Application for transfer of apparatus licence(s)
(In accordance with section 131AA of the Radiocommunications Act 1992)
Instructions for completion
Print clearly. Forms which are illegible, unclear or incomplete details may be returned for clarification.
Note:
Information provided by the applicant that is marked with an asterisk (*) is required, by section 147 of the Radiocommunications Act 1992, to be disclosed to the public by the ACMA in a Register of Radiocommunications Licences. The Register is available for inspection at any ACMA office and on its website.
Licences exempt from licence fees may only be transferred to similarly exempt persons or bodies.
OFFICE USE ONLY
Persons granted licence fee concession may only transfer a licence to persons eligible for licence fee concession or exemption.
Where to send this form:
| Date: | / / |
|---|---|
| Licensee client #: | |
| Proposed licensee client #: | |
| Transaction #: | |
| Circle type: | Licensee Proposed licensee |
Customer Service Centre
Australian Communications and Media Authority
Completed form(s) signed by authorised representative(s) should be sent by email to info@acma.gov.au or by mail to:
Australian Communications and Media Authority
PO Box 78
Belconnen ACT 2616
The transfer fee of $51 will be sent by invoice when the licence transfer has been completed.
If you have enquiries, email the ACMA Customer Service Centre on info@acma.gov.au or call 1300 850 115.
Current licensee’s (seller) details
Client number
Name (or contact name if an organisation)
| SURNAME |
|---|
| GIVEN NAMES |
Organisation name (if applicable)
| ACN number(if applicable) | ABN number(if applicable) |
|---|---|
Trading name (if applicable)
| POSTCODE |
| POSTCODE |
Residential or business address
| WORK( ) |
|---|
| HOME( ) |
| MOBILE |
| FACSIMILE( ) |
Are you currently exempt from payment of licence fees? ð ð
Do you currently qualify for a licence fee concession?
ð Yes ð No
Details of licence(s) to be transferred
| Licence number | Callsign* | Licence type* | Expiry date* |
|---|---|---|---|
Current licensee’s declaration
I agree to the transfer of the licence(s) listed above and declare that the information provided in this application, and in accompanying documents, is true and correct in every detail.
| SIGNATURE |
|---|
| PRINT NAME |
| DATE |
| POSITION IN ORGANISATION (IF APPLICABLE) |
Do you hold a radiocommunications licence? ð Yes ð No
If yes, insert client number
| If yes, insert client number |
|---|
Name* (complete only if transferee is not an organisation)
| SURNAME |
|---|
| GIVEN NAMES |
Organisation name* (if applicable)
| POSTCODE |
| ACN number* (if applicable) | ABN number(if applicable) |
|---|---|
Trading name* (if applicable)
| Trading name* (if applicable) |
|---|
Name of person representing the organisation
| SURNAME |
|---|
| GIVEN NAMES |
| POSITION IN ORGANISATION |
| WORK( ) |
| --- |
| HOME( ) |
| MOBILE |
| FACSIMILE( ) |
| POSTCODE |
Qualifications (for maritime ship and amateur licences only)
| Proposed licensee's qualifications | Certificate number(optional) |
|---|---|
Are you currently exempt from payment of licence fees? ð Yes ð No
New client information—please complete if you are a new client
Client type Government clients:
- Government clients: ð
- Industry—tick which describes your primary function:
- Commonwealth department
- Agriculture
- Other Commonwealth agency
- State government
- Communication services
- Local government
Private sector clients:
- Construction
- Company
- Education
- Person aged 18 years and over
- Community/volunteer group
- Electricity/gas/water supply
- Person aged under 18 years
- Government
- Health Services
- Mining
- Manufacturing
- Recreational and amateur activities
- Safety services
- Transport and storage
- Wholesale/retail trade
- Other:
Proposed licensee’s (transferee’s) declaration
I agree to the transfer of the listed licences from the current licensee and I declare that the information provided by me in this application, and in accompanying documents, is true and correct in every detail and that equipment to be employed meets all relevant standards made by the ACMA.
Name of proposed licensee
| SIGNATURE |
|---|
| PRINT NAME |
Details of payment
| DATE |
|---|
The transfer fee of $51 will be sent by invoice when the licence transfer has been completed.
Please indicate who is paying this fee:
- current licensee (seller)
- proposed licensee (buyer).