For Office Use Only (New LV) - Receipt Details

I authorise for payment to be taken.

Licensing Manager:
Name:
Signature:

Application for a Land Valuers Licence

Please use a pen and write neatly using BLOCK LETTERS. Tick

where appropriate

Application Requirements
This form must be completed and signed by the applicant.

Your application can not be assessed unless ALL sections are

completed and ALL information is provided. It is essential that you
DO NOT LEAVE ANY SECTION BLANK Use N/A or Nil where
appropriate.
This application must also be accompanied by the prescribed fee and those additional
items listed in the Application. The licence fee will not be taken until the applicant has
been assessed as qualified to hold a land valuers licence.

Department of Commerce
Consumer Protection
Level 2, Gordon Stephenson House
140 William Street
PERTH WA 6000
Licensing Branch
Level 5, WestCentre
1260 Hay Street
WEST PERTH WA 6005
Locked Bag 14
Cloisters Square WA 6850

The list of current fees is available at www.commerce.wa.gov.au/CP/licensingfees.

Licensing Advice Line

8:30am to 5.00pm
Monday to Friday
Tel: 1300 30 40 64

1. Details of applicant

Overseas Callers
+61 8 6251 2931

Title:

Mr

Mrs

Miss

Ms

Email
cplicensing@commerce.wa.gov.au

Other

Last Name:

Web Site
www.commerce.wa.gov.au/CP/licences

Given Name(s):
Date of birth:

Consumer Protection Advice Line

Tel: 1300 30 40 54

A11454076

Residential Address:

Current address for purpose of the Register*:

*This address will be publicly available. Please provide an address at which you can be contacted for the purposes off the Act. This can be a residential
address, post office box address, or care of address with a third party (e.g. a solicitor or accountant)

Work phone:

Mobile:

Email address:
Note: Your nominated email address will be used for contact purposes, please ensure that the email address provided in
this application is correct and that you notify the Department of any future changes.

2. Business Details please complete either A or B or C only

A) If you are intending to carry on business in your own right as a land valuer, please complete the following:
Business Name (if applicable):
ABN:
Principal Place of Business:

B) If you are a director, partner or employee of a company or firm, please provide the following:
Name of company or firm:
ACN or ABN:
Role (circle one):

DIRECTOR / PARTNER / EMPLOYEE

Principal Place of Business:

C) If you are employed in a department of the public service of the State or Commonwealth or by a statutory authority,
agency or instrumentality of the Crown in right of the State or Commonwealth, please provide the following:
Name of department, authority,
agency or instrumentality:
Address:

3. National Police Certificate

The Land Valuers Licensing Act 1978 requires any applicant applying for a land valuers licence to be of good character
and repute. Please attach to this application an original or duly certified copy of an Australian police check, which is
no more than three months old. Please note that State Records Act 2000 requirements mean we cannot return the
original document. However, a certified copy can be made available upon request.
Please see www.commerce.wa.gov.au/cp/policechecks for a list of accepted Australian police checks.
Please see www.commerce.wa.gov.au/cp/authorisedwitness for a list of occupations authorised to certify documents.

4. Character
Please answer the following questions about yourself.

Yes No

(a) have you ever been convicted of, or found guilty or, ANY offences anywhere?
(include all traffic offences that went to court but do not include spent convictions)

(b) are you presently under a probation order, good behaviour bond, on parole, released on licence or
subject to periodic detention?
(c) are you aware of any proceedings pending against you for an offence, including proceedings by way of
appeal or review?
(d) have you ever been disqualified from holding a licence by any occupational licensing Board, agency,
other Departments or authorities anywhere?
(e) had any occupational licence or application refused, cancelled or suspended?
(f) Have you ever been, known by any other names?
If the answer to any of the above items was Yes, full details must be provided on a separate attached sheet of paper.

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5. Qualification and Experience - please tick appropriate box

I am a financial Life Fellow, Fellow or Associate Member of the Australian Property Institute (API) having
attained certification as a Certified Practising Valuer. Date Attained:
Please attach evidence of associate or fellow membership of the API with the designation of Certified Practising
Valuer; and written confirmation that you are a current financial member off the API.

I hold a prescribed degree, diploma, certificate other award prescribed by the Land Valuers Licensing
Regulations 1978, and I have had:

practical experience in the valuation of land, for the period of two years immediately preceding the date of
this application; and

a total of not less than four years satisfactory practical experience in the valuation of land within the period
of ten years immediately preceding the date of this application.
Please attach a certified copy of your prescribed degree, diploma, certificate or other award.
I have previously held a licence under the Land Valuers Licensing Act 1978 within the period of five years
immediately preceding the date of this application.
Please attach a copy of your former licence certificate.

6. Business References
You must provide two independent business references which attest to your good character and reputation. At least one
referee must be a licensed land valuer. References from relatives or partners will not be accepted and at least one
reference must be from a person external to your current place of employment.

7. Authorisation and Declaration

I,

, sincerely declare as follows: 1. That the particulars and answers given in respect of this application, are to the best of my knowledge and belief,
complete, correct and true and that the attachments hereto are what they purport to be.
2. I understand fully the duties and obligations imposed upon valuers by the Land Valuers Licensing Act 1978,
Regulations, and associated Code of Conduct.
3. I do solemnly swear/affirm that any valuation I undertake by virtue of the licence issued to me pursuant to the
provisions of the Land Valuers Licensing Act 1978 will be performed faithfully, honestly, impartially and to the
best of my skills and abilities.
4. In order to assist with the determination of this application, I authorise the Commissioner, or persons so
directed, to obtain on my behalf any document, record, file or information that may be necessary and relevant to
consider my fitness and propriety to hold a licence, including but not limited to records relating to my criminal
history or current/previous occupational licences or other relevant information.
5. Further, I declare that information and documents given with or in support of this application, whether or not
provided at the time of or subsequent to lodgement, are true and correct.
6. I agree, during the currency of this application, to do all things necessary to assist the Commissioner in
obtaining the above records upon request.

This declaration is true and I know that it is an offence to make a declaration knowing that it is false in a material
particular.

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This declaration is made under the Oaths, Affidavits and Statutory Declarations Act 2005.
Declared at (address)
Dated this

day of

20

Applicants Signature
In the presence of:
Witness Signature
Print Name of Witness
Qualification as such a witness (e.g. JP, Public Servant, etc)

Refer to section 12 and schedule 2 of the Oaths, Affidavits and Statutory Declarations Act 2005 for the list of Authorised
Witnesses or visit www.commerce.wa.gov.au/CP/authorisedwitness
Any person who knowingly makes a statement that is false in a material particular in a statutory declaration is
guilty of a crime and is liable to imprisonment for 5 years and a fine of $24,000.

9. Application Checklist
Prior to submitting your application, please complete this checklist, attaching your application and supporting
documentation in order set out below:
Prescribed fee (see www.commerce.wa.gov.au/CP/licensingfees for current fee). (Please complete credit card
details below or make cheques payable to the Commissioner for Consumer Protection)

An original or certified copy of an Australian police check (not more than three months old)
Proof of qualifications to hold a valuers licence (see section 5.)
Two pro forma references (at least one from a licensed valuer)

Your completed application may be

forwarded by post to:
Licensing Branch
Consumer Protection
Department of Commerce
Locked Bag 14,
CLOISTERS SQUARE WA 6850

delivered in person to:

Department of Commerce
Consumer Protection
Level 2, Gordon Stephenson House
140 William Street, Perth

Department of Commerce
Consumer Protection
Level 5, WestCentre
1260 Hay Street, West Perth

(Payments by cash, cheque, Visa

and Mastercard accepted).

Please note:
NO CASH PAYMENTS accepted at this
office.

10. For Credit Card Payment applicant to complete

NOTE: The licence fee will not be taken until the applicant has been assessed as qualified to hold a land valuers licence.
Card Type

Visa

Mastercard

Card Number
Expiry Date
Card Holder

Please print

Signature/Authorisation

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