employer/person in charge signs the form.

Enter the year for the date the employer/person in charge signs the form.

Enter the full name of your employer (corporation name if the business operates under a corporation licence, or the individual’s name if the employer is an individual).

Enter your employer’s licence number.

Enter the street address of your place of employment.

Enter the suburb for your employment address.

Enter the state or territory for your employment address.

Enter the postcode for your employment address.

Check this box if the applicant will be employed as the licensed person in charge at this employment location.

Check this box if the applicant will not be employed as the person in charge at this employment location.

Check this box if this employment address is a new place of business that will be operated by the employer.

Check this box if this employment address is not a new place of business operated by the employer.

Enter the passport number exactly as shown on your passport, including any letters, digits or leading zeros.

Enter the name of the country that issued the passport (e.g., Australia, United Kingdom).

Check this box if the passport you are presenting is a government-issued national passport.

Check this box if the passport you are presenting is a private passport (the form's 'Private' passport category).

Check this box if the document you are presenting is a United Nations refugee travel document.

Enter the full name of the person or organisation making the payment.

Enter the payer's postal address (street address, PO box, or other mailing address).

Enter the suburb or town for the payer's postal address.

Enter the state or territory for the payer's postal address.

Enter the postcode for the payer's postal address.

Enter the payer's mobile phone number.

Enter the payer's fax number.

Enter the payer's email address.

Enter the total payment amount you authorize to be charged to the debit/credit card. Fill only if 'Payment method: Debit/Credit card' is 'Yes'.

Enter the month the debit/credit card expires. Fill only if 'Payment method: Debit/Credit card' is 'Yes'.

Enter the year the debit/credit card expires. Fill only if 'Payment method: Debit/Credit card' is 'Yes'.

Check this box if you will pay the fee in cash in person (do not send cash by mail).

Check this box if you will pay the fee using a debit or credit card.

Check this box if you will pay the fee by money order.

Check this box if you will pay the fee by cheque.

Enter the day of the month on which the certifier signed and certified the photograph.

Enter the month in which the certifier signed and certified the photograph.

Enter the year in which the certifier signed and certified the photograph.

Enter the full name of the person certifying the applicant’s photograph.

Enter the certifier’s postal address.

Enter the suburb for the certifier’s postal address.

Enter the state or territory for the certifier’s postal address.

Enter the postcode for the certifier’s postal address.

Enter the name of the town or city where you were born.

Enter the state, territory or region of your place of birth (use the common abbreviated form if space is limited).

Enter the country where you were born (spell out the country name).

Enter the full postal street address (or write 'as above' if it is the same as the residential address).

Enter the suburb or town for the postal address.

Enter the state or territory for the postal address.

Enter the postcode for the postal address.

Check this box if you prefer to be contacted by your business hours phone number.

Check this box if you prefer to be contacted by your after hours phone number.

Check this box if you prefer to be contacted on your mobile phone.

Check this box if you prefer to be contacted by email.

Check this box if you prefer to be contacted by mail (post).

Enter the licence number of the first previous equivalent licence you held. Fill only if 'Yes—previously held an equivalent licence' is 'Yes'.

Enter the start date of the period during which the first previous equivalent licence was valid. Fill only if 'Yes—previously held an equivalent licence' is 'Yes'.

Enter the end date of the period during which the first previous equivalent licence was valid. Fill only if 'Yes—previously held an equivalent licence' is 'Yes'.

Enter the licence number for the second previously held equivalent licence. Fill only if 'Yes—previously held an equivalent licence' is 'Yes'.

Enter the start date of the period during which the second previously held equivalent licence was valid. Fill only if 'Yes—previously held an equivalent licence' is 'Yes'.

Enter the end date of the period during which the second previously held equivalent licence was valid. Fill only if 'Yes—previously held an equivalent licence' is 'Yes'.

Enter the registered national business name (if applicable).

Enter the street address for the principal place of business (not a post office box).

Enter the suburb for the principal place of business address.

Enter the state or territory for the principal place of business address.

Enter the postcode for the principal place of business address.

Enter the full name of the person in charge at the principal place of business.

Enter the licence number for the person in charge at the principal place of business.

Check this box if you previously held an equivalent Queensland licence under the listed legislation (current or repealed Acts).

Check this box if you have not completed the specified modules and have not previously held an equivalent licence.

Check this box if you have completed the specified units of competency/modules.

Check this box if you want to receive a receipt for the payment.

Check this box if you do not want to receive a receipt for the payment.

Enter your residential street address (not a post office box).

Enter the suburb or locality for your residential address.

Enter the state or territory for your residential address.

Enter the postcode for your residential address.

Enter the full name of the second partner.

Enter the Australian Company Number (ACN) for the second partner if the partner is a corporation.

Enter the second partner’s licence number if the partner is licensed.

Check this box if you are applying for or hold a licence to operate as a real estate agent.

Check this box if you are applying for or hold a licence as a limited real estate agent specifically for affordable housing.

Check this box if you are applying for or hold a licence to act as a resident letting agent.

Check this box if you are applying for or hold a licence as a limited real estate agent for business letting.

Check this box if you are applying for or hold a licence to act as an auctioneer of real property.

Check this box if you are applying for or renewing a licence in the 'Motor dealer' category.

Check this box if you are applying for or renewing a licence in the 'Motor dealer (wrecker)' category (wrecker/tow operator).

Check this box if you are applying for or renewing a licence in the 'Chattel auctioneer' category.

Check this box if you are applying for or renewing a licence in the 'Motor dealer (broker)' category (vehicle broker).

Check this box if you are applying for (or adding) the Debt Collector occupation of Field agent and will perform duties as a field agent.

Check this box when you are applying for a licence valid for a 1 year term.

Check this box when you are applying for a licence valid for a 3 year term.

Check this box when you are adding one or more licence classes to an already existing licence rather than applying for a new full-term licence.

Check this box if you do sub-contract your services to another licence holder. Fill only if 'Sole Trader', 'Working Director', 'Partnership' is 'Yes' (any).

Check this box if you do not sub-contract your services to another licence holder. Fill only if 'Sole Trader', 'Working Director', 'Partnership' is 'Yes' (any).

Check this box if you are applying as a sole trader.

Check this box if you are applying as a working director.

Check this box if you are applying as a partnership.

Check this box if you are applying as an employed licensee.